Family & friends

This is a snapshot of my perspective of Lori's situation from Day 1-2. This is not an update on her current state. You may want to reread Part 1, The Arctic Sun. Sorry for the delay in posting, I've been busy!

Part 2:
I sat in the waiting room staring at the wall. My body and my mind were so numb. Staring was all I was capable of doing. Sometime later, I knew once again I would have to call my siblings and inform them of the new bad news that the attractive doctor with thick rimmed glasses delivered to us.   As technologically advanced as this hospital is, you would think they would find a way to have cell service available in the ICU waiting room, but they have not. So Chris & I walked to an area where I could make the dreaded phone calls.

After informing Joey & Joann about the current state of our sister, we walked the bare-walled hallways back to sit in the waiting room. As I sat staring at the wall again, I couldn't help but wonder how many other people have sat here staring at this same wall, numb from the news of their loved one's poor condition.

I knew I couldn't just sit & stare forever. I needed to deliver news of Lori to others. I knew I couldn't talk on the phone anymore. Not because of the ICU waiting room cell phone dead zone, but because I couldn't physically or mentally complete the task. Thankfully, I can text and get the message out. Not that I wanted to, but I felt I needed to. I couldn't text my best friend Cathy. She's usually the one I would text or call first. But she was at the airport on her way to Greece. I didn't want for her to worry about Lori when she was on vacation. I typed a text to Valerie, Cathy's little sister and another one of my best friends, & I stared at my phone for a minute or so deciding if I even wanted to send it. Not that I didn't want my friends to know what was going on, but I didn't feel that I even wanted to talk about the situation at this point. I just wanted to stare at the wall. It's much more peaceful when my mind is blank than when I'm talking and thinking about what is going on with Lori. My finger found its way to the send button on my phone. Within seconds Val texted me back (she knew she couldn't call me, she's well aware of this waiting room cell phone dead zone from when her mom was a patient here). She informed Paige and let me know they would be in the waiting room with us shortly. I asked her to please not tell anyone else right now. I couldn't handle a flood of calls or texts at this point.

People are our family by blood, by marriage, by adoption, and others are bound to us as family by mere friendship. It's not just the good times that turn friends into family, but it's through our most difficult times in life that we know when a friend is truly our family. I'm fortunate to have a few friends that I call my family. They have repeatedly and consistently been there for me through my darkest hours. And I've always done my best to reciprocate. Through their family connection with me, they also feel that Lori is one of theirs' as well. So the fact that my friends dropped everything to be there for us was no surprise to me.

The four of us sat in the otherwise empty ICU waiting room together. Sharing stories and feeling encouraged that we all agree that Lori is a strong person and will pull through this. Valerie and I went in to check on Lori. No changes. Nothing new going on. It's probably best we go home now. Get some rest. It's been a long, exhausting day.

My dream of going home and crawling into my cozy, comforting bed was short lived when I remembered Lori's dog was alone at her house. He had a crazy day as well. I needed to go check on Buster.

Talk about family stepping up to the plate in times of need, my mother-in-law, Mema, is another faithful family member ready to help on a moment's notice. Mema was there to pick up the kids for us and be at the house when their tutor was there. I wanted their day to stay as routine as possible. They're too young to understand the gravity of Auntie Lori's situation. Mema stayed with the kids while Chris and I drove out to Lori's house.

Buster was happy to see humans. Nervous, and unsure of us, but happy. We let him out to potty and made sure he had food and water. I knew I couldn't take him home with us tonight. I wasn't sure how he'd react to my kids and my dogs. I couldn't handle anything else tonight. He'll be fine home alone for the night & I'll get him on the morning.

The night was, as you might suspect, sleepless. I called the hospital in the middle of the night. "We are continuing to cool her body temperature down. She's stable. No changes" stated the night nurse. This was Lori's continued state throughout the night.

I had to continue on with my busy routine, my busy life.  Kids need to go to school, work needs to get done, the floors still need to get swept & mopped. Lori's world came to a halt, but mine could not. In addition to all my responsibilities, I needed to take on many of Lori's as well. She didn't need her little sister to sit around crying for her, she needed me to take care of her life while she couldn't. I've always taken my role as a patient advocate seriously in my professional life, and my personal life was no exception.

It takes time to learn a person's life. What bills need to be paid? What bank does she use? What bills are auto-drafted from her bank? Does her paycheck go thru as direct deposit? This list goes on & on & on. I think occupying my time in this process helped me deal with the situation the best I could.

So I went and picked up Buster, Lori's little fur baby, and brought him to our home. Bella, the alpha dog of our house, or I should say 'her' house, was quite curious who this short little fur ball was invading her space. Coco, afraid of anything that threatens her status as the most spoiled dog in the house, wouldn't even look in Buster's direction. But they managed to all deal with one another. Perhaps they all sensed that is what I needed them to do.

Once again, I was in the ICU to see Lori. She was still unresponsive. No eye opening. No voluntary movements. No attempts to say a word around the tube that occupied her throat. The only movement was her chest rhythmically rising and falling as the ventilator pumped air into her lungs. I became mesmerized watching this movement, looking for any breath that may be Lori's & not forced in by the ventilator.

The nurse came in and broke my concentration on Lori's ventilator breathing. She informed me they had reached the goal cooling temp of 32 degrees Celsius. She was now in a state of hypothermia. So now we just wait.

I have often heard that we spend a great deal of time in our life waiting. Waiting for a red light to change green, waiting for the cashier to ring up our purchase, waiting for our teenager to get home from a night out with friends. Sometimes it seems we are always waiting for something. Waiting for a loved one to regain consciousness is by far some of the worst waiting I have ever done. But there was nothing else I could do but wait.

Dr. Donna Poma Fife

The Arctic Sun

It was not the type of call that I was expecting. "This is EMS, Lori wants you to know she is having shortness of breath & EMS is taking her to the hospital." Working as a nurse practitioner, I felt it was important to clarify. "Are you talking about my sister Lori, or about a patient of mine?" "She said she's your sister ma'am." Oh. Okay. I took a second to process the information, walked to an area of the nursing home I was in where I could have some privacy and called Lori's cell phone. She answered. There was a distinct sound of panic in her voice. She said that she was having shortness of breath. I could hear the voice of whom I suspected was a paramedic in the background. I could barely get a word in before it sounded as if she fumbled the phone.  The line went dead. I stared at my phone and then put it up to my ear several times, checking for the sound of her voice. Any sound. But, there was no sound.

I was about 45 minutes away seeing patients at a nursing home when I received the call. I started on my way back to Lakeland. I made a few calls on my drive back.  Thank goodness for Bluetooth. I don't think I could have held a phone in my weak, shaky hands. I called my husband to let him know what was going on and my work so they could call the rest of the nursing homes on my schedule & let them know I wouldn't be there. Almost back to Lakeland now. So much traffic on Hwy 92. Get out of my way!

It took about 10 minutes to find a parking spot in the parking garage. A full parking garage is not a good place for an impatient woman. Finally, an open parking space! I pulled into the space & darted for the stairs, grateful I wore scrubs & sneakers to work today.  I ran down the stairs, because it had to be faster than the elevator and I'm too impatient to wait for an elevator anyhow. Once in the ER, I was directed to the visitor area. The kind lady opened the door for me with her badge and said "See that Exit sign at the end of the hall? Once you get there, she's in the third room to the right." As I walked through the bustling ER, I envisioned Lori sitting on the stretcher with tubing up her nose providing oxygen, talking on her phone. I thought, "As soon as I walk in the room she'll start telling me what I need to do in her big sisterly way."

Shaken from my day dream, a nurse in black scrubs darted out from what seemed to be nowhere and pulled the curtain closed in front of me. Wow, I know they are all about protecting patient’s privacy, but come on, she is my sister. "Who are you?" Asked the steady and firm nurse. I explained my relation & stated my name as if under interrogation. "What do you know about what happened?" asked the nurse. "Well, my sister was having shortness of breath & called 911" I said as I envisioned pushing the nurse out of my way.  "Aren't you taking HIPPA a little far here lady?" is all I could think. "A few things have happened since you talked to your sister". Oh no. My heart sank. All I could do was stare at her with saucer sized eyes & wait for the details. "When the paramedics got her into the ambulance, she went into cardiac arrest." Asystole. The worst heart rhythm possible. "They did CPR & after 5 minutes they revived her and she was in a-fib with rapid ventricular response. This is what her heart looks like now" she said as she held the EKG in front of my face. Wow. I haven't read heart rhythms in years, but that QRS wave looks an awful lot like a Bundle Branch Block, generally a sign of a more severe heart attack.  "She has a tube in her throat for an airway & she is unresponsive" the nurse continued to spew bad news at me. She opened the curtain and there my sister lay, lifeless on a stretcher. Yep, the nurse wasn't kidding, there's a tube in her throat. In fact, wires and tubing were plentiful. I started to feel chest pain myself. Is it possible to have a sympathy heart attack? Or was this merely a symptom of my own breaking heart?

 A few minutes seemed an eternity, but I knew it was time to call my siblings. The nurse gave me the okay to use my cell phone in the room, but afraid that Lori would hear me, I went to the other side of the room. Fighting back the tears, knowing I had to be strong for them, I called my brother and explained what was going on, the whole time my eyes were fixed on Lori's motionless body. Then I called Joann, who quickly became upset. As I was explaining things to Joann, a tall man with thinning red hair walked in. Dr. So & so (as if I'd remember a name right now) introduced himself & I hung up with Joann. "Your sister is in bad shape" he said with empathy clearly evident in his blue eyes. More chest pain for me. Good thing there is an empty stretcher in here, I may need it. "She's acidotic & has a glucose level over 600. It was over 800, but has come down some.  Her heart rhythm is abnormal and her blood pressure is very low. She has signs of congestive heart failure. I would expect to see all of this going on in an 80 year old, but not in a 55 year old." I know Dr. Red-hair had a lot more to say & ask, but the mind tends to go blank when overloaded with this kind of information. Again, my eyes stayed fixed on Lori's body, which has yet to so much as flinch. "We're going to transfer her to ICU in a few minutes" the nurse informed me. Feeling as though my knees would no longer allow me to stand, I sat back down in the chair across the room. I listened as the nurse gave report to the ICU nurse. Information I should clearly understand with my medical background made absolutely no sense to me.  It was as if she were speaking a foreign language. This happens to other people. Not to my family. I sat, frozen, my eyes fixed on Lori as my mind willed her body to move.

The nurse informed me that I would not be able to see Lori for at least 45 minutes as they assessed her in the ICU. I stumbled outside and walked aimlessly, trying to figure out what I needed to do next. You know in the movies when you see a person walking and they are unaware of what is going on around them, deafened to all sounds? That was me. I saw a bench in the parking garage and sat down, placing Lori's purse on the bench next to me. "I need to call her work", I thought. Damn, I don't even know the name of the company she works for. I looked through the 2 wallets in her purse 3 times each before I found a business card from her work, which was in the front slot of wallet #1. Not surprised that I missed it the first 3 times. I don't know if I could have found it if it jumped up & bit me. I called her work & informed her supervisor what was going on. Then I sat there, on the hard bench in the parking garage for 30 minutes, staring at the opening & closing doors leading into the hospital, wishing I never had to go back in, but knowing I had to.

Somehow I found my way to the ICU. Don't ask me how though. I floated there for all I know. I walked through the ICU doors after the sweet little lady volunteer waved her badge in front of the box on the wall.  An eerie feeling swept through me as I remembered the last time I was in this ICU, when my best friend's mom was a patient here. Overwhelming emotion flooded through me. Scanning the room numbers, I finally saw room 16. As I walked closer my chest began to hurt again. I walked in the room and approached Lori in her new bed. I touched her cold, pale skin and couldn't hold back the tears anymore. Still, she lay lifeless and I still believed I could will her body to move. No such luck. With once again weakened knees, I walked to the chair by the window and sat down. I couldn't take my eyes off of her. "Open your eyes dammit!" I shouted in my mind, apparently not loud enough for her to hear. Sometime later, Lori began to move. Not in the way I willed her to, but in jerking, seizure-like movements. This can't be good.

At some point the nurse directed me out to the waiting room. Thankfully, my husband Chris had made it here by now. We sat in the waiting room for a length of time I do not recall, waiting for the ICU doc to come out and talk to us. In walked a tall, thin woman who looked incredibly attractive with no makeup on. I stared into her eyes hidden behind thick, black framed glasses. "I'm Dr. So & so" she said, (really, who can remember a name at a time like this?).  I listened as she gave me another speech about what bad shape Lori is in.    As she painted the bleak state of affairs, I couldn't help but feel grateful that I don't have to deliver news like this to patients or families. I don't recall all she said. I can't remember a name right now, you think I can remember all the details here? I must paraphrase: "She was without proper oxygenation for a while, she is having seizure like activity, which is generally a bad sign, we don't know how well she will recover neurologically" the doctor empathetically informed me. "Do you know what her wishes are?", "If you have family to call, you may want to let them know in case they want to get here", "Is she religious? Do you want a priest to pray with her?" The attractive doctor with thick framed glasses was full of questions I was not fully prepared to answer. "We will do everything we can" she confidently stated. "There is a procedure called the Arctic Sun protocol that we do for patients in this situation. We will put her in a therapeutic hypothermia in hope of preserving brain and heart function. We cool her body down slowly over a few hours and keep her at the goal temp for 24 hours. Then we slowly rewarm her body temperature and wait to see if she wakes up neurologically. There are no guarantees, but this is her best shot at recovery." Envisioning Lori's lifeless body, I knew we had to do whatever we could. So a few hours later, when her body stabilized, the cooling began. And so did the waiting...

Published with permission of Lori Poma 

Opposites Attract

Opposites attract

After my inaugural blog post, my BFF Cathy Morrow posed the question of how do I find the time to write. She's well aware of the fact that I work for 5 employers so I can have the flexibility to work primarily from home in order to earn an income to support a family, manage (and micro manage) my kids, run a household, and still have somewhat of a social life. I consider myself to be the polar opposite of a person with ADD. I'm highly organized, rarely procrastinate & if I ignore my kids, husband, needy dogs, random texts, calls from students, and calls from nursing homes regarding my patients, I am able to maintain focus for extended lengths of time and tackle a large amount of work. Sounds great, doesn't it? Well, for my own personal sanity & success, yes.  However, it has proved to be my downfall in caring for my daughter. I believed if I shared with her organizational skills and abilities based off of personal experience and research into organization, she could overcome her disorganization (a VERY common symptom with ADHD). Yeah, not so much. All it did was lead to frustration on her part, as well as mine. I'm giving you the tools to be successful! How can you NOT do this? Well, because she can't. Her brain doesn't work that way. The hardwiring of her brain is different than mine. The chemical composition of her brain varies as well. Not that she can't be organized, but without medication, her brain can't organize the way mine can. Even with medication she may not find success in following Mom's Tips for Leading a Highly Organized Life.  She has to organize by her own set of guidelines. Not mine.

Oh, believe me, I’ve done all the basics; charts, graphs, lists of responsibilities, schedules, and the list goes on and on. But keeping up with it all is quite the challenge for this overworked mom. I've always led the way in this organization with little input from Nevia, primarily because when she was younger, she didn’t know how to organize anything! Now as a teen, she has some of the basic skills to organize. Maybe some of Mom’s Organizational Tips did rub off on her.  Developing this plan can be time consuming, but is something we will have to do!

Remember I mentioned how the chemical composition in the ADHD brain is a bit different than us neurotypical (non-ADHD) individuals? Well, here’s a basic discussion on what I mean. There are three primary chemical neurotransmitters out of balance with ADD.  What are neurotransmitters you ask? Neurotransmitters are chemicals in the brain that transmit information along pathways in our brain. Simply put, it is how one part of our brain communicates with another part of our brain. While there may be as many as 200 neurotransmitters in our brain, only 50 have been identified. Research has determined that many common psychiatric disorders result from deficiencies in specific neurotransmitters. Disorders such as anxiety, depression, anger-control problems, obsessive compulsive disorder, and yep, you guessed it, even ADHD/ADD.

So of the 50 identified neurotransmitters, the three main culprits involved in ADD are: norepinephrine, dopamine, and serotonin. ADHD was the first psychiatric disorder found to be caused by a deficiency in norepinephrine. It was also the first disorder to respond to medications to correct this neurotransmitter imbalance. Research on these neurotransmitters suggests that different characteristics occur with certain chemical imbalances;
         Distractibility: too much norepinephrine in relation to the amount of dopamine activity
         Impulsivity: too much norepinephrine or too little dopamine
         Obsessiveness: too much dopamine in relation to the amount of serotonin

So while these psychiatric disorders are literally “all in your head”, rest assured that you cannot control the symptoms related to these disorders without the help of medication (some may find alternative therapy or diet works well enough, but this is not the case for many).  A kid with diabetes can’t control his glucose level without the medication called insulin. Well, just because a disorder occurs in our brain doesn’t mean we can ‘control’ it without medication. We consciously control merely a minute amount of what goes on in our brain. But, if you don’t believe me, then the next time your ADHD kid acts impulsive, tell him to decrease the norepinephrine release in his brain or up his dopamine. Let me know if it works.

Glad you asked about neurotransmitters, aren't you? I could go all scientific on your ass and discuss more, but I will cut you some slack.

Whew! So hopefully I have helped to open some minds to a starting point to understanding ADHD. And trust me, this is only a starting point in understanding this complex disease process. Some people expect these kids to be able to control their symptoms WITHOUT medication. I know I did. Again, my self-directed education has paid off. Hopefully it’s paying off for you all as well. I realize I was all wrong about the management of my child with this disease process. So now we move forward.

How, you ask? Well how the heck do I know? Don't you remember me saying I'm the polar opposite of my child? I know MY way of organization. Not hers. Perhaps I haven’t taken enough time recently to learn her ways. I’ve always tried to stuff her into MY organizational mold. She'll fit. Well, no. She didn't fit in that mold.

Thankfully, opposites attract. We can look for a day when our neurotransmitters are best aligned and come up with an organizational plan that works. One that works on her pole, not on mine.

Dr. Donna Poma Fife DNP, MS-ARNP

Disclaimer: The purpose of this blog is to provide information on ADHD/ADD. It is an informal platform in which I can share experiences and education regarding this disease process. It includes a lot of generalizations of the disease. If you don’t fall into those generalizations, don’t stress it! This blog in no way is providing you with medical advice. Please see your medical professional for medical advice, since you pay them, not me.

She puts the H in ADHD

She puts the H in ADHD

I often try to get my friend Sheri to run with Michelle & I by enticing her with the thought of achieving a ‘runner’s high’. You know, that release of endorphins you get when you run, which makes running feel easier and makes you feel somewhat euphoric? Well, I guess I have achieved a writer’s high!  Because I’m excited to write some more! Remember guys, my blogs are personal commentary, filled with my experiences and knowledge gained through my self-directed education on the topics. Generalizations will be made. Keep in mind, there will always be atypical cases and outliers who vary from the majority. Also, keep in mind this is meant for me to share ideas and experiences and not to be taken as medical advice. Unless you want to pay me.   

Anyone who knew Nevia when she was an elementary aged child could easily see the hyperactive component of this disease process. The child could NOT sit still. Her school agenda was FILLED with comments from her teachers stating Nevia was; disruptive, couldn’t sit still, got out of her chair, blurted out answers, wouldn’t follow in the line as they walked to lunch, was talking to other kids when she was supposed to be paying attention, disrupting class, blah, blah, blah, the list goes on. I tried everything I could to address this issue in a naturopathic manner. I gave her supplements found to help in some kids with ADHD. Chewable supplements that she found disgusting. As you can imagine, it was not easy to get her to take these!  I fed her a breakfast of eggs, bacon, and toast nearly every day. Quite the challenge for the vegetarian mom who nearly pukes at the smell and sight of eggs.  No sugar, high protein was my mantra. I walked her over a mile to school (while pregnant with Oscar, and for quite some time after he was born) as a way to ‘wear her down’ before she got to school with the hope that these measures would help her behavior. Well, of course, it didn’t work.

I made an appointment for her to go to her pediatrician. I marched in his office with her school agenda in my hands, sure that he would want to see the teacher’s comments, which would lead him to a swift diagnosis of ADHD. He never even looked at the agenda. He asked me a few questions, examined Nevia, and said ‘no, she doesn’t have ADHD.’ Seriously? Yep, you guessed it. I fired that pediatrician and found another.  

I recall one of the many times Nevia was put in time out for her behavior. I observed her trying to stand still while facing the corner of the wall. She seemed to struggle so badly when trying to do the right thing and keep still. She was trying so hard to be good. It looked physically painful and mentally draining for her to do such a simple task as standing still. But it was only viewed as bad behavior because she couldn’t follow directions and hold still. I now know better. My how differently I view things with 20/20 hindsight.

Dr. Ned Hallowell (I misspelled his name in a previous post) describes that those with ADHD have an internal ‘itch’. This proverbial itch contributes to this inability to sit still. It can be the basis for the hyperactivity component of ADHD. Kids with hyperactivity can’t turn it off like a switch. They can’t control it. Discipline and punishment have not been found to be effective ‘treatments’ for this symptom. So if your child has this symptom, medication often helps, but do both of you a favor and do your best to limit the amount of frustration and annoyance that you may feel about this hyperactivity (remember in my previous post I mentioned by the time a kid with ADHD reaches the age of 12 he/she has received more than 20,000 negative messages than the neurotypical (non-ADHD) child?).  Find ways to make it a positive. Instead of expecting a hyperactive child to sit still in a chair when doing homework, have them sit on an exercise ball that they can gently bounce on as they work.  They may actually accomplish more this way. It would be in the best interest of all involved if we would break the cycle of expecting ADHD kids to adapt to the traditional ways of doing things. Stop trying to shove the ADHD kid into a mold they don't fit in. It will never work. Be creative and find what works for your kid.

Fast forward a few years after our wasted pediatrician visit in which her diagnosis was ‘missed’. I noticed in the middle school years that Nevia wasn’t as hyperactive. She was off and on medication, but even when off the medication, the hyperactivity seemed to wane. In my recent description of Nevia in relation to the hyperactivity I commented that the hyperactivity was gone. Now she’s just a lazy teenager, I said in jest. Well, my mom-diagnosis was quite off. Hyperactivity doesn’t really go away in the kids who have this presenting sign/symptom of disease. It may diminish to a restlessness, but remains as primarily an internalized issue. This internal hyperactivity or restlessness often manifests itself as sleep issues. Insomnia is a common complaint by those with ADHD. About 85-90% of adults with ADHD experience a burst of energy at sunset or nighttime. The average person with ADHD may spend about 2 hours at night trying to fall asleep. They can’t turn off their body or brain and lie there wide awake. Sleep deprivation may cause as much impairment in people as the ADHD symptoms do.

I’ve had difficulty in finding much research or scholarly literature discussing the hyperactivity component of ADHD. I do know that this component is not present in all people with ADHD. Those without this symptom may be given the abbreviation ADD as a diagnosis. In listening to the ADHD Experts podcasts, I have heard many esteemed professionals discussing how this disorder was not effectively named. Labeling the disorder ADD doesn’t address the hyperactivity component. Calling it ADHD may classify those without hyperactivity as hyperactive. Some also address the ‘deficit’ component of the label. Those with ADD/ADHD don’t have a deficit in attention. They have what one professional I heard describe as a ‘wandering’ of attention, not a deficit. No matter what the label is or what a person’s presenting symptoms are, there is certainly a deficit in the education of many Americans (myself included) on this disorder. Hopefully with time this will change.  

Dr. Donna Poma Fife DNP, MS-ARNP

The gift of ADD

I've been wanting to start a blog for quite some time now. I finally have a few minutes it get the ball rolling! This is a blog with medical information, but is meant for informational & entertainment purposes only and is not intended as medical advice. Please contact your doctor, or better yet, your nurse practitioner, for medical advice, because after all, you pay them, not me.

My inaugural blog is not in my practice specialty area, but is something I have learned a lot about through personal experience. Attention Deficit Disorder (ADD) is a disease process I never imagined I would have to learn so much about. After all, I practice geriatric dermatology & work as a nurse educator. However, it is my lovely, sweet daughter that has led to my need to acquire a vast amount of knowledge on this disease process. It would be time wasted if I did not try to impart this knowledge on to others. So here we go...

It is a common misconception that the only issue or the most significant issue of those with ADD is inattention. There are five main presenting symptoms with ADD. They are; short attention span, poor impulse control, disorganization, procrastination, and distractibility. We'll discuss more about these in future blogs.

The disease process would actually be quite easy to manage if the problem stopped with these symptoms. But as those with ADD can tell you, these symptoms are only the tip of the iceberg.

Did you know that kids with ADD are 30% developmentally behind their peers? This obviously makes school an incredibly complex situation since they are expected to learn at the same pace & the same material as their non-ADD peers (forget about excelling, these kids struggle to keep up!). Additionally, they are about 1 1/2 years behind peers socially as well, which can lead to social issues & isolation.  They have a deficit in higher level functioning and struggle day to day because of this.

What about the high incidence of overwhelming anxiety those with ADD struggle with? There is an extremely high rate of substance abuse in these individuals, not so they can feel 'high' but so they can feel 'normal'. Let us not forget to discuss depression these ADD individuals deal with as well. We're not talking 'I've got the blues today' type of depression, but the 'I can't stop thinking about killing myself and I don't know why' type of depression. Let that thought resonate in your mind for a few minutes.

In addition to the suicidal thoughts and ideations a person with ADD may have, there's also often an issue with nonsuicidal self-injurious behavior common in particular in girls with ADD. You know, cutting, eating disorders, burning her own skin, the list goes on and on. If only inattention were these young ladies' biggest issue.

Did you know that by the time a child with ADD reaches the age of 12, he/she has experienced more than 20,000 additional negative messages than their non-ADD counterparts? I wonder what this does to the child's fragile self-esteem. No wonder they want to hurt themselves.

What about the incidence of other learning differences those with ADD experience? Dyslexia, dyscalculia, dyspraxia, dysgraphia, just to name a few! We've already touched on comorbid conditions associated with ADD, such as anxiety and depression, but did you know that about 20% or so of males with ADD also have Oppositional Defiant Disorder? More on that later...

If a child with ADD is lucky, they will have a parent who learns as much about the disease process as possible and will work hard to ensure the best care for their child. A parent can spend countless hours looking for psychologists, psychiatrists, neurologists, and pediatricians who ‘treat’ the disease. There will be countless calls and emails to the school of the child ensuring the child's learning differences and needs are close to being met (which let me tell you, doesn't happen in a public school system). The hours spent researching alternative therapies, gluten free diet, elimination diet (who on Earth can do that?!?) disease pathology and evidence based medical treatments. Supplements, supplements & more supplements!!!  I once had Nevia trying 6 different supplements at a time. I figured with that and a little bit of prayer she'd find relief of her symptoms without having to take a controlled substance. Unfortunately, neither the supplements nor the prayers worked.

What about the hours a child spends in tutoring, in therapy, at doctor's visits? Time (and money) one hopes is well spent, but realistically one often finds is not.

Oh, and we haven't even scratched the surface on medication! I'm sure every parent finds it easy to put their kid on a controlled substance that is HIGHLY abused by those who don't need it! Yes, after experiencing my child being on medication and not on medication, I can certainly see the benefit. Through researching medications I have found that meds like Focalin have been found to have a neuroprotective effect on those with ADD. Good news for them! Their symptoms may lessen years later after struggling through the side effects! I guess that is something to look forward to. But what about those kids with variations of ADD who react negatively to stimulants? Treatment needs to be individualized, but how often does this happen?

Through all of my reading of books, journal articles, websites, blogs, community forums, etc. the most useful information I have found about ADHD/ADD is from the ADHD Experts podcasts. In particular, listen to any podcast in which Dr. Ned Hollaway is speaking. He is a psychiatrist who has ADD & considers it a gift. He helped me see my daughter's ADD as a gift as well. Those with ADD are often the most creative, most loving people out there. They have bigger hearts than anyone can ever imagine. I've learned more about love, kindness, and generosity through my sweet daughter than I could have ever imagined possible.

I wish the 'lack of focus' issue was all a person with ADD dealt with. It sure does make the disease process seem a breeze! But any person with ADD & any parent of a child with ADD will tell you, that isn’t even the beginning. 

Remember, we all lose focus and can be easily distracted at times. Merely exhibiting these symptoms does not equate to an ADD diagnosis. It’s a much more complex disease process. One I hope to continue to educate others on as I continue to educate myself.

Dr. Donna Poma Fife DNP, MS-ARNP