Now what?

The psychiatrist said no. This is the e-mail I got from Bear's caseworker today:

Dr. M stated that he does not see any benefits in this plan. He also stated that he could not be supportive of that decision if made. I also put Bear on a stand-by list to see Dr. M sooner, but as of today, the appointment remains for 10-21.

My reply to her:

Ok, suggestions? Bear is going to do this now under our supervision where we can hopefully show him (and/or maybe the courts) that it is absolutely necessary and get him back on his meds safely and quickly, or he's going to do it cold turkey 10 months from now.

So what would y'all do?

Giving Bear what he wants

I have to laugh. Saturday at therapy I sprung my plan to try taking Bear off his meds. I did not prep/warn the therapist ahead of time, and I have to say he (the therapist) is really starting to impress me. he picked up on some interesting things... like the fact that Bear, who has been insisting he was going to drop all his meds and go to live with his grandfather, instantly balked when I said I was going to help him. The therapist called him on it and asked if it was because I suggested it (Bear wouldn't admit to that).

I believe that Bear is fighting this for several reasons, with the two most important ones being that he knows he can't go off his meds and maintain control (he as much as said as much when he said he didn't want to do it now), and the second one that he doesn't trust my motives and thinks I'm out to get him.

The truth is that I am out to get him. My motives are honorable, but for some reason I still feel guilty. I am setting him up for failure, and that just feels wrong (it feels more wrong to let Bear go forward with his self-destructive plans, but I still feel guilty). Hubby has been giving me a hard time about it too. I'll admit I probably do sound vindictive, and I've asked Hubby more than once for reassurance that I'm doing the right thing. I've told y'all my reasons. I just need lots of reassurance that I made the best choice.

Bear wanted to wait to change the meds. The therapist asked him why. When prodded, Bear gave different reasons, and when those were addressed, he just shut down and said we could do whatever we wanted. The therapist tried to get him to acknowledge that this was his choice, and commit to the conditions, but didn't really get compliance. That's OK. He doesn't need to acknowledge that he needs help and be in total agreement, he just needs to be informed and have all his concerns addressed so he can't say he didn't know about it.

Once we were all in "agreement" that we were a go for stepping down Bear's meds, and had talked about the reasons why and what it would mean if this works, then we started talking about how we were going to handle things during the experiment.

My biggest concern of course is the safety of the whole family. The therapist talked to Bear about being irritable (since he's already irritable this is a given). Bear said he was going to "just be handle it." *sigh* Yea, right.

We talked about how Kitty was going to have some major issues about this (him being unstable triggers mega-fears and memories for her - he's abused her in the past, and when he got kicked out of homes, she usually wasn't too far behind), plus Ponito is literally a third of his size so therefore we had to dicuss how we're going to deal with keeping the family safe. Bear said he would prefer that if I was seeing an issue that I "write it down." The therapist was startled by this, but this is how the school deals with things so it makes sense to me. My concern is that's fine if his hygeine is slipping, but not immediate issues with siblings.

One of our solutions was that we would "protect" Bear from the other kids, with both physical distance (like he'll be assigned the front seat in the van so he won't be rubbing elbows with the sibs) and he has to come to us when the other kids are annoying him. He is not rational about whether or not what they're doing is really annoying and he does not handle it appropriately.

Obviously we're waiting until we've had a chance to talk to his psychiatrist before we start changing his meds. So imagine my thrill to get 2 calls from him regarding his issues today - and we haven't even started changing his meds! The good news is he called me (that's almost like asking for help!), but how are we going to make it through this?!

Allergy Mania

OH NO, NO, NO, NO, NO!!!!

Recently discovered a new blog called Different, not Diseased (just what I needed a new blog to add to my Reader!) that says she just learned that Zyrtec and other allergy meds like it can trigger mania in bipolars!! I already knew that the "D" in Clairitin D or Allegra D made me so manic I wouldn't sleep for days and avoided that, but this is bad.

Where I live is like the allergy capital of the world. If we don't take our allergy meds, Bear starts hacking and spitting, Kitty's asthma and hives kick up, and I want to gouge my face off to stop the itching and dripping (oops - sorry about the graphic description).

We are all bipolar. I've always been hypomanic until the stress of adopting special needs teens caused me to have to start taking meds. Looking back now I realize that once I started taking meds regularly then I could finally remember to take allergy meds regularly - ooh I now see a viscious cycle. THIS STINKS!

Aargh!

I was just trying to figure out this morning why there are days when I feel like screaming, pinching everyone's heads off and throwing things (or kids). (No, of course I would never do this, but these mood spikes make things very difficult when dealing with people). I was planning on calling my doctor today to see if I needed to up my mood-stabilizer because a manic phase was "bleeding through" the meds.

What to do?! What to do?!

It's official - ADD

It is official, there are no more ADD meds for Bear to try. Every one he has tried (both on and off list stuff) has given him tics and other side effects (sometimes really scary ones!). According to his psychiatrist this does not mean he does not have ADD, it means we are unable to treat it with medication. Poor Bear.

Why does he think like that?

In the comments a lot of you have asked why Hubby thinks the way he does about meds. Of course I wish I knew the answer to that question (not just about meds). Here's some of my rambling guesses:

I think it's because unlike kidney stones, diabetes, or broken legs, most mental illness can not be diagnosed with x-rays or definitive tests. Plus there is a continuum (mild to wild)... in other words it's all very subjective. Subjective doesn't make much sense to my husband who is a concrete thinker. You have an ear infection? You take this antibiotic. Done. You have your wisdom teeth removed, here's an antibiotic and some pain meds (he took the antibiotic, but not the pain meds).

There are no exact diagnostic and treatment steps, meds work for some at one dosage, but it takes double that for someone else or it doesn't work at all, even though two people are genetically related with the same illness. In addition to being frustrating, this makes it seem like it's all fake somehow?

With most illnesses you don't have anywhere near the same amount of input as to what med(s) you will take and how much. Aren't doctors supposed to just "know" all this? It's scary to have that much control over diagnoses and treatment when we know how little we know.

Most of the time we're told there is no med that will help treat something the kids have, like the C-PTSD. I think that it's untreatable makes it feel a little less "real."

The kids' diagnoses are so complex that no one or two methods/meds will treat them, but at the same time how can two kids who look so "normal" need all of those meds?! As they get older and have been in therapy for so long, should we be reducing their meds? Which ones? By how much?

Which diagnoses can you "recover/heal" from and which are life long? What if a diagnosis is wrong? (Does Bear really have ADHD?) What about the childhood disorder, RAD, that they will spontaneously heal from when they turn 18 (isn't that a miracle?!)? What does it mean when the child's diagnosis changes?

I've never been "officially" diagnosed with bipolar disorder. Unlike the kids I get my meds from my regular doctor and he basically took my word for it (although my therapist believes I have it as well). Most of my family has it, and going over my history, I've probably have had it my whole life.

It frustrates him that it often feels like we're throwing more and more meds at the issues (which he obviously already has problems with), and they're just not helping - at least in any obvious way. Sometimes the kids just seem to spontaneously get better or worse. Therapy takes so long to show any differences that it's hard to remember that it is having an effect. Life (stress, PTSD flareups, academics, friends, illness...) has a major effect on their behavior and issues too. Meds sometimes have an instant effect (but often not in a good way). There's been times where we thought a med was working, but later when we took the child off of it we realize it wasn't.

I think he worries we're "hypochondriac parents" (Munchhausen syndrome?) or treating our kids like guinea pigs.

Abusing the drugs is not a concern as much as are they worth the side effects? - like turning Bear into a zombie or me into a robot, the joint pain (did it cause permanent damage?), the tics, the weight loss or gain, sleepiness or sleeplessness, thirst, the bed wetting... who gets to decide if it's worth it? At one point the kids were even taking one med to counteract the side effects of another med.

OK, enough rambling. Going to bed now.

More on Medication

Medications - To Take or Not To Take?
Around 1 in 5 of the world's children and adolescents have a mental disorder. 

A study by the World Health Organization, or WHO, found that between 30 and 80 percent of people with mental health issues don’t seek treatment.

Shame and Stigma
There has historically been great secrecy and shame associated with mental illnesses. Although we no longer imprison, burn, or kill the mentally ill as in the Middle Ages or in Nazi Germany, most people struggling with mental illness still fear the stigma and shame of admitting they need help. Admitting their problems to doctors, spouses, parents, or even themself can be difficult. 

Depression is not a sign of weakness, and neither is taking medication for it by Jenna Jones

Today, 1 in 10 Americans take antidepressants, a 400 percent increase from 1998. That’s a hell of a lot of people swallowing pills every day, yet the subject is still somewhat taboo. In addition to politics, sex and money, mental illness is not something most Americans generally discuss.

The idea that medication is for “crazy people” was and is constantly culturally reinforced in media and society at large.

Personally, I’ve dealt with the misunderstanding of well-intentioned people who encouraged me to simply try harder and resist the pharmaceutical industry’s secret plan to get the entire population on happy pills to finally achieve world domination. At the very least, I felt weak for thinking I might need medication.  

"Biologically-based" vs "Trauma-based" 

Asthma, diabetes, pneumonia, ADHD, bipolar disorder... are diagnoses where you can usually see relatively quickly the results of taking or not taking meds. These types of issues are what I call biologically-based (including genetic components). There seems to be less stigma with diagnoses that can be treated effectively with medication, especially if they don't require treatments like therapy and psychiatric hospitalizations. 

Mental illnesses, especially non-biologically based illnesses tend to not respond well to medications. Trauma-based diagnoses like C-PTSD and RAD, in addition to not responding well to meds, are less understood and tend to have more stigma and shame associated with them. 

So Why Take Meds If They Won't Fix/Cure Illness?

Medication Strengthens Healing

Scientific evidence shows that the body heals better when it is not in pain so medication can be an important part of treatment. 

Imagine that you've broken your leg in a car accident. The doctor surgically inserts a pin in the leg with the shattered bone, puts on a cast, gives you a crutch, and prescribes major pain meds. The cast keeps things stable while your body works on mending and healing. The crutch helps you be able to do the things you would normally be able to do if you hadn't broken your leg (like walk and go to school). The pin is necessary to give the remaining bones strength and something to heal around. 

Some medications are like the cast and crutches and will not be needed down the road. Other medications are like the pin and the body won't work right without them. 

Some people believe it is possible to heal most things without medication. If you're "strong enough" and pull yourself up by your bootstraps.  

Technically, you could use alternate methods to mend a broken leg that aren't as invasive or long-term as a pin. You don't have to get up and move around so a crutch isn't absolutely necessary. Legs don't have to be straight to work so a pin and/or cast aren't technically required either. In theory, pain won't kill you, so pain relievers aren't needed. Right?!

We've all heard the story of "that guy" who was able to drag himself off a mountain with 2 broken legs, 2 broken arms, and nothing but a toothpick and a breath mint... but do you really think he would have suffered all that pain if he'd had the option of immediate access to medical care?

Alleviating Symptoms Allows Healing
Experts recommend alleviating symptoms (like insomnia, anxiety, restlessness, irritability...), even when it doesn't cure or affect the actual diagnoses. This gives the person time to heal (and in the case of children, time to mature and process). That's why they give highly addictive medications like morphine and hydrocodone to patients right out of surgery. Studies show that people in pain heal slower than those on pain-relievers.

I know a lot of times there is a huge resistance to giving children meds, and while I agree that there are times some foster children are over-medicated, I also believe that these kids are struggling and they can't heal and learn if they feel like they are living in the middle of a war zone or they are struggling with basic coping skills, unable to function.

In my opinion, you can't work on healing trauma if you can't sleep, focus, sit still, and/or react normally to external stimuli (someone saying, "who left the butter on the counter?" should not trigger a screaming rage but has)...

Kids can't heal and learn if their brains are stuck in the middle of a war zone, can't sleep, can't focus, can't function... 

EXAMPLE:

Sleep Meds

My kids suffer from PTSD (like most kids of trauma) and sleep is HARD! If you don't get enough sleep, then you can't learn in school and it's harder to control your emotions - sleep deprivation is a common form of torture! If you're living in a war zone in your head (PTSD), or you can't focus (ADHD?), then you aren't learning (my kids have HUGE gaps in their education). If you're struggling with depression or anger or anxiety (bipolar, RAD, mood disorder NOS, GAD, ODD...) then you're so busy fighting or coping with symptoms that you can't learn like things like other kids - age-appropriate developmental lessons or how to get along in a family...

Medicating Kids with Trauma Issues

Higher Likelihood of Serious Issues

I think one reason we see a high rate of prescriptions of psychotropic meds for foster kids is less about overmedicating and more about there being a higher prevalence of serious mental illnesses in our kids.

It's a documented fact that people with "issues" are attracted to other people with "issues" and those people tend to make poor choices... which often leads to pregnancy. Having 2 parents with "issues" (such as bipolar disorder, alcoholism, trauma issues...) often means scary genetics for the child. Add in continued drug/alcohol abuse and/or things like stress/anxiety hormones during the pregnancy and the fetus is being "pickled" in "toxic soup." Even if this child is adopted at birth, it is unlikely that the child will be unimpaired. [Like Attracts Like]

If the parent keeps the child and is mentally ill, neglectful, abusive, addicted... this frequently leads to more trauma and damage for the child.  All leading back to more children ending up in foster care and starting the cycle over again. 

{Not only is my children's birth mother mentally ill, much of which was genetically passed on to my children (bipolar disorder, ADD/ ADHD, GAD, Borderline Personality Disorder, insomnia...) but they also have brain injuries (from unknown and/or multiple causes - genetic, FASD, injury during abuse...). We have to assume they were most likely "pickled" in the "toxic soup" of anxiety hormones, drugs, and alcohol in utero, and then there's the abuse, neglect, and other trauma-related events causing PTSD, RAD, and night terrors. Add in the genetics of their respective biodads... and you get the idea.}

Finding The Right Meds

Proper Diagnosis and Medication
When our kids came to us, they weren't properly diagnosed or medicated.  Bear was diagnosed with PTSD, mood disorder NOS and possible conduct disorder.  Kitty was diagnosed with ADHD (unmedicated for some unknown reason - possibly because it killed her appetite and she was underweight already), ODD and "attachment issues" (which the caseworker claimed couldn't be true, because she was such a loving child who always hugged the caseworker - actually a typical RAD behavior), and learning disabilities.

First step - a really good Neuropsychiatric Evaluation with a psychologist familiar with trauma issues in children/teens. 

After we'd known them long enough to get an accurate neuropsychiatric evaluation, they were diagnosed with:

• Bipolar Disorder (which apparently they'd been diagnosed with before entering foster care and had been removed for some reason - possibly because many doctors don't believe in child-onset bipolar or maybe because it made them seem less adoptable (but if the latter was the case then they sure left a LOT of other stuff in!).
• Reactive Attachment Disorder (I asked their previous therapist from foster care why this wasn't diagnosed sooner and she claimed not to have seen it - it's possible that in previous foster homes no one had tried to emotionally bond with them or the therapist was not experienced enough with the diagnosis to recognize the symptoms),
• ADD/ADHD - Kitty was already diagnosed with this, but now Bear was as well.
• Brain injuries (cerebral dysrhythmia - strongly affecting memory and processing), which is probably tied into Kitty's learning disabilities, but for Kitty also affects her emotions.
• Complex Post Traumatic Stress Disorder,
• Emerging personality disorders.

The discrepancy between the previous and current diagnoses was huge! Their medications were all wrong, the kids were raging and miserable, and their "misbehavior" had made a mess of their lives. 

I won't say medications fixed all their problems, but... without it I know we couldn't have adopted Bear - his behaviors weren't safe, and Kitty has come SOOOO far with her healing. Healing that she couldn't have done without alleviating some of her symptoms through medication.

FINDING THE RIGHT MEDS

When finding the right Medication Cocktail (each person's needs are specific to their body chemistry, diagnoses, trauma, current situation, stressors, hormones, and even personality), the individual often feels like a human guinea pig. We preferred the kids to be in a psychiatric hospital or residential treatment center during major med changes because their behavior could be quite scary.

Some meds stop working after a time. Some work best only in combination with others (Abilify and Wellbutrin are good examples of this). Kids' needs can change as they hit puberty or have a growth spurt, experience new trauma or begin healing, are under great stress (ex. exams and major life changes like divorce, moves, new siblings, relationship issues...)... 

I've heard good things about GeneSight - a genetic testing company which with a cheek swab and a maximum of $200 (It's sliding scale) will report which meds are unlikely to be metabolized well, which are not likely to work, and which are likely to cause problems.  I have not personally tried it (I found out about it after we found the right med combos for my kids), but it's been highly recommended to me.   

Medications for Children and Adolescents. 

Many medications used to treat children and adolescents with mental illness are safe and effective. However, some medications have not been studied or approved for use with children or adolescents.

Still, a doctor can give a young person an FDA-approved medication on an "off-label" basis. This means that the doctor prescribes the medication to help the patient even though the medicine is not approved for the specific mental disorder that is being treated or for use by patients under a certain age. Remember:
It is important to watch children and adolescents who take these medications on an "off-label: basis.

Children may have different reactions and side effects than adults.

Some medications have current FDA warnings about potentially dangerous side effects for younger patients.

In addition to medications, other treatments for children and adolescents should be considered, either to be tried first, with medication added later if necessary, or to be provided along with medication. Psychotherapy, family therapy, educational courses, and behavior management techniques can help everyone involved cope with disorders that affect a child’s mental health. - NIMH 

Unique Biochemistry

My kids are bio half-sibs with almost identical diagnoses and yet, they still needed different med combinations and dosages. 

Meds don't work the same for everyone. I tried Lexapro (recently mentioned in a comment by someone it works well for) and it was HORRIBLE for me! True, it helped me stop feeling the overwhelming stress, but I also didn't feel ANYthing! I was like a robot (and robots do not "cuddle" if you know what I mean). Plus, I started having horrible side effects that got even worse as I went off the med (which I discovered is common for this med - this is one scary med). Bear tried Vyvanse which caused a horrible reaction for him (gastrointestinal issues, tics, nausea, dizziness...).  Abilify worked like a miracle med for Kitty and didn't do diddly squat for me. After about a year and a half, Abilify stopped working for Kitty and we had to start all over looking for a new "miracle" med (we found it in Lamictal).

Medication Cocktails

This article about children being overmedicated in foster care makes a big deal about kids taking more than one of the same category of medication. 

Especially for people with bipolar disorder, taking two or more different mood stabilizers is frequently recommended to keep the person stabilized. Especially when there are multiple diagnoses. Overlapping Diagnoses in Children 

It often takes a medication "cocktail" to help the child get and stay stabilized, and unfortunately, our body chemistries are unique. Finding the right "cocktail" can take years of experimenting as everyone's body is different and changes over time (especially when dealing with puberty), sometimes new diagnoses emerge (many mental illnesses have adolescent-onset). Sometimes meds stop being effective. Sometimes meds have a negative interaction with each other. Sometimes better meds came on the market. Sometimes symptoms healed/subsided and a particular med is no longer needed... It's easy to start feeling like a human guinea pig.

Over-Medicating
In recent news, there've been lots of articles about children being overmedicated in foster care.  

In the past, Hubby's opinion was that I have allowed the kids to be over-medicated. I disagree. They are on lots of meds, but it took time to find the right meds and good combinations that worked for their individual body chemistry. They are already taking fewer meds than they did 2 years ago. I think a lot of this is due to the fact that they could finally focus on internal healing when their outside world didn't feel totally chaotic. (I hope it goes without saying that we are not addressing anyone's needs and issues with ONLY medications). 

I'm not recommending people medicate their kids into zombies (although we did have to do that once for a short period of time to keep our son and family safe while we waited for a bed to open up in an RTC), and yes, there are some nasty side effects from medications that aren't tested on children... but without meds, my children would have been virtually unadoptable and I have no doubts that my son would have ended up dead (self-medicating with drugs, gang life, suicide...) or in juvie many years ago. 

When the child is stable, I start looking at lessening or removing their meds (or ramping up therapy treatment) - for as long as they continue to make progress healing.

Years of the right medications gave my son time to mature, learn, and attain coping skills... When he decided to stop taking his medications at 18, he learned very quickly that he needed them, but I also believe that the consequences of his actions off the meds were much less severe because of that time of growing/ healing.

Medication Review:

http://www.dr-bob.org/babble/index.html

Bipolar meds specific:  
http://www.aacap.org/galleries/default-file/aacap_bipolar_medication_guide.pdf

Medications and stress

When Hubby calmed down and came back downstairs after me telling him I'd let my mom pay for a business expense and my meds, we talked about me being on meds. I know Hubby doesn't like meds. He rarely even takes a Tylenol for a headache. The thought of being on meds long-term is hard for him, and when the kids were taking 10-15 pills a day it really bothered him.

I know Hubby doesn't like the idea of me taking lots of meds or increasing my meds. I also know it bothers him to hear about me sobbing or being miserable. I think Hubby feels that because I was doing OK without meds before we got the kids that I don't really have Bipolar disorder. Or that's it's controllable by willpower or something. I know he generalizes this to the kids' issues too.

Gotta admit, this ticks me off a little. I've struggled with depression my whole life. Most of the time I've been able to handle it without meds, unless under severe stress like final exams or, I don't know, having 2 emotionally disturbed kids and a teenage daughter with a business that is struggling and a husband who hates his job?! When the kids are out of the house, assuming I do not find another way to add stress to my life (I'm probably addicted to it), then we can talk about reducing or removing my meds).

Sometimes I think I wait too long to take meds and that I could be a lot happier. I don't want to take "happy pills," but why should I and my family suffer because of this stupid disorder if I can find a med that takes the edge off without side effects. I don't like living on the edge like this, just because I'm not suicidal.

Hubby said he wanted to alleviate MY stress by getting rid of the business. That really ticked me off! My stress does not come from the business. This company needs only an hour or two a day from me and I can spend the rest of the time dealing with the kids. The only way getting rid of the company would alleviate my stress is that it would alleviate Hubby's stress as he tries to continue to deal with a full-time job and the business, and while granted that is important - it is also short-sighted.

I asked him about filing bankruptcy, but since most of the debt is from buying the business it is personal debt so if the company declares bankruptcy it wouldn't help. Now that Hubby has a good paying job, if we declare personal bankruptcy then most likely the company would have to be sold to pay off the debts. Although the company is not making money now, it is the only way to get out of this hole - unless Hubby wants to work at this job that makes him miserable for the next 10 years.

I also pointed out that while I am obviously not dealing well with life right now, I'm also OFF MY MEDS! And I'm yo yoing back and forth off and on them - half doses or none at all if I can't afford them. Even if I didn't need them this would be messing me up. If I can remember back that far I think we've finally found the right combo and dosages and was on a pretty even keel and handling life. All I need to do is get back to that.

So if my last few posts are rambling, TMI, or I sound mentally unstable I apologize.

I'll take two pills and call you in the morning.

Teenagers and time

Didn't get the job. I'm assuming that's a good thing since I can't seem to find enough hours in the day as it is. I've got a new volunteer job that I'll post about soon.

Kitty is still napping and melting. Napping when she takes her meds. Melting when she doesn't. You'd think it would click when she starts yelling and crying that she hasn't taken her lunchtime meds, but it never does! Hours after I've gotten her calmed down, or she's out on the swings, I'll realize she's missed the med.

Bear has been giving us some trouble lately. He has a new girlfriend. Nothing new there, and wouldn't be a big deal, but his girlfriend is staying with her best friend who lives in our neighborhood. The best friend has a younger friend who is friends with Kitty from the special ed classroom at school. Kitty has become friends with the older sister and her friend (she always seems to do this - especially the ones with mega issues). With me so far?

The older sister is a junior in high school and drives. She'd brought her little sister to our house to hang out with Kitty. Then she recognized Bear from school. She started calling the house to talk to him. She is a large girl, and Bear prefers petite little girls, so he found the older sister annoying, right up until he met her tiny little friend.

So here's where the trouble comes in. Bear is sneaking around to spend unsupervised time with the new girlfriend. The older sister and girlfriend are hanging out here a lot (because I don't let my kids out of my sight - I refuse to become a grandma). Kitty is "bonding" with the older girls.

Kitty is upset with me because I've told her I don't want her hanging out with juniors and seniors in high school (she's only in 8th grade). Nothing against the girls, but Kitty is a mess right now and doesn't need to add to it, plus I'm pretty sure the girls are using her to get closer to Bear. This isn't the first time this has happened. The younger sister doesn't even come over anymore. Also, the girls are nice to Bob too. This sends Kitty into a jealous rage. People are not allowed to like Bob.

Bear is upset with me because he's been busted for lying to me and sneaking around (which he will deny to his dying day). He's also thinking he doesn't need his meds anymore. I've seen some evidence that he's starting to reduce them on his own (unconscious lip movements and irritability).

I need to start channeling Claudia, especially now that I'll have almost all teenagers in the house.

I'm finding that now that I've figured out the key to parenting them {teens}
(you can't control them, no matter what you do, so instruct, consequence, and
observe -- but treat it like a movie that you're watching, and enjoy seeing how
the plot unfolds). Parenting teens by attempting to control them is as foolish
as sitting watching a movie and thinking that by your own will power you can
change then ending.

It's something I need to work on. Probably won't happen for awhile though. I'm still dealing with feeling rundown since I have had to start weaning off my medications. We can't pay for our private health insurance anymore so I can't get my meds or see my doctor. The adopted children are OK because they qualify for Medicaid. The rest of the family are sickeningly healthy.

Better get some sleep. Tomorrow we have to view properties to move our business to, and I'm going to have to take Kitty with me (who will be "BOOORRRED, or take Ponito (to protect him from Kitty). *sigh* Plus I have to be sure to be home at 11am so I don't miss the police officer delivering my summons to small claims court. One of our clients has decided she doesn't like our work so she wants us to refund her money.

Breakthrough?

We were hoping that now that Kitty has friends at the new "school" that the meltdowns at home would decrease, but no such luck.

Got a call from the PDH's psychiatrist. She's been out of town for the last week and now the insurance company is pressuring her to make med changes (since obviously that's all that's wrong with Kitty. *sarcasm drip*). So she called me and started suggesting new meds?! I asked her if she'd discussed these with Kitty's psychiatrist (who Kitty can't see while she's in the PDH program, but has a lot more info about Kitty's past then I do and she has been in his care for over 2 years). Nope. She hadn't contacted him about Kitty at all. I mentioned that the psychiatric hospital had planned to change her meds until they discussed it with our psychiatrist, and changed their mind. I was fine with any changes she wanted to make - as long as she had discussed it with our psychiatrist first.

She'd said she'd call him that day (Bear had an appointment that evening so we knew she hadn't called), but she apparently did finally make the call this morning. We're going to be changing a lot of meds for Kitty. Wellbutrin for the depression (not supposed to make bipolar kids manic and decreases appetite so we might get rid of those extra 50lbs Kitty has put on since this Summer). She'll start that tomorrow morning. Early next week she'll start on Lithium for the bipolar and once that's in place we can start decreasing the extremely high dose of Trileptal Kitty is on - assuming it works of course. Then Adderall in place of the Concerta. Who knows?! Maybe this will help?!

We're still questioning whether or not the PDH is the right placement for Kitty. She is getting so much more aggravated during the day (stress is higher at this school because of the type of kids she comes into contact with), that she is coming home and taking it out on the family - much worse then when she was in public school. She is having a LOT more meltdowns at home. She has also started cussing a lot more (and not "naughty" words, but real cussing). Some of it could be the schedule change. Instead of leaving the house at 8am for school, she has to leave at 6:30am. That's a LOT less sleep, and with the added stress, she's probably not sleeping as well either.

She is often justifying her behavior with "I have issues" and "that's just the way I am." That does NOT make it acceptable behavior, but I'm not totally sure how to address it either.

Because of her PTSD (which is not really treatable by medication) once she is triggered into "Fight, Flight or Freeze" mode she is no longer rational and is reacting purely on instinct. If she were a small child and behaving like this (typical for those terrible twos!), I would just put her down for a nap, and try to eliminate whatever stress triggered the incident (food, tired, overwhelmed...). No long term consequences of course. The problem is, while at the time she is a small child emotionally... chronologically and in the eyes of the other kids (and later even herself) she is not a small child, and therefore should be held accountable for her actions. Every time she "gets away" with this type of behavior she sees it as permission to continue with it.

Because of the RAD (again, not treatable by medication), most of her issues are at home with her family of course, so all the extra therapy she's getting at the PDH is, I'm sure, helpful, but not with this issue. Once a week family therapy that's not conducted by someone who is very familiar with attachment disorders will not solve this "issue." I'm a little concerned that by admitting she has "issues" with family to this therapist that she will now reinforce her self-perception as someone who doesn't need/want a family. In other words it will become part of "who she is." Just like being a "girly girl" or "friendly."

In the 2 1/2 years we've had Kitty she HAS gotten attached to us. She does trust us not to hurt her (I think as evidenced by the fact that she will hit and scream at us - which she would never do with a stranger or Bear- aren't we lucky?!). She will occassionally admit that she loves me, sometimes will let me cuddle her and tell her that I love her, and will even sometimes that she loves Hubby, but it's rare. Most of the time though she denies that she wants to be part of the family, says she hates to be touched, and rages about how much everyone hates her. If we tell her we love her, the first word out of her mouth is "NO." Sometimes it's so hard to remember to tell her anyway. It's easy to convince someone you don't love them, but how do you convince them you do?! Just keep doing what we've been doing I guess.

Kitty has been in therapy more then half of her life. She knows and uses all the buzz words like, "I have anger management issues" or "I need to work on my behavior management." She knows what the therapists want to hear and she is EXCELLENT at changing the subject with tangents or other distractions.

I have no idea what our alternatives besides residential treatment would be, and I can't see residential treatment as being a good alternative for her. She is becoming more violent, but it seems to me that most of her issues are caused by her Complex PTSD (which being around agressive kids would aggravate even more, in addition to the fact that she's already afraid she's becoming "like her brother" - out of control and violent) and her RAD (which should alleviate significantly when she's not around the family as much, but certainly won't help her progress any).

Though keeping her at home is causing major problems too. Hubby is starting to feel like the warden again. Bear's PTSD is triggered by Kitty's meltdowns (last night he had to leave the house), and of course the other kids aren't getting a lot of attention (although they are not scared of Kitty like they were of Bear). I have to admit I'm highly frustrated because I feel a lot of pressure to "fix" everything. Mommy guilt makes me feel like there's a "right" way to handle situations or a "right" thing to say that would make it all better. My head knows that's impossible, but...

We had our second family therapy session today. Much of the session was just Hubby and I talking about our concerns to the therapist (who now reads this blog, "Hi, Mr. O!" - so I better watch what I say!). When Kitty did come in she started the session with this new quiet voice that I've only really heard her use with this therapist. He commented on the fact that he's never heard her use this voice before either.

Then, breakthrough! He started talking to her about an incident yesterday (she witnessed two girls coming to blows at the PDH) and what happened when she got home (meltdown with Grandma that involved cussing and yelling and then the same with Hubby and I that denegrated to hitting Hubby). The "real" Kitty started coming out. She talked about her hatred for our family, gave the therapist several "real life" examples of her vengeance issues (he'd been asking us about it), and generally showed him the side of her that only us as her family and a select few of her therapists get to see.

Not a very productive session, but for some reason I always feel a little better when other people see her acting like this, and how we respond (calmly). I often feel like "they" think it's all in our head or we are "provoking" it (by yelling at her or treating her badly). With Bear it was a lot easier because he was unable to control his behavior at all when he "lost it" so it wasn't always directed at us. Kitty puts up the charming, friendly facade that is so typical for RAD kids.

So now what? What are our options?

1. We can put her back in public school where at least there was less stress at school. She will continue to fall apart, but it probably won't be as fast.

2. We can stick it out with the PDH and hope that the med changes will take effect quickly.

3. We can move her to residential treatment and hope that the neurological assessments make a big difference (and she won't be home while they make med changes which would be easier on the family).

4. ???!!! I've thought about an attachment intensive, but she has so many other issues that would make that so complicated. And more importantly (unfortunately) this would cost a lot of money and time that we just don't have. I haven't found a local therapist willing to do an intensive. Most of the few I can find on the internet are in Colorado (not just a hop, skip and a jump from here!). I do have family in CO, but the other 3 kids need us too. Not to mention that she is now 14 so attachment therapy at this age is VERY difficult. Of course emotionally/ developmentally she is only about 4-5 years old so maybe that helps.

Purplewalls - thanks for the suggestion regarding TinkerBear. I am strongly considering it! Say hi to the ladies at the C&C board for me. In my 3 computer change this year I managed to lose my user name and password and I can't get it to e-mail it to me. *sigh* Will keep working on it! Do you know if the user name is an e-mail addy or a name? That would narrow down the choices some.

Marythemom

Pharmacies Part Deux

So I sat around work all day pretending to be doing something when I was really reading other people's blogs! I didn't get a single e-mail and everything I could even try to do I needed our Creative Director for - and he was in meetings ALL day. One of the blogs I found through Postcards from Insanity (http://afostermamaslife.blogspot.com/) was a hilarious blog written by a pharmacist (http://www.sickofstupidpeople.blogspot.com/). After reading her blog I tried very hard to be patient with our pharmacy tonight, but it was tough!!

It was 5:30pm. So when they told me that the p-doc hadn't called in the prescription for Kitty's Trileptal I was very frustrated. The p-doc's receptionist assured me she'd called it in 3 days ago, and they'd been closed for an hour so there was no way to have them do it now. The pharmacist did allow me to get a 3 day supply after I asked.

So then we switched to talking about Bear's Amantadine (the one they gave me a 3 day supply of Provigil for?!). They insisted that they'd filled it on the 17th and therefore we'd only had it for 8 days and couldn't be out since they'd given us a 2 week supply. I insisted that I would be out tomorrow. Finally someone got a code from the insurance company that allowed us to fill the prescription. She laid the bottle on the counter full of the little red pills I needed - all within reach. Then she told me she had no idea how to get a code from Medicaid so the co-pay wasn't covered. It was only $10 so I almost just paid it, but then decided I was going to have to be here tomorrow to pick up Kitty's Trileptal I'd wait and see if they could get the code. Tomorrow I'm going to remember to ask how many pills they gave me. It'd be ironic if they only gave me 14 when I needed 28 or something.

When I got home I was so frustrated that my Mom took pity on me and invited us out to eat. I had a 20% off coupon for IHOP so we loaded up the kids and went (Hubby is teaching scuba tonight, tomorrow night, and this weekend - so I'm single parenting). We got to celebrate the fact that we can finally afford to get the kids back into school!!! Wooo hooo!!! Grandma is ecstatic. She loves the littles, but they were running out of stuff to do and knowing they were about to go back to school anyminute I wouldn't let her buy new workbooks. They start tomorrow. (Photo: Kitty in chapel at HCA last school year)
Here's how I told them as we were sitting in Grandma's van:

Me: "OK girls, put your hands over your mouths." (They both did, sometimes they actually listen!!)

Me: "I have good news and bad news."

Ponito: "Tell them the bad news so the good news will make up for it!"

Me: "Ok, the bad news is you have to find clean socks for tomorrow (a big issue!), because the good news is you start school tomorrow."

Kitty (dropping her hand): "AAAAAHHHHHH!!!!"

Bob: "MMMMMPPPPHHHHH!!!"

Me: "KITTY! That's why I told you to put your hand over your mouth! Take it down a notch!"

Kitty: "Sorry! MMMMPPPPHHHH!!! AMMMMMPPPPPPHHHHH!!! I love you Mom!!"

*sigh* Why can't she love me when I'm not giving her something she wants?

(Photo: Bob and Hubby after Bob wins a medal at HCA last school year)

I was mean Mom again when I wouldn't let Kitty have chocolate chip pancakes (she had to settle for regular), order extra toast (I gave in on this, but it had to be wheat toast - mean mean Mommy!), or order Sprite mixed with orange juice like everyone else because she's allergic to oranges (practically evil Mommy!).

The Meanest Mom in the World

Pharmacies

AAAARRRGGGHHH!

So after the kids p-doc appointment I went to the pharmacy to drop off their new prescriptions. They needed a couple of refills, we made some changes to Kitty's meds and the rest needed to go on file.


I always return the bottles to the pharmacy when asking for a refill (for one thing I don't need 20 bottles a month). When filling the kids med box for the week, I just set aside the bottles when they are empty then take them all to the pharmacy. Recently we've been having so much trouble with the pharmacy that I've started putting pennies in the med box for each missing pill. That way I won't give them the meds and think they have them all.


So on Monday I dropped off 2 prescription bottles and said I would pick them up the next day. The person said both had no refills so it would have to be called in. No biggie, I always have at least a 3 day supply when I drop them off. So when I came to pick up the meds, they said that Kitty's Triliptal had no refills. It wasn't on the prescription sheet I had (I assume the doctor had called it in earlier so hadn't wanted to put it on the prescriptions). They wouldn't loan me any and I was completely out. Luckily, Bear takes this too so I was able to borrow from his bottle.


They gave me a bottle of Provigil for Bear with only a 3 day supply in it because they didn't have any more on hand. More would be coming soon and they would call me. I was pretty sure I needed more Amantadine, but they insisted that I was mistaken. I guess I need to start writing down what I take in. That would prevent what happened with Kitty's Zoloft last month too. *sigh*


So I went home and checked. I had Provigil coming out my ears and needed Amantadine. I called the pharmacy and we argued for a few minutes. She said she had no idea why they'd filled the Provigil (this has happened before), but she insisted we'd just picked up the Amantadine on the 17th. That sounded familiar, but nonetheless we were out of Amantadine. Finally she realized that when they'd filled the Amantadine on the 17th, they'd only given us a 2 week supply because that was all the p-doc approved until the next office visit. I asked if the prescriptions I just dropped off had Amantadine included. Why yes, it did!


So hopefully I can pick up Bear's Amantadine, Kitty's Seroquel increase, and I'll call in Kitty's Triliptal to the p-doc so he'll fax his approval. Why does this have to be so complicated?!!


The good news is that Bear is very stable and doesn't have to see the p-doc for 6-8 weeks instead of monthly!! The bad news is that Kitty is still not stable - so we won't be removing the last bit of Geodon just yet. We'll increase her Seroquel substantially first before we try removing it. We have a great p-doc who believes what I'm saying (refreshing!!), but I was still glad that he was able to see Kitty being her usual slightly obnoxious self so he knows I'm not just a big whiner.


Kitty wouldn't let me kiss her goodnight last night. She's in full 'don't touch me' mode. *sigh*


Mary

I hate my life!

Ok, never thought I'd hear HUBBY say those words. I hear them a lot from the littles of course. I know he's been overwhelmed, but this morning was the last straw for him.

Yesterday we had yet another staff meeting reminding the staff that they need to be recording their time on the time sheets. We don't have a lot of work right now, and everytime they don't enter hours, we probably don't get paid for that. We have enough work for 7-8 people, we employ 10. We are so close to going under. We should have let 2 people go yesterday, but we keep putting it off. We have such a good team. When the work starts again, then we'll need every one of them. We've had lots of client meetings, but so far, not enough people signing contracts. *sigh*

A couple of months ago we were leaving work for an important meeting. At the end of the alley is a sidewalk about 10-15 feet back from the street and visibly blocked by tons of plants and a building. Hubby had started slowing so that we could turn out of the alley when out of nowhere a bicyclist on the sidewalk popped out in front of us. We hit her with the car! The downtown neighborhood where our office is is comprised primarily of lawyers so 911 was called immediately (we called too). Because the woman was not wearing a helmet she was taken away in an ambulance. She appeared to have just some bruises and small cuts. There was no damage to her bike or the car.

So this morning we get a citation delivered by a police officer. She's suing us for her continued pain, inability to work or attend school, and possible life long injury. *sigh* It sounds like the insurance will take care of it though. Still, one more thing to deal with. Also found out that our insurance was cancelled mid-August due to non-payment. This is covered because it happened last June, but we are still uninsured drivers.

I got a call from Nebraska this morning saying they would not pay for Bear's medications because his adoption was final months ago and he should have TX Medicaid. I told her we still have not received his birth certificate from Indiana, so can't get him a new Social Security card, so can't get him a TX Medicaid card. His adoption was finalized in July. His sister didn't get her new birth certificate until July and her adoption was in March!

After thinking about this for a bit I went and looked through the stacks and stacks of unpaid bills and found his TX Medicaid card! One more thing to do today.

So much stuff that's been falling by the wayside, the rotting second story deck my children play under, the carpenter ants that have been living in the kitchen ceiling for years and treatments have no effect, my thyroid surgery that I can't get because we don't have the $1K deductible, the 40lbs I need to lose that is probably caused by my meds, the repairs to the roof and windows that we haven't had time to fix because we're too busy fighting fires, the creditors just keep calling and calling and calling.

Hubby said a few weeks ago that he thinks this is God's way of trying to get him to take anti-depressants.

Sorry about the whining.

Mary

Mystery solved!

Kitty's behavior has been worsening and worsening and we've been blaming it on all the changes in her life, our stress level and parenting skill, her recent weight gain making all of her meds less effective (she's gained over 20lbs this Summer since we reduced her dose of Concerta).

Hubby noticed tonight that we haven't been giving her her Zoloft. We fill med boxes weekly using each child's bag of meds (kept in a lock box the rest of the time). We probably took the empty bottle to the pharmacy for a refill as we usually do, only there were no refills left. They usually fax the doctor under these circumstances and fill the bottle when he calls in a new prescription. Apparently someone dropped the ball, and we didn't catch it. I immediately went in tonight to get a refill and that's when I discovered that she has no refills and put 2 and 2 together.

Here's the bad part. I asked when we last had it filled (knowing we get a 30 day supply). They said JUNE 27th! That means she's been without this med for one month!!! No wonder the poor thing has been having problems. This is a major antidepressant that we KNOW she needs. Now it's even more obviously so. So the pharmacy won't give us any loaners (on a prescription that's been out a month!) and of course it's Labor Day weekend. Luckily another member of the family (OK it's me) takes the same medication and can loan her meds to get her through the weekend.

I feel like such a bad parent when this happens, but it's easy to understand how it happens when you look at how many meds they take - and they used to take a lot more.

Kitty takes:

Zoloft

Seroquel

Trileptal (2 pills twice a day)

Concerta

Geodon

DDAVP (for bedwetting)

Plus the OTC stuff like a multi vitamin, stuff for constipation, Zyrtec, and Omega 3

Bear takes

Trileptal (2 pills three times a day)

Lamictal (2x daily)

Amantadine (2x daily)

Provigil (2x daily - once at school)

Seroquel

Plus the OTC stuff like a multi vitamin, stuff for constipation, Omega 3, Zyrtec, and Glucosamine

Thank goodness Medicaid pays their co-pays or we'd be paying a small fortune every month. I'm so upset this happened, but at the same time, it's good to know that Kitty isn't just totally losing it!

I noticed there were a lot of comments I need to answer. Obviously I'm addicted to this blogging thing so rest assured I will address them! I do want to say welcome to all my new friends! I hope my posts are semi-entertaining!

Better get some sleep now! Hugs and prayers!

Mary