Friday, February 15, 2008

Safe in Grace

I had a meeting with Acadia's doctors at the hospital today. The latest and most significant development is that she has developed hyperthyroidism. This is most likely a result of being on lithium. Statistically 12% of patients on lithium develop hypothyroidism while a rare 2% develop hyperthyroidism. Some studies I've read suggest that withdrawing lithium can cause this, and we did withdraw her lithium for about 6 weeks before adding it again.

Because hyperthyroidism causes symptoms such as anxiety, erratic behavior, nervousness, irritability, or panic attacks; this could be contributing to or causing some of her difficulties right now. So this is the first thing we will be treating.

Acadia will be in the hospital for at least two weeks. I was able to take her out for an hour today and we went to the mall. She did well, but she seems a little bit on edge. Today she got a roommate. It will be good for her to have another girl to hang out with. She's not doing school right now and kind of bored...she even asked me to bring in her math book!

Our family is relieved to feel safe again. Acadia is safe where she is and in an environment that she can handle. Lily is free to build forts without having them destroyed, Dan can cook in the kitchen and have the knives out on the counter, and I don't have to keep looking behind me to keep from being hit or hurt. Without living in that environment for two weeks you cannot know the relief that we feel to out of it. Instead of feeling sad or scared that our daughter is in a psychiatric hospital, we have peace and hope for her recovery. That is God's Grace in the ups and downs of life.

Wednesday, February 13, 2008

Code Green

We hospitalized Acadia yesterday. We went to the hospital intending to do an intake eval for the day program. It had just dawned on me the day before that Acadia Hospital (the private psych hospital in Bangor) has a day program for kids that I could try to get Acadia into. On the way into the appointment she screamed "Help!" for 30 min. I think she sensed what was about to happen. We got about 20 min into the eval and the clinician said "I don't really need to go any further. I can tell you right now that she should be admitted." When Acadia heard that, she bolted. She opened the door and started running down the halls. The clinician pushed the button on the wall. "Code Green in the Access Center!" 15 people appeared out of nowhere and 4 of them restrained her. They were very calm and quiet, and only spoke a few necessary words. They used her name and asked her to calm down. Even with four people holding her she was still trying to bite, kick, and get away! I thought "Wow, I've been doing that by myself, and it's actually a four person job."
So since we were at the hospital when this happened, they immediately started the process (with my permission) for admission. I was relieved to have avoided the whole emergency room scene this time. I even felt a bit sly for having found the back door in to the system!
After we got her a room, Mom and I left. She threw a fit and had to be restrained again, but eventually she calmed down. We went to meet Bekah and Evan at the mall and I got a little baby therapy before we headed home. Dan and I packed Acadia's bag and got her a happy meal and went back to the hospital. We played a game and got all her stuff put away in her room. I read "The Stinky Cheese Man" to her. When we left she started in again, but I don't know yet how things went after that. We plan to go visit again this afternoon.
I feel so relieved to have her in the hospital. I knew I was tired and getting depressed and feeling trapped, but I feel all of that melting away now that I know she is in good hands. I was very impressed with the hospital and the staff, and I feel like she really needs to be there to get the intensive care that she needs right now.

Sunday, February 10, 2008

God complex

We tried to go to church this morning, but we never made it out the door. Acadia had her morning episode and that pretty much took away any thoughts we had of getting to church. She has been having 2-4 episodes per day now. These are mixed states of surging energy and dark thoughts, which usually results in screaming, crying, hitting herself and others, and raging through the house making huge messes. Other times she is just irritable or hyper and silly. The most disturbing thing right now is her fixation on trying to figure out why life is worth living. She also has this heightened spiritualality or as Dan described it this morning a "God complex". When she is upset she starts talking (or yelling, or crying) to God and asking him to do things or answer her questions. It's strange, I want her to pray, to reach out to God in the midst of her struggles, but this is not quite right. She was frantically searching her Bible this morning for verses that tell parents not to torture their children. She was praying that we would stop being cruel to her and that God would help her show us how wrong we are. She keeps telling us to do what God wants us to do. Then she sits there and screams that she is doing what God wants her to do. She wanted us to go to church so that we would learn something.
Since all that blew over, she's been okay this morning. She has these hours of being calm before she explodes again. We've decided to keep her at home unless she tries to injure herself or someone else, or unless the episodes get closer together again.

Saturday, February 9, 2008

To Whom it may concern

I sat there while you spoke to her, trying to figure out if I was really hearing those words. You did not yell. If you had I would have jumped up and blocked her ears. I would have used my body as a shield against the arrow coming at her. But I didn't know until it was too late. Words cannot be gathered up and put back again. They are arrows that sink deeply in the heart. That makes them especially hard to forgive. When they hurt a child, they are hard to forget.
You are an adult. She is a child with mental illness who has been suffering more than she ever has before. Dan and I have been painstakingly rebuilding the house of cards that is her emotional stability. Trying to show her that we love her unconditionally and yet have standards for behavior. Rewarding her progress with praise and encouragement. She was doing well today. Really only two episodes with many hours in between. She was struggling this evening, but she was pulling through. She ate dinner at the table. Do you even know what it took for her to be able to do that? When you asked her to stop saying things over and over, she did. When I asked her to log off the computer, she did. She was frustrated, but she did what she was asked to do with no fighting. That was huge! When she let out a short scream, it was like a pressure valve allowing a burst of steam to escape, so that nothing explodes, so that the situation doesn't become dangerous. She was calming down, when you walked in and spoke your piece..and she went to pieces.
She blames herself. She thinks that if she were never born, you would still be here and we would all be laughing and playing a game together. That we would all be happier without her. She hates herself, wants to die, wants to know why she should keep living. Thinks she can't do anything right. Won't listen to a word I try to say.
Her tears burn my heart. I can't stop the arrows she aims at herself, anymore than I could stop the ones that come flying.
But why? Why do they fill the air over the head of my little girl. She is sick. She doesn't mean to be, she is not manipulating, she is not pretending. Why can't thinking adults just understand that!
Sometimes all I can do is write. When she is finally done for the day, I take all the outrage and pour it through my fingers. I don't have the energy to do anything else with it.

Tuesday, February 5, 2008


Our world has been spinning and our daughter has been spinning out of control. But for about 24 hours she managed to hold it together while she stayed over at her cousin's. How or why she was able to do this I don't know. As soon as she stepped into my car, she let it all out. When we got to Dr. D's office she told me her name was LaFreaka and if anyone called her Acadia she was going to turn them into dust and put the pieces of dust in different countries. We went into the waiting room and she wrote on the wall with a crayon. In Dr. D's office she started scribbling on paper, flailing on the floor, crying, yelling, screaming, biting herself, hitting herself, etc. Dr. D asked her if she felt like hurting herself and she said "Yes, but I don't have a plan!" Can you tell she knows the drill now? "Do you have thoughts about hurting someone else?" "Yes!" "Who?" "Everyone!"
So she was a wreck and the doc said she should probably be hospitalized.
Now to catch you all up, we tried to hospitalize her Monday and that resulted in 5+ hours in the ER and then going home because there was just "No room at the Inn". Still nothing available Tuesday morning which is when my SIL offered to take her for the day and overnight if it worked out. So that's what we did, and it apparently worked out. Jump back to today, I have to make a decision. If I go head with admission, we can skip the ER because we just saw the doc. But what about the previous 24 hours? Where does that come in to the picture? The doc didn't have much of an explanation for me other than sometimes in a different environment kids can hold it together for awhile. She said it was up to me whether I wanted to take her home and try again, or admit her. Dan didn't know what we should do, either. In the midst of this, Dr. D took a break to call the hospital and I took Acadia to get a snack. At this point she switched. All of a sudden she was calm and talking to me. She started talking about how she was just pretending in the doc's office, and that she really could control herself. The next minute she was telling me that she thought maybe I wasn't real and I was some person in a good costume trying to kidnap her. Probably not, but she couldn't really be sure. is she manipulating? Paranoid? I have no idea. She says she wants to go back to the doc and tell her how she "really" feels. Sounds like a good idea. Back we go and she does start talking and answering questions. Acadia's story now is that she feels fine and wants to go home. I notice her movements getting faster and more driven. She starts setting up this whole playset of dinosaurs and gets so involved in playing with them, that she's not hearing what we say to her anymore. No one is going to make this decision for me so I say "Okay, I think that we are probably seeing some progress at least in the length of time that she is able to use self-control, and possibly in the length of time between episodes. I think I will take her home and we will wait and see what happens from here. If things go really badly tonight and we need to hospitalize her tomorrow I will call you, otherwise we will deal with it at home."
I drove home with her screaming, smashing the car vents, and describing each of her feelings with a different face and a different voice; happy, sad, angry, grumpy, scared and zooming. At home we tried to have a "normal" evening routine. The girls played on the computer together and started connecting again. We had some screaming and fits, but we also had cooperation with our bedtime routine. She was anxious about going to bed alone and threw a fit, but she told me that she stopped and asked God to help her do the right thing. Then she came and calmly asked me to lay down with her for a few minutes. This was a huge step for her and we told her how proud we were of her for that. Before she drifted off to sleep she asked me why God made her with Bipolar. I said that there isn't one answer to that question, like 2+2=4. It's more like a mystery. And she has the rest of her life to look for clues.

Friday, February 1, 2008

"Show the doctor, honey."

We took Acadia in to see Dr. D today. Mom came with me. Cadi quit talking as soon as we were in the office. But she tried to express herself by drawing pictures and finding toys to act out her emotions. She was tearing around the office with a lot of energy. Dr. D told us that the citalopram triggered a mixed state.

Here's a description of a Bipolar "mixed" state: "Symptoms of mania and depression are present at the same time. The symptom picture frequently includes agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. Depressed mood accompanies manic activation.
Sometimes severe mania or depression is accompanied by periods of psychosis. Psychotic symptoms include hallucinations (hearing, seeing, or otherwise sensing the presence of stimuli that are not actually there) and delusions (false fixed beliefs that are not subject to reason or contradictory evidence and are not explained by a person's usual cultural concepts). Psychotic symptoms associated with bipolar disorder typically reflect the extreme mood state at the time (e.g., grandiosity during mania, worthlessness during depression)."

The problem is that even though it was the medication that triggered this, and it should be out of her system now, the mixed state could continue for weeks. We can try to bring it down with other meds, but there is no guarantee. Dr.D said that if we put her in the hospital she could be monitered and meds could be adjusted quickly. Mom asked if we put Acadia in the hospital if I could be with her. I shook my head, Dr. D said no, and Acadia started crying. We talked about our options for awhile and Acadia clung to me and cried. Dr. D said she would feel better about us keeping her at home if Acadia would talk to her about whether she felt like hurting anyone. Acadia sobbed "I don't want to hurt myself. I don't want to hurt Mom, I just want to stay with her." So we agreed to take her home and give her Seroquel and Ativan in increased doses, and take her to get bloodwork done in the morning for her Lithium level. If we need to we can take her to the ER this weekend, but otherwise we will check in with Dr. D on Monday.
I do have some good news. After we gave Acadia her medications and a warm bath, she started feeling really sleepy. I got her in bed, Suzy read her part of a story, and then she decided she was ready to go to sleep. And now she is asleep in her own bed all by herself! A medical miracle! Something finally knocked her out. Sweet dreams.

Anxiety Attacks!

We had a rough beginning to the month of January. Acadia was having a hard time adjusting to being home and there was a lot of anxiety about schoolwork, nighttime, and transitions. On the 7th, we took her to see Dr. D who prescribed citalopram (Celexa) for the anxiety, as Dr. T from NIH had recommended. She started taking it on the 10th. We started to see some improvement about a week later, although I'm not sure whether it was due to the med change or just settling in to the structure at home. Acadia had about a week and a half when things were finally going smoothly for her. We were able to do schoolwork and daily routines, and we were working hard on the anxiety and seeing cooperation on her part.

Monday Cadi had an appt with Dr. L. We went in with a good report, things had been going well for a couple of weeks. We agreed to wait on changing anything and see if things would continue as they had been. Of course they didn't. The tide came rushing in. Monday afternoon she started to get irritated and frustrated. Tuesday we had a difficult morning trying to do our routines and go to the library for school. We were only there about 30 min when Cadi got really frustrated and started hitting her head and biting her knees. We came straight home and she was hitting and kicking in the car. When we got home she tried to throw her backpack in the snow and when I took it from her she punched me in the arm. We went inside and she started crying and hitting her head again. She was saying how much she hated herself and how she could never make herself behave. She had a strong urge to bite something. I wrapped her in a quilt and she let me hold her. I asked her if she wanted to apologize for hitting me and she did. I forgave her and explained that she needed to forgive herself too. She was biting her hand so I got her a carrot and she ate that and calmed down. She even finished some schoolwork and seemed okay until later in the afternoon. I gave her 5mg of Adderall at about 2pm. This is her normal dose but lately I had been forgetting to give it to her in the afternoon. She had a rough afternoon and evening, but I don't remember any specifics.

Wednesday morning we tried to do schoolwork and get ready to go to the therapist. She was frustrated, crying, angry, depressed, and trying to express her feelings to me. I decided to just read out loud to the kids for school. We managed to get to the therapist, where she drew a sad and frightening picture of herself and a tornado that was sucking her up. She stopped using words and communicated with the therapist only by using props and acting out her feelings and drawing scary pictures. At one point she ran out the door and down the hall. The therapist asked her if she felt like hurting herself, and she nodded. She asked if she felt hurting me and she nodded harder. When asked how much she pointed to the opposite ends of the room. When we left she started communicating with words again to me. We called Dr. D and got some Ativan to calm her down. We went home, watched a movie and ate supper. She seemed okay during this, and even laughed during the movie. I had bought her a teething toy which she was using constantly to bite on really hard. As soon as the movie was over, the anxiety rose up again. She was crying and panicked. She refused to be alone. I tried to tuck in her bed and she wouldn't stop crying and trying to explain the feeling she had. She seemed driven to have to get me to understand it. She asked me what she could do with all the problems she was worrying about. I suggested we pray and she could start by asking God to help her with the things she was worrying about. She started praying by thanking God for everything she could think of...but then she couldn't stop. I could tell she was getting tired of listing everything of so rapidly and I told her that was enough, but she said if she didn't thank God for everything it would disappear. I suggested she use the word "everything". She wouldn't, but eventually she switched to crying out to God....."Why won't you help're the only one who is big enough to handle my problems but you won't help me. Why can't I see you, why can't i know that you're real? you have to help me i need you!" etc. She finally stopped praying.

I asked Dan to take a turn with her. She kept on talking and crying with him. He finally left her and said she could come down if she needed anything so of course she immediately came down. she started checking the livingroom and listening to the floor. she said she was checking for bombs. she said a homing missile was hidden in the cupboard. We couldn't tell if she believed they were really there or if she was worried that they might be. She drew a robot on her knee and called it "squarebot" she said he was her only friend. I took her up to bed with me and Dan slept on the couch. I read Winnie The Pooh out loud until we were both falling asleep. At one point she asked me "What is the point of living? No, mom, really, I need to know". She also said she would kill herself if she could but she didn't know how. I had given her another Ativan at 8pm. At about 11 I couldn't stay awake anymore so I shut the light off and gave her a back rub. She said it was the best feeling in the world, but then she kept getting freaked out that it wasn't my hand. Finally we both fell asleep and slept all night. I got up at 7:30 and she slept until 9am.

Thursday was a repeat of Wed. Super anxious and depressed. Wanted to run, so I took her outside and she ran in the snow. I had to stay with her constantly, she just kept going from one thing to the next trying to either express her feelings to me or try to get away from them somehow. Mom came over and took care of Lily and the house, so I could watch Cadi. When Dan came home i had to take a nap. She would get distracted by computer or movies for a while and then it would just hit her again and she would start freaking out. She hasn't really been aggressive since Tuesday, although she has talked about wanting to be. She still bites her knees and blankets. She made a huge barricade of stuff and said that she was blocking her feelings. I had to stop her after a while because she couldn't make it big enough to satisfy herself. Last night went about the same except I got her to watch a DVD in bed for awhile by herself. I still had to come in and sleep with her. She said she really wanted to kill herself but she wasn't brave enough. When she went to sleep she woke up a few times and said she'd had a nightmare and asked where she was.

This morning she is still the same. We are watching her closely to see if she is safe, and so far she is, but she is so tortured. She is in a lot of mental pain, and I wonder how long it's right to keep her at home, as much as I don't want to admit her. I am going to call Dr. T today and also see what Dr. D thinks we should do now. It has been more than 3 days now. We have taken her off the citalopram only since Thursday am. So if that's what's causing this it may still take longer for it to get out of her system.