Between Knowing and Doing

My first week on 30mg of Vyvanse did not go off without a hitch, but I don’t think it was because of the medication. This time, I knew it was the trauma.

A little background to make this make sense. Maybe because I feel the need to justify my reactions, maybe because I am trying to paint a picture—maybe both.

I’ve experienced a great deal of loss in my life, as I've mentioned earlier. I won’t totally trauma-dump the details on you here; I have a whole other book full of that already. It’s called Choose Your Discomfort, and you can get it on Amazon. That being said, a lot of that loss and trauma has impacted my life in the winter, and specifically around the holidays. To say that I’m a bit more sensitive at this time of year is an understatement.

Just over a year ago, I very suddenly had to make the decision to put my beloved cat, who had been by my side since I was 19, down. Gato had been with me through my most formative, challenging, and growing years. She comforted me through breakups and blackouts, through the loss of my grandmothers, my cousin, and my father. She kept me company while I worked three jobs and attended—and subsequently dropped out of—university. She was with me through career changes, two diplomas, eight different homes, and various roommates. Her presence helped me survive the pandemic and all of the tumult that came with it.

She was the first and most constant source of comfort in my life since my mom died when I was 12 years old. And then one day she just stopped eating and started behaving strangely—more reclusive.

I tried to get her a vet appointment, but the soonest they had was two days away. So I monitored her, tried to encourage her to eat, and ended up taking her to an emergency vet the next day when I came home to find her literally hiding in an obscure corner of our office.

I couldn’t find her at first—until I noticed her black tail slightly poking out from behind the textured green reading chair in the corner. I had to pull the whole chair out to get to her, and when I did, she seemed terrified. I rushed her to the nearest emergency vet where we spent the next four hours. Gato bounced between the waiting room, the consultation room, and various trips to the back for bloodwork while I followed where I could, and waited as patiently as possible when I couldn’t.

There was Netflix playing in the waiting room—a rom-com, I believe. I can’t remember which one now, but I know I sat through the whole thing and part of another. Ultimately, they couldn’t determine what was going on with her, so they sent me home with some pain medication, a copy of her medical reports, a $500 bill, and a recommendation to keep her appointment with the vet the next day.

By the time we went to the vet the next day, there was not much they could do. The vet told me that if I took her home, she would pass away. They suspected she had some kind of neurological event, like a stroke or tumor, but wouldn’t be able to confirm or treat it without a $7,000 MRI from a specialist vet—where she would likely need to spend the weekend being stabilized, assuming she even survived the trip.

So a decision had to be made: risk it, pay thousands of dollars I did not have immediate access to, simply to know—without any guarantee of recovery, survival, or quality of life—or say goodbye right there. I chose the latter, and I still wonder if I was right.

Fast-forward to a few weeks ago—my first day at 30mg of Vyvanse—when Zazz, my partner’s cuddly little fluff of a cat, stopped eating.

After living with and caring for a diabetic cat for a number of years, and after losing Gato so suddenly last year, it’s safe to say I am what you might describe as hypervigilant regarding our pets’ behavior. I noticed right away when Zazz’s appetite tanked.

Zazz is my partner’s cat, and although we’ve all lived together for about two years, it’s very clear that Zazz only has eyes for our man. Sure, he’ll accept cuddles from me in certain situations—or when his preferred human isn’t available—but generally speaking, I’m a backup option at best. I am, however, usually the one in charge of meals.

My other cat, Doc—the diabetic one—is on a strict feeding and medication schedule. By default, when we started living together, Zazz had to be on the same schedule because Doc can’t be trusted not to eat his food. So, Zazz’s feeding became part of my routine too.

When I noticed the change in Zazz, I tried not to worry at first. I told Rich, and we monitored him to see if it improved, but it didn’t. So, once again, the process of trying to get a vet appointment began.

After a few calls—and more waiting than I liked—we got him in for a check-up and some tests. Again, they couldn’t determine what was wrong aside from mild dehydration, likely a result of reduced food intake. They gave us appetite stimulants and told us to keep an eye on him. By the next evening, even with the stimulants, he was barely eating. I called and emailed the vet for further instructions. I bought special treats, different food, even bone broth—anything to entice him—but nothing worked.

After another vet visit, some fluids, and anti-nausea and antibiotic medications, Zazz’s appetite eventually returned and he started acting like his usual self again. But I didn’t.

While Zazz struggled with his appetite, so did I. In fact, I struggled with almost everything. The anxiety that boiled up during that week was the worst I’ve experienced in nearly four years. If I wasn’t fixated on Zazz’s care or completely engaged with a client—which was no easy task—I felt frozen.

I could barely eat, and when I did, I had to force-feed myself. My insides were tied in knots, my belly rumbling, while my chest felt heavy and tight—like it was slowly being compressed under the weight of my worries. Every loss, every abandonment, every failure, and every other little thing my heart sometimes effortlessly balances came tumbling down. And all the while, I kept wondering, Is this me, or the medication?

I knew Vyvanse could cause decreased appetite. I also know anxiety does the same to me. So which was it? Maybe both. Even after Zazz improved, I still felt stuck. I couldn’t shake the feeling that something was wrong. My appetite wouldn’t return. I couldn’t get back into my normal routine, and it opened a small window to my not-so-distant struggles with food and eating.

As someone who has worked hard to end a pattern of chronic undereating, disordered eating behaviors, and a general preoccupation with food, eating, and my body, this change in my eating triggered another spiral. It was during this spiral that I approached the bottom of my prescription bottle.

In my third week of medication—right after my jiu-jitsu tournament—I had a telephone appointment with my doctor. At that point, I was still on two pills (20mg) but intended to increase to three the next day, the start of my fourth week. Because I hadn’t increased in week three, my prescription was still about half full, and I hadn’t yet decided what dosage I wanted to stick with.

In our hurried conversation, my doctor didn’t ask about my ADHD symptoms, mental health, or much else. She asked about caffeine, and seemed pleased when I said, “I’ve actually cut back to only one cup of coffee per day.” She asked about my heart rate and blood pressure—both low-normal as usual—and said, “Your ECG did not change. I’m not worried.”

Then she asked about refilling my prescription. I explained my process and where I was at, and she replied shortly, “Okay, so you will call to refill your prescription when you’re ready, and you can tell the nurse how much you’re taking.” I agreed, and that was that.

“That’s simple enough,” I thought. “I’ll just keep going slowly, and when I need a refill, I’ll call, tell them where I’m at, and they’ll get my prescription for me. No problem.”

It’s important to note this conversation happened the day before I increased my meds—and began the aforementioned trauma-triggered downward spiral.

As Zazz returned to his usual behaviors—like trying to steal food from my plate and affectionately terrorizing (or possibly sexually harassing) Doc—I was still just going through the motions. It didn’t help that I got my period that week and had persistent cramps on top of the anxiety, negative self-talk, and all the other bullshit that seems to come with female hormones. I could acknowledge the circumstances that triggered my anxiety had resolved, but the spiraling thoughts and overwhelming feelings remained.

By this point, it had been nearly a full week on 30mg, and I had no idea how I felt about it. From my perspective, the whole week had been trash, and while I couldn’t figure a way out of the pit yet, I knew it wasn’t a good indication of whether that dose was right for me.

There were many moments in the pit when I blamed the Vyvanse for the extremeness of my reaction, the intensity of my overthinking, and my lack of appetite. Other times, I thought, No, it’s not the Vyvanse. Maybe I was wrong. Maybe I don’t really have ADHD—maybe it’s just anxiety after all, and I don’t have it under control like I thought. Maybe I do need an SSRI. Maybe my therapy isn’t working anymore. Maybe I just need to get back into my fucking routine.

I proceeded to lecture myself on all the things I know I should be doing for my mental health but haven’t been:“I haven’t been working out or eating enough. I haven’t been journaling consistently. I haven’t been getting enough sleep. I haven’t been going for walks. I haven’t been kind to myself.”

Sometimes the most complicated part of healing and personal development—at least for me—is knowing I have all the tools but, for whatever reason, being unable to transition from knowing to doing. I know I feel better when I’m exercising regularly and moving in ways that bring me joy and make me feel strong. I know fueling my body consistently and mindfully, and prioritizing activities that allow me to clear my head, disconnect, or reflect on my thoughts and emotions, is crucial for my physical and mental health.

Unfortunately, what often appears for me in the disconnect between knowing and doing is shame.

Cautiously Optimistic

November 24, 2024

I’ve Been on an Adventure Lately

There have been some ups, some downs, and quite a bit of time spent stuck somewhere in the middle.

When I finally saw my doctor, I was prepared. I wanted to go in with a thoughtful plan and a clear idea of what I wanted to do next so that there would be no ambiguity in our conversation—at least not on my end. I know I struggle to advocate for myself. Avoiding conflict, confrontation, or rejection is always my first instinct. Preparation is my best weapon against that instinct.

Needless to say, I gave my plan a lot of thought and ultimately decided I wanted to try stimulant medication. I was prepared to start slow, pursue recommended behavior changes, and reduce my cannabis use. I was also open to changing my mind if it didn’t feel like the right fit. So, after answering more questions about my sleep and caffeine consumption, promising to monitor my heart rate and blood pressure, scheduling another ECG two weeks into medication, and booking a follow-up for three weeks later, I left with a prescription for Vyvanse.

Almost immediately after starting on a subclinical dose, I noticed a difference. I was using my time more effectively, feeling more energetic, and experiencing less of my usual social anxiety. While I was feeling phenomenal, I still couldn’t quite turn off the part of my brain whose sole purpose seems to be overthinking any good feeling and questioning its validity. So, while the first two weeks on medication felt like a success, I couldn’t help but wonder—was it just a placebo effect? Was I just trying harder to stay on task because I wanted the medication to work? Maybe it was all just a temporary wave of productivity and hyperfocus spurred on by the newness of it all. I had no choice but to wait and see.

Unfortunately, I didn’t realize how much waiting there would be.

After my second week on Vyvanse, I was ready to try an increase. I had started at 10mg in week one, then increased to 20mg in week two. Midway through week three, I was registered to compete with a team in a women's jiu-jitsu tournament. I’d been training regularly since starting the medication and had been monitoring how I felt during and after training, with no issues. But I knew the intensity of competition was different. I didn’t want to risk adverse cardiovascular symptoms during the tournament—and I didn’t want to have any extra worries on competition day. That alone would be enough. So I held steady at 20mg until the following week.

I’d love to tell you the competition went off without a hitch, but that wasn’t the case. Still, I don’t think it had anything to do with the medication.

First of all, I lost my first match in under a minute, and ultimately, our team came in last place. But none of that really mattered. We were three hobby athletes with a combined weight of only 400lbs—spread evenly between us—usually competing in the masters category (ages 35–45). This tournament, however, featured opponents who were not only bigger than us, but younger too. Still, we put up a damn good fight and deserve to be proud.

That said, after my second match—which I won, by the way—I sat down next to my teammates and immediately noticed all of my toes and part of my feet had lost circulation and turned white. On its own, this wouldn’t typically concern me—it happens sometimes when I get cold—but I was dripping with sweat. I started to feel lightheaded. As my teammates noticed the color drain from my face, I recognized the feeling in my head as the one that precedes fainting, and I chose to lie down.

Truth be told, I’m not sure if it was adrenaline, a drop in blood pressure or blood sugar, or something else entirely. It was an experience I hadn’t had in years. Thankfully, after some supine-time, drinking electrolytes, eating some dried fruit, and having a cry, I started to feel better—well enough, in fact, to finish two more matches. One was a slightly less speedy loss to the same opponent as my first match, and the last ended in a draw. By the end of the tournament, I felt like myself again and was bursting with pride. Of course, the unconditional support of my team, a soak in the hot tub, and a delicious dinner with the girls helped too.

I was pleased with my decision not to increase the medication at that time. I still don’t know if it had anything to do with how I felt that day—maybe I didn’t eat enough breakfast, drink enough water, breathe properly while fighting, or maybe I just pushed myself really hard. It's hard to say. Ultimately, after I got home, I decided to try another increase.

My first week on 30mg did not go off without a hitch. But this time, I knew it wasn’t just about the medication. It was the trauma.

Forget this Whole ADHD Business...

October 20, 2024

I was originally booked to follow up with my doctor about my ADHD assessment in mid-September—the day before my much-anticipated girls’ trip to Austin, Texas, where I was attending a three-day women’s jiu-jitsu and wellness retreat.

True to form, in the days leading up to my trip, I overstretched my schedule and was feeling beyond overwhelmed with everything I had to do before I left. In my frazzled state, I decided to reschedule my appointment for after my trip. Thanks to the state of our healthcare system, that meant it would be another month before I’d see my doctor.

Ultimately, this delay turned out to be a good thing. It gave me the time I needed to really think through my options.

When I first walked out of my psychiatrist appointment, I was flooded with relief, just knowing that there were options. I quickly made a plan to explore them, starting with a break from cannabis. After that, my initial idea was to begin treatment for anxiety and, depending on the outcome, proceed to explore treatment for ADHD afterward.

But as I took more time to consider my options, that plan didn’t feel quite right.

After six years in therapy and countless hours spent reading, writing, and learning about mental health, anxiety, personal development, mindset change, attachment styles, grief, trauma, and behavior change—I’m not going to say I’ve mastered my anxiety, but I’ve definitely developed a vast and powerful skill set to help manage it.

I’ve used those skills time and time again, and they’ve helped me accomplish and experience so much. I’ve left relationships that didn’t serve me and developed deeper connections in relationships that do. I’ve changed many patterns of thinking and incorporated new behaviors that nourish me—mind, body, and spirit.

Do I still get anxiety? Absolutely. 

Does it sometimes get the better of me? Sure. 

But overall, I no longer fear ending up in a situation where anxiety takes the wheel.

When I shared my diagnosis with a good friend—who also has ADHD—she reassured me: “Of course you’re going to have anxiety. Having untreated and unacknowledged ADHD would make anyone anxious.”

At first, I felt a little defensive. It was like the idea that my anxiety might be caused by ADHD somehow diminished the validity of my generalized anxiety. I had subconsciously decided that anxiety was the real problem—so maybe I could just forget this whole ADHD business after all.

But she was right.

The more I thought about it and reflected on everything I’ve done to manage my anxiety up to this point, the more I could see that the things I still struggle with are different from—but just as valid as—my anxiety.

As I came to that realization and inched closer to my rescheduled doctor’s appointment, I had some decisions to make.