Meds meds meds

I think that meds can be very useful.  I also think that meds can create issues that were never there in the first place, and can cause one to end up chasing one's tail after each new issue... to the point that you become far removed from the original issue you took the meds for in the first place.

L is a fairly typical teen in that she has her mood swings.  She's also very very sensitive, and very introspective.  And she hates to be anything but perfect, or at least perceived as anything but perfect.  She'll also probably be irked I am writing about this, but, hey, it's my damn blog so tough.  :-)  In this family we own our quirks and flaws just as much as the positives.

I've worried over the past years how everything has and will affect her.  Her bio father's disappearance during her first concussion, the many MANY issues that followed in dealing with him, the emotions she HAS to have somewhere about that relationship, the surgeries, and typical teen stuff... all of it adds up.  Chronic pain changes people.  Feeling isolated or rejected or prevented from pursuing goals changes people.  Eleven, twelve, thirteen year old kids, even fifteen year olds, are not equipped to process and handle everything she's been asked to deal with... and even though I feel good about how Matthew and I have supported, talked, listened, hugged, pointedly asserted and otherwise guided them through all of this, the reality is, none of us are equipped to deal with what we've faced as a family these past 6 years.

But, I think on the whole we've come through... THEY'VE come through... stronger, more self-aware, more resilient.  And, theoretically, able to identify and address any unexpected emotional glitches or pre-dispositions that manifest down the road.

When L tried the amitryptaline after the first concussion, it was ugly.  She was to take it before bed, and if she did not fall asleep before the med kicked in, it was like interacting with an argumentative drunk (you know how it is: they are 100% certain in the intelligence and accuracy of what they are saying, all the while they are making exactly zero sense... and there is no way to de-escalate the situation because if you don't talk they'll keep coming after you and if you DO try to reason with them their complete irrationality takes over).  She'd wake up in the morning knowing she'd been really angry and trying to fight with me but having NO idea why or about what.  It was awful, and it didn't help with the symptoms.

I've also heard, and personally seen, horror stories about people getting off of Zoloft.

So in thinking about the two options (propranolol and zoloft) and talking to M, my friend who is a pharmacist, my sister, and L's regular Mayo physician, I decided to go against what Dr. C recommended and go with the MD's original choice, and we started on the propranolol.  I haven't told UPMC yet, as I am waiting to see what happens with it.   Yesterday was her second full dose after a week of half dosage.  She had some side effects a few days during the single dose, including feeling disconnected and unfocused one day with kind of racing thoughts... but it was better the next day.

 Now, yesterday she had what I consider a more serious side effect in that she felt like her body wasn't getting enough oxygen while she was swimming, and felt extremely weak.  Like, pass-out weak.  This is definitely a side effect of the prop to be concerned about, as it is actually a banned performance enhancing drug used by archers etc to slow their heart rate during competitions.  That may work well for such a calm sport, but us swimmers NEED the heart to crank it up when we exert ourselves, or our body won't get what it needs to keep going.

So we will give it another few days to see if the side effects fade and any positive effects kick in... and if not, then I will wean her off of it.  We discussed trying the zoloft if this doesn't work, and she and I agreed we don't want to do that.  She'd rather deal with the headaches.  And we can pursue the biofeedback and some other relaxation techniques to help with her self-imposed pressure etc.

This puts us in the position of having chosen NOT to take the main recommendation of the foremost concussion guru.  And not having told him yet that we are following our instincts instead of his.  Awkward.

I deeply respect doctors, and I admire what these guys are doing.  But, as with any doctor (or anyONE, really) I also believe that people bring a paradigm to the table that they seek to follow or confirm.  Each time we have been to UPMC one focus of the questions has been whether L's thoughts are making her symptoms worse.  I know that they strongly believe in the mental component of PCS... isolation, dark thoughts, anxiety, stress, etc.  And I 100% agree that that is an important aspect.  But, I also believe that we are more equipped than the average person to deal with those aspects externally, rather than through medication.  Our relationship with L is not the typical parent-teen relationship, and I know a lot more about this psychological stuff than most other laymen do, unfortunately.

So, we are going to keep pushing with the vestibular and exertional rehab, and give the propranolol another week or so (unless the side effects get too bad first).  L is making definite, albeit slow, progress.  Her grades are slowly improving.  Her headache levels are taking longer to rise, not getting AS high, and dropping faster.   She is back in the pool on a limited basis, although the effects of the prop may limit it more than we had anticipated.

But we are going to pass on  the Zoloft.  And maybe that makes us undesirable patients.  But I've got to be a mother first, and my mother compass emphatically says "NO".

On we go.