Wednesday, February 22, 2006

Facing fear...

Chance favours the prepared mind. -William Osler, 19th century physician (&, according to C, "the Grandfather of Internal Medicine")

C quoted this favourite saying of his to me on our way home from our visit today to Dr. M, B's psychologist. We try to see Dr. M just on our own every couple of months, to discuss the latest "hot" spots in B's behaviour & strategies for coping with it/him, or whether or not we actually need to intervene at all. One of Dr. M's many talents is giving us a strong sense of whether or not what we're doing is really effective, as well as positively supporting us as parents. There is no question in my mind that life would be much scarier without his help...

As I've been documenting over the past few weeks, B has had some big developmental changes going on, & while much of this is positive (in that he's developing appropriately for his age), the changes are quite challenging. B never does things in a subdued manner. Most of the strategies we've all put together for coping with the OCD have become less & less useful over the past few weeks & we are facing a vacuum of new strategies (although we are all working hard to find replacements!!). We spent the greater part of our appointment looking at the nature of the behavioural changes & discussing developmentally sound ways to approach them. It worked out well that B saw Dr. M yesterday afternoon, so he could see first hand where B is at. Since B is nearly 10 years old, he's beginning to work on his identity as a separate person from us, his parents, & also dealing with a lot of anxiety about mortality & being injured. Dr. M was very pleased that not only have we added the strategy of checking some of these fears out reality-wise to B's toolkit, but that he uses this strategy quite often with us & finds that it does alleviate his anxiety. We discussed the strategy of using physical activity as an antidote to anxiety, & tried to think of ways to motivate our essentially couch-potato kid to be more active. Our house really isn't big enough for a stationary bike, nor are we sure he's actually use one... although I would certainly make room if we thought it would work. Dr. M suggested that perhaps B would respond well to lifting weights, since B seems to like weighted things (like the ball-blanket he uses for sleeping). I also mentioned trying to get in the habit of going for a walk after school (after snack & homework). B has never been into this sort of thing, but will go if it's presented to be good for my health... I just have to get my act together & try it.

Our discussion eventually turned to dealing with some new & scary behaviours. As I have mentioned before, B is on medications (zoloft & seroquel) for anxiety & which prevent psychotic episodes that B has had during extremely anxious times. We are beginning to see some avoidance behaviours from B when eating & when taking the medicines. These behaviours appear to be motivated by the OCD, & Dr. M suggested that it might be best to not get too fussy about when B finds eating difficult. Intervention may come naturally (when B gets hungry) & making issues around eating oftens results in endless family struggles that we simply don't want to get started with... The meds issue is different, though, & although it's really nothing major so far, it's enough to make us worry about how to cope when he finally refuses to take his medicine. Dr. M told us that almost all families with kids on meds eventually deal with this issue, since it seems to be part of a kid's identity establishment to question things they've "always" done, like taking medicine. In essence, parents have "no cards to play" when it comes to the meds issue. If a kid refuses, there isn't much you can do but take them to the hospital or ride it out at home (depending on the medications the child is on)... however, it may be possible to weather the meds stand-off by making it less a confrontation than an exploration of the parameters. With B, the fear is that he will become psychotic & hurt himself without the medicine. C & I stated to Dr. M that the issue of B harming himself is what we use to determine whether or not B would need to be taken to the hospital during an extreme anxiety attack. Knowing our personal parameters helps enormously to prepare for such an event. C mentioned that the meds remaining in the blood stream for quite some time after dosing is stopped helps him feel less nervous about such a situation, although we can always tell if B's dinner dose of seroquel was forgotten because he can't go to sleep, but this does give us a cushion in the event B decides he doesn't want to take them. Dr. M suggested the idea of approaching going without meds as a scientific experiment, with well-established parameters that the whole family agrees to, which is something that would appeal to B & would also keep us in the equation. Luckily, so far B's ambivalence to the medicines have been motivated by OCD thoughts telling him that they are unsafe, so we discussed ways to make the pills seem different- putting them in a special container that could be declared "safe", offering them in a different place or time, offering them with chocolate milk or soda... as ways to divert B from the OCD thoughts & make them desirable. In a way, discussing these scenarios fell a bit surreal to me. There is a part of me that has been dreading to face this issue. I know what my kid is like without his medicine & that scares me so much, but I've only recently come to a sense of peace about B being on medications in the first place... The thing is, I feel very strongly that in the event B does refuse his meds, I have to be able to stay calm. B has always been able to sense my fear & scaring him could turn the whole thing into a confrontation, rather than something we can solve creatively together.

On the way home from our appointment, C & I continued to discuss our fears & how easily they could allow us to escalate possibly simple situations into major confrontations. C quoted Dr. Osler, & said that, although there's no guarantees for success, all of the advance planning we do just has to make a difference. I know one difference it has made already- by pulling my fears out of my imagination & discussing them in the light of day, they just aren't as scary. Also, by going through this process with C, I'm not only not alone, but we have the creativity of two different people to put into action. All this, plus basing whatever we do on our love & respect for our child... gives me the strength to face what ever may come. (stay tuned... :)

2 Comments:

At 1:13 AM, Blogger Zilari said...

One thing that B might be able to understand (seeing as he sounds like a very bright kid) is that if he suddenly stops taking medication, he's likely to feel much worse. Has this been explained to him? I don't know if it would be too scary of a thought or not, but it might be something to think about. (If you do decide to withdraw the meds, do it SLOWLY -- rapid withdrawal from neuroleptics can be extremely dangerous, not just uncomfortable.)

I'm also wondering if he could be experiencing long-term or new side effects like Tardive Dyskinesia -- this can cause an increase in tic-like movements, but I'm assuming you know about this potential effect of neuroleptics already. If this is the case he could be feeling less "in control" of his own body. But that could also just be the Tourette's. I'm not sure how that would be distinguished, in all honesty.

 
At 10:46 AM, Blogger Lisa/Jedi said...

Thanks again, zilari, for your comments. B sees his psychiatrist monthly, plus has bi-yearly blood tests, to keep an eye on the side-effects you mention, although he hasn't been on them long enough to be having many of the symptoms you mention. And, yes, we certainly plan to have him think about how he feels with enough seroquel in his system vs the times he doesn't- we started discussing this when he recently ran low due to the growth spurt, & I know it will be another strategy to help him reality-test his perceptions as he grows...

 

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