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What’s Up with Me?

This morning I woke up feeling sick to my stomach. Unlike my son, feeling crappy doesn’t keep me from eating nor do I sleep all day. Even though I was nauseated and loopy, I managed to finish my first chapter of my book. Working with Sarah Fader as my book coach starting last week, I’ve drawn up character sketches, a book outline, and a draft of the first chapter. The first chapter focuses on childhood up to eighth grade: born in San Francisco, five years in Saudi Arabia, two years in Massachusetts, ending the chapter in Rancho Palos Verdes. The second draft will begin with our move to Valley Forge, Pennsylvania. My goal is to have a working draft by the time I attend the Sunriver Writers’ Summit in late May.

Parenting a High Needs Chronically Ill Teen

My 17-year old son’s been sick and suffering from migraines (again, still, nothing new). He frequently gets ill, has had migraines since he was a toddler, and struggles with anxiety and depression.

Honestly, I’m exhausted trying to care for him, trying to take him to doctors’ appointments when he won’t or can’t drag himself out of bed, trying to get him to eat when he doesn’t feel well, trying to get him out of bed and to school. He’s been a very challenging kid to parent. Now he’s a young man — a sweet, highly intelligent, and handsome young man — but difficult to help, difficult to parent. I’ve tried. Oh, how I’ve tried.

Recently my husband took him to his psychiatrist (my son has an army of specialists). They agreed on lowering his topiramate dose. My son doesn’t like the negative cognitive side effects of topiramate, nicknamed “Dopamax.” When I took it as a mood stabilizer over a decade ago, I was a complete idiot. My son can’t find words or understand concepts as quickly as he once did. He complains that he used to read his Spanish vocabulary once and had it memorized. Now he has to read it multiple times. I told him, “Welcome to everyone else’s reality. Most people must study harder than you do.”

My son keeps hoping that he’ll outgrow the migraines, which he still may, for testosterone protects against migraines. He had asked to see an endocrinologist hoping he’d be prescribed testosterone, but the pediatric endocrinologist wouldn’t prescribe it. He just told Matthew that he had delayed puberty (late bloomer), and that he’d catch up.

When I heard that the psychiatrist again suggested lowering the topiramate dose, I emailed his neurologist who responded that it was a bad idea, for his migraines return whenever the dose is reduced. Got him back up to his therapeutic dose, but he’s still not 100%. Last night he threw up, as he did once last week. Migraines + viral illness = miserable son sleeping 24/7.

Hypnotherapy

Hypnotherapy Mind Body Connection KittOMalley.com

Last Friday, I drove my son down to La Jolla (across the street from UC San Diego!) to see pediatric hypnotherapist and pulmonologist, Dr. Ran D. Anbar, MD, FAAP of Center Point Medicine. My son struggles with migraines (greatly improved with recent medication regime), depression, anxiety, eczema, and frequent school absences due to illnesses.

According to Dr. Anbar’s brochure:

Children who use hypnosis:

  • Become empowered to help themselves when they feel poorly, and are proud of themselves for being able to do so.
  • Feel better about themselves and their medical condition because they can help take control of how they feel.
  • Become aware of their inner strength that allows them to cope more effectively with all aspects of their lives.

My mother used hypnotherapy to help her battle non-Hodgkins lymphoma (along with chemotherapy and monoclonal antibody therapy). Hypnotherapy enabled her to feel more in control, and lessened her pain and anxiety. My father quit smoking using hypnotherapy. I’ve used self-hypnosis (all hypnosis is self-hypnosis) to perform well on exams (I studied, too).

Hoping that self-hypnosis will give my son a tool, an effective coping mechanism, not just for somatic illnesses that respond well to hypnosis, but for life. Somatic illnesses are not “just” in the mind. The mind and the body are connected.

Prayer, meditation and self-hypnosis all help body, mind, and soul.

ALPIM Anxiety-Laxity-Pain-Immune-Mood

Many of us living with mental illness have other chronic illnesses. Often we are not treated for our “physical” illnesses, as many doctors dismiss them as psychosomatic. “Mental” illnesses ARE “physical” illnesses, and “physical” illnesses affect our “mental” illnesses. We are not just our brains, just our bodies, just our minds, just our feelings, or just our souls. The more we learn, the more we understand interconnectedness and comorbidities.

The ALPIM Spectrum

In the Spring 2015 issue of the Journal of Neuropsychiatry and Clinical Neurosciences, researchers proposed The ALPIM Spectrum:

  • A = Anxiety disorder (mostly panic disorder);
  • L = Ligamentous laxity (joint hypermobility syndrome, scoliosis, double-jointedness, mitral valve prolapse, easy bruising);
  • P = Pain (fibromyalgia, migraine and chronic daily headache, irritable bowel syndrome, prostatitis/cystitis);
  • I = Immune disorders (hypothyroidism, asthma, nasal allergies, chronic fatigue syndrome); and
  • M = Mood disorders (major depression, Bipolar II and Bipolar III disorder, tachyphylaxis. Two thirds of patients in the study with mood disorder had diagnosable bipolar disorder and most of those patients had lost response to antidepressants).

Study Conclusion

We conclude that patients with ALPIM syndrome possess a probable genetic propensity that underlies a biological diathesis for the development of the spectrum of disorders. Viewing patients as sharing a psychological propensity toward somatizing behavior essentially denies patients access to care for the diagnosable medical conditions with which they present.

– J Neuropsychiatry Clin Neurosci. 2015 Spring;27(2):93-103. doi: 10.1176/appi.neuropsych.14060132

Download the Study

Should you want to read the journal article, I purchased the pdf version: A Novel Anxiety and Affective Spectrum Disorder of Mind and Body—The ALPIM (Anxiety-Laxity-Pain-Immune-Mood) Syndrome: A Preliminary Report (J Neuropsychiatry Clin Neurosci. 2015 Spring;27(2):93-103. doi: 10.1176/appi.neuropsych.14060132). No copyright infringement intended.

Associations in ALPIM Domains

ALPIM SYNDROME FIGURE 5. A Schema Demonstrating Significant Associations Within and Between ALPIM Domains. Anxiety - Pain Attacks (included in Phenotype). Laxity - Joint Laxity Syndrome (Beighton), Mitral Valve Prolapse. Hernias. Scoliosis. Double-Jointedness. Easy Bruising. Pain - Fibromyalgia (included in Phenotype), Headache, Prostatitis and Cystitis. Immune - Asthma, Rhinitis, Irritable Bowel Syndrome, Chronic Fatigue Syndrome, Hypothyroidism. Mood - Major Depressive Episode (included in Phenotype), Bipolar II Disorder, Bipolar III Disorder, Tachyphylaxis. This schematic diagram depicts, via line connections, significant associations within and between the ALPIM domains (see the Results for a description). Table 2 repors corresponding significant probability levels, odds ratios, confidence intervals, and Wald statistics. ALPIM, anxiety, laxity, pain, immune, mood.
J Neuropsychiatry Clin Neurosci. 2015 Spring;27(2):93-103. doi: 10.1176/appi.neuropsych.14060132

Diagram of Comorbidities

FIGURE 7. The ALPIM Syndrome: A Neuropsychosomatic Spectrum Disorder. Schematic Venn diagram showing the hypothesized spectrum of comorbidity in patients having a core anxiety disorder with laxity, pain, immune, and mood disorders. The overlapping circles demonstrate that comorbidities exist along a spectrum, in which a patient might have anywhere from just one disorder under one domain to multiple disorders under multiple overlapping domains. ALPIM, anxiety, laxity, pain, immune, mood.
J Neuropsychiatry Clin Neurosci. 2015 Spring;27(2):93-103. doi: 10.1176/appi.neuropsych.14060132
Bipolar III is cyclothymia, a “milder” form of bipolar than bipolar II.

Sick with Dread

Dread background image of red alarm clock

Frustrating to parent an adolescent who feels sick chronically. Difficult to know if he feels sick because he is sick with a contagious disease, or if he has a migraine, or if he is anxious. Honestly, right now, I’m feeling sick to my stomach. Sick with dread. Dreading a summer trying to get my kid out of his bed, out of his bedroom, out of the house, and to summer school.