Author: USICO

Don't be sick alone!

Hyperactive son – Is it ADHD?

Published on by USICOLeave a comment

My son is very hyperactive and also has strange behaviors. He likes banging on doors, kicking things and making loud noises to get our attention. We’re having a hard time now as he’s really difficult to control. His doctor says he might be having ADHD symptoms.. is this condition treatable? What options do we have?

USICO:

Hello and thank you for your question regarding your son’s behavior. 

The answer to your first question is definitely yes. The condition is treatable, especially for a child who is as young as 8. 

Before I explain some options for treatment I would like to caution you about diagnosing your son. It seems common practice for physicians these days to diagnose and then try to fit a child and their treatment into a section of the DSM 5. 

While your child may need some training / conditioning to alter his behavior, I would not recommend medication. 

From my post doctoral experience working with children who have social skills / human interaction challenges, I noticed the amazing changes that take place over time (sometimes 1-2 years) as a result of parental interventions using well-tested strategies. 

Again, I would like to advise you not to categorize your son into any named behavior disorder such as Asperger’s or PDD-NOS. These are simply attempts by clinicians to organize strategies to support children. However, I believe the categorization of behaviors into specific disorders is counter productive.  

Your son’s challenges are unique to him only, but by utilizing what has been learned by parents with similar challenges, you will be successful. 

Your interventions will change his future in school, work and within your family. 

What you will be doing is what can be broadly termed ‘Shaping behavior’. I am not talking about general reward and punishment child raising strategies, but a much deeper and structured approach. 

http://www.ldonline.org/article/14545/

If there is an opportunity to join a social skills class, working with other parents and children, I would recommend it. Often they are connected with universities and are inexpensive.

Many involve assigning very simple home chores to children, and providing big rewards for completion. The routine of this continued interaction is very successful. And, it is the kind of attention your son needs and will thank you for later. 

Hyperactive children often loose steam as they get older, and develop a calmer disposition. Although it is not always the case, in my own research, I have noticed that children who exhibit these behaviors tend to be more intelligent  – an advantage you may see later. 

Lastly, I would like to suggest you develop an additional relationship with your son that will improve communication, and his understanding of the world. I don’t know if this is already part of your routine, but time setting aside each day for a story book, really goes a long way. 

I expect you will see big changes after about six months if you follow some of these strategies. 

Best wishes to you –

Simon

Are my kidneys failing? I don’t trust doctors…

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I’m having horrible anxiety lately and I can’t deal with it.
I am pretty sure my kidneys are failing. I have a sharp pain in my kidney and if it’s a kidney stone, I’d rather have that than acute kidney failure. I am generally known for not drinking too much water- I am a small person I weigh around 49kg and I drink around 1 liter a day approx, and have been doing that so far in my life. I am so afraid of kidney failure, I’ve been obsessed with it for days now. This morning I sent an urine sample to my mother who works as a doctor and even though I wasn’t present there, she said they took the sample and tested it, and it came back fine – only my ketones were slightly elevated mostly because I have no been eat enough for a while now.

This is the third urine work I have had in the last month. I had blood work done and the results were generally fine. However for some reason I don’t trust in these results because I didn’t see them personally and I think my parents might be lying to me since I’ve had health anxiety for three years now. I just feel like everyone is lying to me and ignoring the actual symptoms, and I feel like I will die. I just don’t want to die yet, I am only 19.

USICO:

Hello and thank you for your question about your anxiety concerning possible kidney failure. You are not wrong to worry about your kidney if you are feeling sharp pain. 

I accept that your pain is real and so should every physician you talk to. However, there are many types and causes of kidney pain – In this article types of kidney pain are discussed :

https://my.clevelandclinic.org/health/symptoms/17688-kidney-pain

Do you have any of the symptoms listed here ?https://www.nlm.nih.gov/medlineplus/ency/article/000501.htm

I am hoping that you do not have these symptoms. It is a good thing you have had check ups, and you are aware of the seriousness of such a condition. 

If you are worried that your parents are lying to you, or that your symptoms are not being taken seriously, you can request an independent lab to test you, or ask the doctor to show you the lab results. Often, they will give you the lab test results. Or, you could perform certain tests yourself with a basic kit from the pharmacy. 

Here is how to read the results:

http://emedicine.medscape.com/article/2074001-overview

(You can perform certain blood tests yourself too at home)

If you are worried about the functioning of your kidneys, you could request a kidney function test :

http://nkdep.nih.gov/resources/explaining-kidney-test-results.shtml

The main point of me providing these links for you to learn about your kidneys is so that you can know for sure if your kidneys are in fact failing. 

Doctors are just people who learned how to diagnose and treat medical conditions. But you do not have to trust them. Find out the answers for yourself. 

Your anxiety is a result of you not knowing for sure what is causing your pain. 

It is a good thing you are questioning your results. It shows you are taking control of the situation.

If you cannot find a reason why people may be lying to you about your health, it is unlikely that they are lying to you. There is no benefit for health professionals to lie to you because it only doubles their work. 

We become doctors to heal, and to help people live happy lives. 

I wish you the best. 

My daughter is bipolar

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My daughter is 13 years old and was just recently diagnosed as having bipolar disorder. I am very very concerned because my mother had bipolar dis and I have no idea how to raise my daughter in this condition that she has right now. At this point I am asking anyone and everyone for their advice and I hope that you can help me Dr. Downes. at this point I’m very concerned my daughter might grow to abuse the medication just like my mother also abuse the medication for her illness. Help!!

USICO:

Hello and thank you for your question about your daughter’s bipolar diagnosis and concerns about medication abuse. 

Firstly, I would not worry that your daughter will grow to abuse her medication as the knowledge freely available today, in combination with a multidisciplinary team should allow her to lead a normal life – and experience normal ups and downs as we all do. 

Below is a great article for you to read:

http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/treatment/con-20027544

Please take note of how it says that counseling, especially cognitive behavioral therapy can help her to develop good coping skills that will carry her throughout her whole life. 

Please don’t underestimate the power of an excellent counselor. Our profession is dedicated to helping people deal with psychological issues – often working with psychiatrists. However the psychiatrist will only spend a short time with your daughter to adjust medication. 

The most important factor in your child’s well being is you. Parents typically spend the most time with their children and therefore have the greatest chance to influence behavior.  

Therefore, please learn as much as possible about bipolar disorder. However, don’t let that define her, as that is just one aspect of her personality. 

Medications can be adjusted, even to the point where they are almost only a placebo, but excellent coping skills will turn out to be most valuable. 

Also, please don’t discount natural therapies. Allow your daughter to take an active role in dealing with her condition. 

My Long Covid Battle – Can you solve the puzzle?

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Quick summary:

In my case, 3 months after a non-hospitalized Covid infection, I developed
substernal chest pain for 6 months on exertion. (I am an avid runner and lift
weights 4x/week, no previous cardiac pathology, no family Hx – only light asthma)

Then, while on a medical school rotation, I developed atrial flutter – and 5 months after an ablation
procedure at NYU, I am still experiencing debilitating inflammation (feels like substernal chest pain)
upon exertion and with anxiety – to the point I can barely exercise anymore.

(Clear MRI – normal EF, no coronary artery blockage, no psychiatric Hx – but spasm of LAD noticed during the first cardiac cath procedure, and slightly widened aortic root of 4.4)

While the mechanism of the pain has been diagnosed as symptomatic left
bundle branch block (from aberration), I am symptomatic even with movement, even
taking showers or drinking water (worse with colds) –

Recent case studies are showing that His-bundle branch pacing is beneficial for
patients with no heart pathology and LBBB. However, upon reading up on long covid
I came to realize that it might all just be long covid…even my LBBB.

I hope that by sharing my story and records we can get closer to finding a remedy for
everyone suffering from long covid symptoms.

Comments welcome!

Painful Left Bundle Branch (LBBB) Syndrome & Long COVID: What is the cure?

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I was diagnosed with painful (symptomatic) left bundle branch syndrome in August 2023, about 4 months after contracting COVID 19.

After 6 months of steadily worsening symptoms with exercise and at rest (anxiety-related), I develped atrial flutter, and received an ablation during an electrophysiology study – with excellent doctor …very satisfied with the service.

(I have a normal heart MRI, normal ejection fraction, normal EKG at rest)

The symptoms during exercise seem to have improved. This is not to say that the substernal chest pain and shortness of breath have dissapeared, just that the symptoms seem to be improving with exercise. I run 3-4 times per week, and lift weights 4-5 times per week. This improvement with exercise has been documented in studies such as this one:
Exercise Induced Left Bundle Branch Block Treated with Cardiac Rehabilitation: A Case Report and a Review of the Literature.

Also, there have been reports of success in treating painful LBBB (including anxiety-related symptoms at rest) with His-bundle pacing:
Persistent Exertional Chest Pain in a Marathon Runner: Exercise-induced, Painful, Left Bundle Branch Block Syndrome Treated With His-Bundle Pacing.

However, it has also been said in this article, that excercising for Long Covid patients can worsen symptoms.

The article lists lists four hypotheses on that could explain Long COVID’s initiation and progression:

  • After a person has COVID, a persistent virus or remnants of it cause chronic inflammation and ongoing symptoms.
  • The body’s disease-fighting B and T cells trigger an immune response—and subsequent inflammation—in a process called autoimmunity. The stimulus that triggers this occurs continuously in the body, making it difficult to pinpoint and shut down.
  • Latent (or dormant) viruses inside an individual reactivate. (Every person carries multiple viruses that are dormant. Under certain circumstances, they can be reactivated.)
  • Chronic changes occur in the body after the acute inflammatory response (COVID infection). Inflammation in one tissue can damage other tissues.

Paxlovid is the primary treatment for COVID, and there is currently a clinical trial investigating whether Paxlovid would be helpful Long Covid sufferers. Sign up for the YALE LISTEN STUDY if you are interested in participating.

The article says we should be careful about exercise:

Exercise may also be beneficial for some patients, she adds. “It’s just a different way of exercising than we’re accustomed to,” she says. While rehabilitation for non-COVID pulmonary patients may involve a push to build muscle and strength, that type of exercise method can worsen symptoms for some Long COVID patients. “So, we have to figure out a way to get them to exercise that targets their needs but isn’t detrimental to them,” she says.

The article explains ‘POST-EXERTIONAL MALAISE (PEM)’.

From article – Not every symptom falls into just one category. A challenging one is what’s called “post-exertional malaise (PEM),” which Dr. McAlpine describes as a kind of “energy crash” or worsening of other symptoms, such as fatigue, brain fog, and muscle pain after exercise—even if the activity was mild. PEM can range in severity. “Some people will walk up the stairs and then not be able to get out of bed for the rest of the day. Others will go on a 10-minute walk or run errands and then be out of commission for a couple of days,” she says.

Physical problems like PEM can lead to anxiety and depression. “It can be a very scary experience,” Dr. McAlpine says. “People feel disoriented, and this can cause new mental health issues. It can be a long road.” In these cases, mental health treatments, such as cognitive behavioral therapy (CBT) and medications, can help, she adds.

–

My cardiologist told me at first that beta blockers could be used to handle the symptoms…more recently, he told me he would recommend anxiety medicatons such as Klonopin.

As for me…I would rather not take anxiety medicines…mostly becuase I really do not feel anxious…the symptoms I feel at rest are very disruptive to my life. If they do not subside, I will contact one of the authors of the case studies who report sucess with His-Bundle branch pacing.

Comments welcome!

Coping with PMS mood swings

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In the cases where my PMS symptoms cause me to feel sad and depressed, how can I better cope through the week or normalize my mood? I can feel myself as a grey cloud or a charging bull and the emotions are so significant that I can not drop anything. It sticks (arguments, my sensitivities). Is there a way to balance it out? My defense mechanism is to stay away from people…do yoga and meditate, but my incosistencies in those practices have this firey woman erupting. Any ideas?

8-year-old boy who enjoys breaking the rules and getting in trouble

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My 8-year-old boy seems to enjoy breaking the rules and getting in trouble. I am constantly getting complaints from his teacher that he is very disruptive in class and that he is bullying other children. Sometimes he refuses to go to school. I have to force him to go to bed. He leaves the house to play outside with his friends when he hasn’t completed his homework. We try to teach him right from wrong and we do not expose him to violence on TV or the household. How can we help Robby behave?

Feelings of apathy after trauma

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I am concerned with my indifference toward others and dislike of being in social situations. Is the feeling of apathy normal after having been through a lot of traumatic situations and deaths from childhood to teenage years? I’m often told people deal with death in different ways but I always feel like I could have stopped it or it should have been me. I tried therapy once and did not like the psychologist so now I am wary of more visits. What advice do you have for me?

How can I treat depression without pharmaceuticals?

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I have been depressed for about 4 months. I was just sad at first. Now depression is interfering with my life. I do not want to get out of bed or leave my house. I find myself making excuses to friends and family for why I cannot go over during the holidays. But, I am afraid of taking antidepressant medications. I have taken Prozac before and felt like a complete zombie. Are there any methods of treating depression without pills?