February 23, 2012

 Thursday

Tyler had an appointment with a new psychiatrist at Pine Rest today. Her name is Dr. Palamara. She was very nice, and VERY knowledgable. It was the longest appointment we have had there, lasting about 1 1/2 hours. She went through everything with Tyler - when voices started, when hallucinations started, what drugs he was doing at the times, what was going on in school, in family life, all the way to present. She went through all the depression, and his grandiose ideas, his anger and outbursts.

She is very concerned about Tyler. She hinted that she thinks he should be in a mental facility. He said they would have to drag him kicking and screaming back to one. He said that he has thoughts of hurting people. He says he sees visions, and feels the blood spatter on his face, and it feels good. He says it sick and disgusting, and he doesn't know why it is satisfying. He said he doesn't want to hurt anyone. When she asked him what things he has in place that will keep him from hurting someone, he said he has nothing. He just keeps himself in check. He doesn't let himself be violent. Then in the next breath he asks me why we are scared of him.

There was a few times where he would say something and then immediately contradict himself, and say "Does that make sense?" and we just both said no, not really. He couldn't explain why he was contradicting himself. I don't even know if he realized he was doing it.

She is worried about him completing school, and wanted to know if we had options we were thinking about to make sure he graduates this year. I told her that he can't seem to last a whole day in school, and right now I am taking it day by day. If he can't do all day this coming monday, I am going in to talk to the school counselor about his options. He really does was to finish, and he told me last night that he feels bad about himself that he can't make it. I told him that I am behind him, and I will make sure that we do everything we can to make sure he graduates, and he doesn't have to do it by himself. He felt better after that.

She said that if Tyler is bi-polar and on anti-depressants, it will cause a manic state (the past 5 days have been very, very good which scares me), and when he crashes, it will be devastating. She says his ADHD is caused by Geodon, and it's a known symptom,  and it's unacceptable, and we need to change his medication NOW. She says Geodon also causes diarrhea, which he has. He also needs to be taking all meds with about 300 calories. Without the food, the uptake is only about 60%. She is only changing meds 1 at a time so she can better pinpoint the side-effects and eliminate them. The Geodon was the most alarming, so she is changing that first. He will stay on the Intuniv, and if this new med is working, then wean him off of that, along with the Lexapro. She put him on Risperidone 1mg per day. The restless legs can be a side effect, but it usually is not one, unlike the Geodon, which usually is one.

She asked what Tyler's intentions were with seeing Dr. Barber, the family physician. Dr. Barber had told us this past tuesday that Ty needs to see Palamara for his meds until things are stable, then he can just continue to write his scrips so he won't have to go through Pine Rest. He told us that Palamara was more qualified than he, and she has more expertise. Palamara backed that up. She said that what Tyler is experiencing is not his specialty, and it could really mess things up. Good to know we are all on the same page, and one is not trying to work against the other.

She explained to Tyler how important it is for him to stay drug free. She asked him all about smoking weed, and how it made him feel. He says that when he does, his anxiety level goes way, way down. He just smiles and feels happy and relaxed. She said that is not a bad thing, but no matter how benign he thinks weed is, it is imperative that he keep his body as pure as possible while we are trying to figure out how the drugs are interacting with him. She explained all the dopamine and seratonin and how the drugs interact with the receptors, and how having anything else in his body, no matter how harmless it may seem, will have an affect on these things, esp when it's first being introduced to him. He seemed to get it. He agreed that he would not be smoking anything or taking any other medications at all. I believe him, but I will still be checking up on him like every day about drugs.

She said that when he turns 18, he will not be able to be seen at Pine Rest since it's a children's facility. He will have to find a psychiatrist for adults. She said she would set him up with one before that time comes, so we can have a smooth transition by his birthday.

I asked her about getting an MRI. She said at this point, it would not show anything. She said a brain tumor would have other side effects that he is not showing. She said that in KNOWN schizophrenics, the brain patterns can show up differently, and that doctors and scientists are just figuring this out. She said it's too early for Tyler to have anything show up and go "Yep, it's schizophrenia." In other words, an MRI is not used for diagnosis, just for studying the differences in established schizos and normal brains. At that point, I started crying, and told he I just wanted to try everything because I just don't want to accept this. I can't wrap my brain around it. I don't understand it. I don't believe it. I've just been desperate to get my son help, and this all is my last resort because I have been in denial that this can't be happening. She said she understands, and they will try everything they can to get Tyler the help and support he needs. She said it's a very difficult thing to deal with, and it's not an easy diagnosis to make.

I think all this therapy is just as much for me as it is for Tyler.