I like to think of John as a tall skyscraper, and his disorder is a strong wind that tries to knock him over. Some days the breeze is light - on other days it is almost a hurricane.
Most people think medication is an anchor that holds the building in place, but that's not how it works. I picture medication as a force that pushes back from the other side. This isn't entirely accurate either, but it's a little closer to the truth.
Meds are written to a particular prescription, a fixed force that pushes back on the building. If the wind varies from day to day, the meds will be woefully inadequate on some days, allowing the building to lean left. On other days the meds will be too strong, pushing the building to the right. As long as his symptoms vary from day to day, medication is not going to help. I've seen this in my home, and I've tried to explain it to his teachers at school. "We're not even going to try meds again," I declared, "until his symptoms have stabilized."
Guess what? He's stable. When John is on the antibacterial diet, as described in the previous section, the wind blows at 25kph every day. We're ready to try meds again.
When we picked John up from his group home four years ago, his caregivers warned, "Don't try ritalin. It's a disaster! Actually, none of the drugs work, and we've tried them all. But ritalin is the worst."
Well we did try ritalin, and some days it helped, but some days he became autistic. It was horrible. We've never seen these symptoms before or since. When the wind is blowing hard, ritalin deflects the building, so that it falls in a different direction. He becomes autistic instead of insane. I'm not sure which is worse.
Yet somehow I always felt ritalin would help. I thought it was the right drug. So we decided to try it again. His doctor prescribed a time-release 20mg tablet, which is a pretty low dose for someone who is almost as tall as me. I gave him the first pill on Sunday and didn't really see any change at all. So we gave him the second pill on Monday and sent him off to school. That afternoon we got a call from his long-suffering teacher.
"If I were younger I'd be doing cartwheels. In the past year and a half, I've never seen him look this good. He's doing work that I thought was simply beyond him." She continued to sing his praises for the rest of the week. This is clearly the best school week he's ever had. Maybe ritalin is a wonder drug after all.
"Wait a minute?" I hear you cry. "Aren't you dead set against ritalin?"
Well - I try not to think in terms of black and white. I try to keep an open mind. I saw Dr. Crook, the Dr. Crook, on TV the other day. He's 85 and sharp as a tack. The host asked him about ritalin, and he responded this way.
"If you need ritalin, or some other medication, then take it. But you don't want to take it, day after day, year after year, without searching for the underlying cause. I mean, suppose you got a headache every night. You wouldn't suffer in silence, you'd take something for it, right? But if it happens every night, you and your doctor would want to know why. I don't understand why doctors don't take the same attitude towards ADHD. But they don't. They just throw up their hands and prescribe ritalin year after year."
I believe we will "cure" John's disorder eventually, but in the meantime, we have a drug that will help, with virtually no side-effects, and it would be irresponsible not to use it.
John remembers when he was on asthma medication. He knows he needed it to breathe, and he also knows he doesn't need it any more. The same is true of Mary. In addition, Mary use to get headaches three or four times a week. We gave her tyenol as needed, and there's nothing wrong with that, but guess what, she doesn't need it any more. We're taking the same approach with ritalin. He needs it, and it helps, so we're going to use it. At the same time, I will continue to treat his disorder with diet, and probiotics, and anything else that makes sense, and perhaps someday the winds will cease, and he won't need this medication any more.