How Much Freedom Do We Give Her?

The answer in the past has been very little. Caroline has been historically not to be trusted in any unstructured social situation. She forgets who she is, crosses all kinds of boundaries, shows off, doesn't pick up on social cues, and ends up losing friends as fast as she makes them. Even a birthday party sleepover is totally out. Disaster kind of follows her around without direct supervision.

She has had a great year as far as stability goes. She hasn't been hospitlalized even once since her return from the RTC in Texas, which is truly a record. She has been well liked at school this year. But the summer brings big challenges. We can't afford to keep her in sports camps week after week, so the other options are the house, the pool, and the gym.

But the pool presents some major issues. Lots of junior high and high school kids from mostly upper class homes, all in the same schools together, pretty "hip" and Caroline just doesn't fit the mold. So she ends up hanging out with the uncool kids, which I don't actually mind, since the "cool" kids are often already involved in sex, alcohol, and you name it. But there is this boy there among the "uncool" kids who definitely has a crush on her. He has PDD and is 21, but acts like he is about 14 or so. Very slow. Nice, but just too old for our daughter. He asked if she could leave the pool and go to the 711 with her. Absolutely not, obviously. I am afraid that she will be flattered and do something stupid. She wants to hang out there without us but I am just not sure that is a good idea. Too many freedoms.

The gym is better.

The End of School!

Caroline has finished one complete year at one school! Yay!!!!! She wasn't feeling too well, probably the residual effects of the double dosing two nights ago, but she went to school, got the yearbook signed, teacher gifts handed out, and found out that she did quite well on her final exams. So thank you God, for getting her through this year successfully!! We found out that the less competent teacher is not returning, which is a relief, and that while Caroline's favorite friend is not returning, the other new girl is, so we are all happy. And Caroline will be going up to the ninth grade for some of her classes. Thus we stroked the registration check, and hope for the best for next year. Now what to do with her for the next three weeks until lacrosse day camps start? I wish she loved to clean. :)

Med Lesson Learned, Again

Last night Caroline accidentally took her evening meds twice. She was watching the American Idol finale with us, and had the pill sorter box next to her, and apparently she was so engrossed that she took Wednesday and Thursday nights' dosages. I was sitting right there next to her, but I didn't notice how many pills she was taking. This meant that she took double the amounts of all of her psych meds plus four Benadryl and two Clonidine, a blood pressure lowering medicine! I freaked. I called the doctor, and his answering service got in touch with him and they called me back to say that he felt she was going to be fine. I didn't feel entirely reassured. I got up twice last night to check on her, making sure she was still breathing. She is still asleep this morning at almost noon, still breathing, but I am not giving her any of her morning meds. I am particularly concerned about the Lamictal overdose because of its potentially life-threatening adverse reaction, as well as her liver and kidneys being damaged. I think if this happens again I will just take her straight to the ER because I don't want another night of no sleep wondering if I am doing the right thing. This is the first time this particular med screw up has happened, but other mistakes have occurred when we didn't hand her the meds in a small bowl, already taken out for her. You would think a fourteen year old could handle her meds but honestly, I think it will be years before we can trust her to do this on her own.

Well, It was Good While it Lasted

Her demerit-free school year that is. Today was her last final exam, and apparently one of the most obnoxious boys would not stop clicking his pen after she asked him several times to stop during the test. He started trash talking, and she hauled off and punched him in the back. I got the phone call around 9:30 am, shortly after realizing she had FORGOTTEN TO TAKE HER MEDS! She was also up too late last night (my fault). I am not excusing her actions, but probably she would have kept her cool if she had her meds and had more sleep. So she has her first demerits. Two more days of school and it's over! We aren't too mad at her since she has had a great year behaviorally at school aside from this. She is bummed about not being able to say she is the only kid without a single demerit, but I told her don't sweat it. Again, the school has been very gracious. She probably would have been suspended at any other school.

You Might Need "Starfish"

There is a great online website/resource for educational advocacy for kids with all kinds of neurological challenges called STARFISH. I have posted a link to their site on the right hand side of my blog. Check them out! Very impressive source of information and actual help as you navigate the public school system.

Schooling Undecided, Church Issues

Well, just when you think you know what you are doing, things change. We are now quite unsure that we want to send Caroline back to the school she has been at all year. The kid is just so lonely. If the two new girls don't come back, like we are hearing they aren't, then it will be her and the boys again. Adolescence is hard enough, but going through it with not a single friend is awful. We are now wondering if academics alone is a reason to keep a kid at a school where she has no friends. Probably not. She is retreating to her room every day after school, spending hours just writing her novel (90 typed pages now), living in the world she has created for these characters. Not healthy. Creative yes, but not engaging in reality.

We have similar problems at church, with there being a very small group of girls to choose from. Increasingly I wonder if we should find a new church where she can start fresh. She feels rejected by the other handful of middle school girls because of her past mistakes while manic. We tried another church before, but the church we switched to didn't meet everyone else's needs (too far away, too big, didn't like the sermons or music.) But to see her suffering, refusing to go to church, Sunday School, anything because of her feelings of alienation is really hard. Adolescents form a lot of opinions about spiritual things early and she is at a critical point in her life regarding her relationship with God. We are in a difficult place. Please pray for direction, clarity, wisdom. We love our church, our pastor, our friends, but when does your child's needs take precedence over your own? Are we being selfish if there is another church where she would thrive? I hate these kind of decisions because you feel like there is no perfect choice that will satisfy everyone.

"We're Too Normal"

I was watching "Wife Swap" tonight on the TV with my two youngest daughters. The show should really be called "Mom Swap" because that is what it is essentially. They take two radically different families, switch the moms for two weeks, and lo and behold you have a reality show. Of course one mom is always much too permissive, usually on the low end of income and education level, and the other one is often well-educated, materially blessed, Type A, and uptight about everything, and extremely protective. Mae asked if we could sign up to be on the show. I gave her a "no-way" look. Then Jane said we couldn't anyway because our family was too normal. TOO NORMAL?? Did I hear that right?! I was tickled. I really thought that she would say we were too messed up. Yes, we are a normal family, with issues like every family. Our oldest comments frequently that we have a very dysfunctional home, but then I ask her to look at the home lives of most of her friends. We are doing okay in comparison. Yes, at times we haven't felt the least bit normal, but I must say that this year has been a new "normal." I am grateful for the reprieve from the holes in the walls, the running away from home, the constant crises we were in for so many years. I realize that things could change, but for now, I am just thankful.

Summer Camp Advice

One thing that we have learned after years of different summer camps for Caroline is that bipolar kids usually cannot handle camps that involve large numbers of kids in one place, out in the heat all day. Look for camps that have small number per counselor, in a small environment, with plenty of indoor time. Lithium makes kids need a LOT more water (it is a salt, remember) and bipolar kids have a hard time regulating their temperature anyway for some reason (see The Bipolar Child by Dr. Papolos.) Tell them that your child is bipolar, obviously, and give them some tips on how to handle outbursts and meltdowns. Sports camps are ok if they LOVE the sport they are playing, but again, WATER and more water. We have had bad experiences with chaotic camps.

Ugly Morning

Do you ever have those mornings when you get out of bed, come downstairs, and then all hell seems to break loose? Then you find yourself yelling at the kids because you are so groggy you can't figure out what is going on and you need at least three cups of coffee before you are ready to deal with this kind of stuff anyway. My oldest and Caroline got into a huge fight over whose Odwalla was in the fridge. Puh-lease!!!! There was a big C on the top of the bottle, which I had put there because it was Caroline's. Elizabeth's was in there too with her initial on the top but she didn't see it before she left for school. Both were accusing the other of taking their drinks, food, etc. My oldest thinks Caroline eats everything in the house before she gets to partake, which is partly true, so I gave E. her own stash of her favorite foods. Not good enough, I guess. She was incensed over an Odwalla. I hate the way I handled the situation (screaming), and I hate the way they can't ever seem to give each other grace. Ugh! I am sick of the morning school routine with five people in the kitchen all trying to get out the door about the same time. We need two kitchens, or two school start times that are farther apart than half an hour.

Drug and Alcohol Rehab Program for Teens and Young Adults

There is a wonderful nationwide, faith-based addiction rehab program I have discovered called Teen Challenge. They serve young adults as well. If you know someone who is trapped in addiction please check out their website which I have posted under Great Resources to the right on my blog. As you may know, many teens and young people with depression and bipolar disorder end up self-medicating if they are not properly diagnosed and treated early.

Something to Celebrate

Caroline tried out for the select summer girls lacrosse league team, and she made it! Most of the girls on this U15 team are already in high school. The head of the league came up to my husband and asked where in the world Caroline came from, because she was really good and he had never seen her before. We explained the broken ankle and the missed season, but I have a feeling that a lot of people will be asking where she came from, given her incredible talent on the field. God has given her quite a gift and we are thankful that she has something she can call her own. Maybe it will lead to a college scholarship one day! The next five years are going to be so important in determining the direction of her life in her twenties. We just hope she can graduate from high school! She is very smart, but bipolar disorder in kids and teens has a way of dampening their academic performance due to a lot of missed school, slow processing speed due to the drugs, short term memory issues, etc. One step at a time. Final exams this week and the next, then summer is upon us!

Adding an Additional ADHD Med to Intuniv

We decided that Mae needed something in addition to the Intuniv to help her focus in school and at home. The Intuniv makes her calmer, but is not as effective at keeping her focused, so we are adding Vyvanse to the mix starting today. The psych doc said that he has posted a lot of Intuniv info on his blog, including the need to add another ADHD med to it in many cases. You will find his blog on the right of this page under Great Resources, Dr. Charles Parker, Core-Psych Blog.

It has been raining and raining and I think it is affecting my moods and energy levels. All I want to do is sleep! My kids are always crankier when the sun doesn't shine.

More on Handling the Difficult Child

One of my blogger friends Mary the Mom came up with a wonderful set of guidelines for disciplining the difficult child without spanking, which, many of you know, often exacerbates the problems with explosive, bipolar, or severely ADHD children. You can find a link to her site on the right of my blog, towards the bottom. Her blog is Muddling Through Mayhem. Check it out!

Possible New Good Friend

One of the new young ladies at Caroline's private school happens to live a minute from our house, plays lacrosse, and comes from a very nice family. She is also diabetic (type 1) so that makes this friendship even better, because, as I have said many times, managing bipolar disorder is a lot like managing diabetes, with the constant medication adjustments depending on their blood levels, etc. Monitoring their meds becomes a full time job in itself. I don't want Caroline to share that she is bipolar too quickly. She did that before a few years ago with another new friend and it really backfired with the mom obviously discouraging their friendship. I just want this young lady to know Caroline for Caroline, not the girl with the mental illness. If this girl decides not to come back to Caroline's school (she can't stand the disruptive troublemakers either) then I will be very bummed. But at least she plays lacrosse, lives very close by, and I can tell her mom is someone I could trust to be a good rule-enforcer.

Lacrosse tryouts happen this week for summer games. I hope that Caroline will make the select team and be able to play and make up for the lost spring season. We shall see!

Stressed today: prom is tonight for my oldest, and besides all the preparation (hair, brow wax, makeup, is the camera ready, pick up flowers, go to picture session, etc), we had two soccer games, ballet rehearsal, a sleepover last night, the Greek Fest which my kids won't miss, and I am now totally wiped out. But my husband and I are going on a date, so I hope I perk up. I just want to sit, not drive, just sit.

Problems with Drug Manufacturer of Lamictal ODT

Unfortunately, we may have to switch Caroline back to the regular generic Lamictal instead of the extended release because GlaxoSmithKline is having a problem with manufacturing, exactly what I don't know. This is disappointing because we did notice an increase in effectiveness with the name brand and not the generic. Our insurance wouldn't pay for the name brand Lamictal, which is why we requested the Orally Disintegrating Tablets, which only comes in the name brand.

Bad Day

Oh, I wish the end of school were here. Caroline is having a very difficult time staying at school. She says she can't deal with the behavior of the boys there anymore. She only has twelve more days of school, including six days of final exams. I had a conference with the assistant principal today about strategies to help her get through the final push. I really felt like pulling my hair out from the stress of dealing with Caroline's attitude of "I quit!" My husband is out of town so I am playing single mom and having to be four different places at the same time (all I do is drive it seems.) Caroline had her last meeting with the counselor she has had since last May, and now we will have to adjust to someone who is new. Oh boy. I am just really tired tonight. Tired of homework, and kids who don't want to do homework, the end of year projects (four in two weeks) the AP exams, the SAT, etc. I am looking forward to summer in a big way.

Handling the Rages

One of the worst parts of dealing with a bipolar child is handling the many rages. These are not your typical temper tantrums. One of my children can still throw a major tantrum, but nothing like what we have seen in the past with Caroline. When she was very young, three or four, I was so bewildered and defeated by her rages that I would frequently call my husband at work and beg him to come home to help with her. He was able to do that then (only in big emergencies now) which was a lifesaver. Bipolar rages are more akin to seizures than to fits of anger. They are triggered by seemingly nothing, and the power behind them makes little ones look like the Incredible Hulk. I can still see her face distorted, red, eyes in this weird glaze, screaming, clawing, kicking, biting, physically trying to hurt me or one of her sisters. Awful. Really awful.

I have been asked how you handle these incidents. Honestly, we tried so many things. We tried spanking her, which no matter how "correctly" we did it, produced only greater anger. (she thought we were inviting battle.) We tried time-outs, loss of privileges, holding her, yelling at her (never works), throwing her in the car and driving around (actually the best calming tool) and in the worst of scenarios we took her to the hospital. If she was a danger to her sisters, we took her to the hospital. If she became a danger to herself, we took her to the hospital. If she was raging but it didn't become dangerous, we would let her rage in her room. Nothing strikes at your heart more than when you have an angry, out of control child who is scaring her siblings and you, and you feel helpless to solve the problem.

She has outgrown most of this, we think, or the meds she was put on at Meridell have solved this problem. She hasn't raged like that in a very long time. We are very thankful for the passing of this mixed-state behavior.

How to Know When You Need to Find a New Psychiatrist

On the CABF online support group for parents of bp teens, a woman asked what we thought about her psychiatrist suggesting that her son, age 16, who was finally doing well on his present med mix, could go off of his meds because he had probably "outgrown" the "bad behaviors" he had first exhibited nine years earlier when he was first diagnosed. What?!?! We were all appalled. Obviously this doctor is unaware that bipolar disorder is not a conglomeration of "bad behaviors" that kids can grow out of eventually. Don't we wish! Rather bipolar disorder, like Aspergers or schizophrenia is an organic, genetically influenced, biological, and chemical disorder! We emphatically suggested that she find a new psychiatrist fast. To experiment with "what happens if we just stop all of the meds" when her child is finally functional is downright cruel. Tapering one med at a time I can see. But to stop cold-turkey to see if he miraculously improves doesn't make any sense at all. Some doctors just don't get it. We have been firm with our doc, as much as we believe that he is brilliant and on the cutting edge of psychiatry, that we are unwilling to change Caroline's present med mix prescribed while at Meridell except to try tapering later because she too is the most stable she has ever been. Don't fix what isn't broken, right?

Note on Kids Taking Iron

I just found out that supplemental iron can block the absorption of some psychiatric medications. Caroline was prescribed iron for anemia, and after about a week we noted a downturn in her behavior. Another mom on the CABF support group for teens noted that her daughter's medications had to be increased while on iron because of this problem. So if your child is low on iron, check with his/her doctor about increasing the dosage of their mood stabilizers if they need an iron supplement.

Happy Mother's Day!

For all of the moms of bipolar kids who are constantly working to help their children succeed in life, you are the best! God gave you this special child to raise and when we look to Him he gives us the courage and strength to keep going when we want to give up, and when our hearts feel hard towards them. It is not easy to love well, and to love those who seem unlovable much of the time feels impossible. With God, all things are possible. I pray that today you will get some much needed rest, that others will celebrate you. Happy Mother's Day!

Note on Seroquel XR

If your child is taking Seroquel XR you may want to be sure that they are taking it on an empty stomach, a few hours after dinner. Apparently the XR part of the drug isn't effective if you take it with food, which we forgot. Caroline was really irritable yesterday, and then I remembered what the doc had said about how to take this AAP. We weren't following that little rule and I think it makes a difference.

Mental Health Week on Discovery Health

I don't know how many of you out there know that this week Discovery Health has been showing nightly documentaries about different mental illnesses, including one about a child with bipolar disorder. I don't get the channel on cable, but you can watch the videos on Discovery Health's website. I have already watched some of the bipolar girl and it is VERY familiar. The shrill screaming and the slamming of doors (repeatedly) rings a bell with many of us, I'm afraid.

Off Topic: Where Have All the Gentlemen Gone?

I love helping my oldest daughter pick out fancy dresses, plan her accessories, and fuss over her hair, nails, and makeup for homecoming, prom, etc. We are both girlie-girls. She has been planning for weeks on going to the prom with a senior guy who is just a friend, she insists. I believe her. She thinks having a boyfriend in high school is stupid, after seeing all the drama her friends go through. Well, last night she called me in tears because he was mad that she couldn't stay out until 2:00 am, hanging out with some other couples at a friends house. We don't see the point in hanging out in couples at some guys house after prom. Sounds like trouble to us. My husband knows how guys think about prom, and he is right. I remember too. She was basically being given an ultimatum: stay out with me until 2 or we don't go to prom. The jerk! Whatever happened to being a gentleman and respecting a girl's curfew? I wanted to punch the guy. No one treats my daughter like that! Well, she said no and he said fine I am not taking you. I applaud her conviction and stance. But I was so upset by the insensitivity this guy showed toward my precious daughter! We already spent $200 on the dress and another $100 to get it altered! She says she may go single to the prom, or with another friend, hopefully one who respects her more. The dress can be used next year, if not. She is sick of high school, and frankly so am I! The immaturity is amazing sometimes! She is worth so much more. Watch out for mama bear, boys!!

Calm PRT Helpful

The NeuroScience supplement Calm PRT seems to be helping with Caroline's overstimulated adrenal glands that were pumping out too much cortisol. She says she feels much calmer since starting the 3 capsules a day. The next supplement we will add is the Trava Cor. Anything that works, right? If you have an interest in having your child's neurotransmitters tested (beyond the big three: serotonin, norepinephrine and dopamine) see their link on the right under Resources. I am slowly becoming a believer, and I am truly a sceptic by nature about a lot of "alternative" medicine. My sister is a doctor, and another is an ICU nurse by training, so I am slow on the uptake for anything non-traditional. I think I need the Calm PRT! I have really been on edge the last few days. I think the stress of the last push during the end of school gets to me. Too many tests, projects, deadlines, etc.

Schooling Decided

Surprisingly, we have decided to send Caroline back to the private school she has been in all year, despite the numerous issues we have had this year. Why? Well, for three reasons, the first being that there are very few schools out there that have been as flexible as this school has been regarding her many absences during the depressive and manic episodes she has experienced, and will experience. In our school district, you can only miss so many days of class per year or you must repeat that grade or class, regardless of circumstance, even if you make up the work. In the other private schools, she simply wouldn't be able to keep up like she has been able. They move too fast and are too rigorous academically compared to this private school. She needs a lot of grace, and her present school has given her a lot. Secondly, the girl who has been such a bully to her this year isn't coming back, and the same goes for another boy whom she cannot stand (very disruptive in class.) The third reason is that she has gone from school to school since the fourth grade, often changing schools mid year, and so to finish this year and possibly the next at one school would be very good for her academically, boosting her sense of accomplishment. High school will be another matter, and we will consider other options at that point. She is such a great lacrosse player, and it would be nice for her to be able to play on a school team in high school, which could only happen at another school since this one is too small to field a team.

Now it is the summer I am worried about. She needs tight structure every day, and the summer presents a a huge challenge to keep her occupied. A bored bipolar kid is not a good thing. I may sign her up to volunteer a lot of time at the local animal shelter, or something like that. She has three week-long lacrosse camps, but her other sisters need to have some fun too, so all of the alloted camp money can't be spent on her alone. My oldest may be going to Scotland for a few weeks, so that will help with keeping the peace.

I hope you have a good week. I schedule a Mother's Day pedicure for myself and brunch for all. Not that my husband won't do something nice that day, but a little self-care doesn't hurt!!