My Peregrinations

Winging my way through life

Month: June 2017

Year-end holiday plans: Japan

This month is bonus month for me, which means this month is bill-paying month. Actually, every month is bill-paying month so nothing’s unusual there. What’s special about this month is that it’s the month in which I book the flights for our year-end holiday in Japan!

The kids have been patiently waiting for this since last year. Being otakus, they can’t wait to explore all the manga, anime, and toy shops in Akihabara, Tokyo, and Den Den Town, Osaka. They’d like to visit those pet cafes with wildlife, but I’m not in favour of it as it’s unethical. Then there’s USS Japan, and maybe Disneyland (they’ve outgrown Disney). And food, glorious Japanese food! We’ll be based for a week each in Tokyo and Osaka/Kyoto, flying into Osaka and out from Tokyo.

After some research and using the Japan Rail Pass Calculator to see if all our planned travel would make the JR Pass worthwhile, I realised that it’s cheaper for us to take a domestic flight between Osaka and Tokyo, than to take the shinkansen. We’ll do that another time – maybe when the kids are old enough to backpack. Lugging suitcases on the trains isn’t exactly fun.

We’ll be travelling with my mother-in-law, and the airfare for all five of us was very reasonable for SIN-NRT-ITM-HND-NRT-SIN. There’s a 2.5 hour transit in Narita on the inbound leg, but with one senior and two youths, I’m pretty sure the transit time will pass comfortably.

I’ve also secured all our accommodation for the trip, using my favourite and AirBNB. Since I always make it a point to save as much as I can on accommodation without having to sleep in a dump, I’ve been keeping an eye on room rates. They have come down a lot over the last few months – I managed to book a very nice apartment in Asakusa, Tokyo for half the price of two adjoining hotel rooms in a hotel near the Hanzomon area. All the accommodation I’ve booked are traditional Japanese-style rooms with tatami. I figure it’ll be a good experience for the girls.

More to come on our preparations for the trip as we draw closer to our departure date. In the meantime, I have another trip to prepare for – London in August!

Resources for parents with anxious kids

I didn’t expect so many friends to send me private messages to share their struggles with their own kids, after my last post. It just goes to show that many families struggle privately – and alone – with their children’s mental health.

I thought I would compile a list of things that have helped the girls (and me) since we started on this journey. Some have worked better than others, but all are worth a try if you’re at your wits’ end.

Do progressive muscle relaxation
Girl #2’s psychologist introduced us to AnxietyBC, which is an excellent resource for all kinds of topics related to anxiety. The site has scripts for progressive muscle relaxation for children and teenagers, which is helpful to teach them how to be aware of the effect that being anxious has on their bodies, and what they can do to relax. Girl #2 and I used this script for a few weeks, just before bedtime. Although she was reluctant to follow the instructions in the script at first, she actually started to practise the relaxation technique when she was anxious in school. So it works – you just need to give it some time and reinforce it consistently so that it becomes ingrained.

Explore supplementation*
I’ve always been skeptical about the need to take supplements, because we really should be getting most required nutrients from a balanced, nutritious diet. But my kids don’t eat very well. Their appetites and eating habits are mainly mood-driven despite our best efforts to regulate mealtimes. Which is to say, if they don’t feel like having dinner, they just don’t. And then they go downstairs at 2am to make themselves a snack. They like to say their stomachs are the size of their fists, so I shouldn’t expect them to be able to eat that much. I’ve given up fighting them on this.

I give them a daily multivitamin to ensure that their micronutrients are accounted for. This is all the more important now that they are on fluoxetine, because the medication does deplete nutrients such as magnesium from the body. Fluoxetine also suppresses the appetite, which makes eating more challenging.

I give both girls a good probiotic because there is increasing evidence of the impact of the gut-brain connection on anxiety. Healthy gut, healthy brain. It helps keep bowel movements regular, too.

I mentioned magnesium – magnesium is a calming mineral, so it should be taken just before bedtime to promote restful sleep. Magnesium oxide is the most commonly available form of magnesium on the local market. It’s also the form that will give you the runs if taken in too-large quantities. If you want to try magnesium supplementation and your child is not currently on medication, look for magnesium l-threonate if you can, as research indicates that this form of magnesium is best for anxiety. I just went with magnesium oxide, though it’s not so well absorbed, and gave tiny doses so the girls wouldn’t get diarrhoea. I’ve tried ChildLife calcium and magnesium (these two minerals go together for better absorption) and the orange flavour from Natural Calm. Between the two, the girls like the latter better. But they would prefer not to have any magnesium at all, if they can help it, because it doesn’t taste particularly nice. If you don’t want to supplement with magnesium, or if your kid hates the taste, give them natural sources of magnesium such as spinach, yoghurt, cheese, and almonds.

Omega-3 fish oil
Omega-3 comes in fish and non-fish versions, but we are not vegetarian, so we go with the fishy capsules. There are combined EPA+DHA forms, and there are also forms which have more of one or the other. I’ve read a few articles like this one suggesting that a higher ratio of EPA to DHA is beneficial for anxiety and depression. But I think that if you’re starting at a deficient baseline, a combination supplement would be more than good enough. The girls take Nordic Naturals’ Ultimate Omega 2X Mini. I freeze the capsules and they swallow them, to prevent any nausea or fishy burps. I’ve also tried Barlean’s fish oil but that didn’t go down so well. It’s not that the taste is bad; I think the girls just have very vivid imaginations and imagine that what they’re swallowing is syrup with essence of fish or something. So the Nordic Naturals capsules work best for us.

This should only be given if your child is not currently on any medication for anxiety or depression. You can read more about l-theanine here. If you like Taiwanese Chun Cui He milk tea, you may remember that they were removed from shelves shortly after launching in Singapore because they contained l-theanine, which is not an approved food additive here. That is not to say that it is unsafe. The US Food and Drug Administration classifies l-theanine as “Generally Regarded as Safe” but countries such as Singapore don’t allow it in food even as they allow its sale as a supplement. GNC sells this as mint flavoured chewables, and four a day is the most that a child should be taking if you buy this. You can also look at Source Naturals though the dose per chewable for this brand is much higher. I gave Girl #2 l-theanine for several weeks but she didn’t feel like it did much for her anxiety. When the husband and I tried it, we both felt very relaxed and sleepy less than half an hour later. So your mileage may vary.

*Note: Please consult your doctor and do extensive research before trying any of these for your child. I have to say this because I’m not a doctor and your child may have other health considerations that may make supplementation of any kind without prior medical advice risky.

Join an online support group
There doesn’t seem to be a Singapore-based support group for parents of children with anxiety, but there are thriving communities on Facebook. Check out Parenting Kids with Anxiety which has members from all over the world. There’s also a group called Parenting Kids/Teens with Social Anxiety Disorder, which discusses holistic and alternative treatments such as using essential oils. These groups make it less of a lonely journey.

Read books, watch shows
There are plenty of books out there on living with mental health disorders. I bought a couple of books on OCD for Girl #1, who found them helpful because she could relate. Titles you can check out are The Man Who Couldn’t Stop and Being Me with OCD. I also bought a copy of Brain Lock, which teaches a simple but effective four-step method of managing OCD. For anxiety, there are books for younger children, such as What to Do When You Worry Too Much. I haven’t bought this last book, but the reviews are good. Since Girl #2 is into manga and anime, I tried looking for titles with themes to which she could relate. A Silent Voice was a big hit with her. She watched it in the cinema not once, not twice, but four times.

Don’t focus on the cost of treatment
I know the general impression of mental health treatment is that it is very expensive. Yes, it is, if you decide to go private. However, if you’re a subsidised patient at a restructured hospital, the cost is moderated significantly because of government subsidies, and the fact that you can use some of your Medisave to pay for doctors’ consultations (psychologist’s consultations are not claimable). If you have an older child, you can also look to places such as Shan You Counselling Centre, which charges no more than $50 for a 50-minute counselling session. Fees vary according to the client’s income level. Help is definitely out there, so don’t feel like you shouldn’t get help because you can’t afford it.

Find the right time of day for therapy
Girl #2 is generally much more receptive to her psychologist and psychiatrist in the morning. It’s understandable, because the afternoon appointments are after the school day is over, which means she’s tired, hot, and thinking about all the homework she has to do. Knowing the best time to take your kid for therapy will make it less painful for all involved. Unfortunately, we don’t always get to choose morning appointments. When it’s an afternoon appointment, I keep Girl #2 happy by enticing her with things like ice cream, bubble tea, and waffles.

Manage the side effects of medication
Every medication for depression and/or anxiety has its own laundry list of side effects, sometimes running into the hundreds. A list of side effects for fluoxetine can be found here. While both girls mainly complained of headache, dizziness, and nausea, fluoxetine appears to also have an impact on the menstrual cycle, making periods heavy and/or irregular. We dealt with the headaches by taking paracetamol (you shouldn’t take ibuprofen or other non-steroidal anti-inflammatory drugs on fluoxetine), used Sea Bands for nausea, and made lots of peppermint tea. At one point, I also used ginger capsules from Gaia Herbs which were very effective for nausea, but I stopped when I found that ginger interacts with fluoxetine. Which brings me to…

Download drug interaction checkers
If you’re like me, you probably have a handful of over-the-counter medications that you give your kids whenever they are down with garden-variety sicknesses that don’t necessarily require a visit to the GP. Once you start on antidepressant and anti-anxiety medication, however, self-medication becomes a lot more tricky. For example, I’ve learned that Clarityne for a runny nose is OK, but not Clarinase. Paracetamol is OK, but not ibuprofen unless the pain is intolerable. Whenever the girls see our family doctor, he pores over his drug guides to double-check that the medication he’s prescribing is safe to take with fluoxetine. You can do the same at home by downloading apps such as Epocrates, Medscape and I err on the side of caution – if any of these apps throws up a possible interaction, I don’t give the medication. I also ask the duty pharmacist at Guardian and Unity – they are super helpful.

I’ve just typed over 1,500 words. Phew! I hope you find something in this post to help you, if you’re parenting a child with anxiety. Let me know if you do!

Laying it all out .

The first half of the year is nearly over and I am finally feeling like I can catch a break from what has turned out to be a pretty awful six months. I’ve hesitated to write about what’s been going on in our family for a few reasons, the main one being that the girls are old enough to appreciate personal privacy and don’t like me talking about them even though few can put two and two together from this blog to identify them in real life.

I want the girls to take control over who they choose to tell about their struggles, and when and how they do so. However, I also want to tell the story as I have been living it, because it might help other parents out there who are going through the same situation. There is also nothing shameful about all of this, so I’m doing my part to destigmatise mental illness and to tell the world that having something wrong with your brain chemistry is no different from having problems with your insulin, or with your vision.

Late last year, Girl #1 was diagnosed with obsessive compulsive disorder. She had been under psychiatric care for a while because she had several episodes of hyperventilation and also reported hearing voices. I was worried that she might be exhibiting symptoms of early onset schizophrenia, but after several visits to the psychiatrist and psychologist, and in-depth assessments, she was diagnosed with contamination OCD, which is when a person is obsessed with cleanliness or the lack thereof, and manifests this obsession in the form of compulsive tidying, handwashing, or cleaning in general.

Girl #1’s diagnosis was a revelation to us because her contamination OCD showed up mainly when she was in the bathroom. We had never noticed her spending long periods of time in there, and were at first reluctant to believe that she could have OCD because we obviously could not see her scrubbing away while in the bath. But the diagnosis must have been a relief to Girl #1 because she no longer needed to hide her compulsions, and could finally get some help to cope with the symptoms. She started seeing a psychologist regularly for exposure response prevention, which is a type of therapy that teaches people with OCD to control their thoughts such that they do not translate to actions. She also started on an anti-anxiety and antidepressant medication called fluoxetine, which is better known as Prozac.

We went through some terrible times in the early months of the year trying to find the right dose of Prozac that would help her keep her anxieties under control without incapacitating her with its side effects. At one point, the side effects (headache, nausea, dizziness) were so bad that we stopped the Prozac and switched to another drug, Lexapro. That turned out to be a huge mistake as Girl #1 felt that this new medication did nothing for her. Her OCD was exacerbated  to the point where she felt that she was so crazy that life was no longer worth living. In early April, she overdosed on paracetamol in school. Thankfully, she did not ingest enough to cause permanent damage or death.

After that incident, Girl #1 went back onto Prozac and we worked through the dose increments and side effects until she got to a dose that the psychiatrist felt was optimal for her. She has been on this dose for several weeks now and her OCD is currently well controlled such that she doesn’t feel the need to see her psychologist for the time being. The side effects have also mostly abated. But because of this tough situation, she missed more than half of the first school term of the year and had to work hard to catch up.

That’s Girl #1.

While all of this was going on, we were also dealing with Girl #2, who was diagnosed with social anxiety disorder early this year. In hindsight, she has probably lived with anxiety for at least the last four years. We just didn’t realise that her worrywart ways are not her personality, but a mental health problem.

Her social anxiety showed itself as extreme reticence. She would not greet or speak to people she has known her whole life. As you can imagine, this prompted comments on her “bad behaviour”. People couldn’t understand that she wasn’t being rude; she was simply too anxious to be able to interact with others outside her immediate family. I lost count of the number of times I had to explain the situation to people and assure them that no, it wasn’t something that they had or hadn’t said or done.

Like Girl #1, Girl #2 went through several psychological assessments before the diagnosis of social anxiety disorder was made. Unlike Girl #1, she was not prescribed medication immediately because of her age. Her psychiatrist felt that we should give Girl #2 a chance with therapy before we considered medication. 

Girl #2 started seeing a psychologist who worked with us to identify her “ladder of anxiety” and learn ways to work through her feelings whenever she was in an anxiety-inducing situation. I would force her to do progressive muscle relaxation with me every night, to inculcate self awareness of the difference between being tense and relaxed, and how to use relaxation to cope with anxiety. I went on a supplement buying binge on iHerb and put both Girl #2 and Girl #1 on multivitamins, probiotics, and Omega-3 fish oil. To their dismay, I also bought a magnesium supplement for them to take before bedtime, as magnesium is a relaxing mineral. (These days, I no longer make them take magnesium, but they still get all the other supplements.)

Unfortunately, Girl #2 was not receptive during these sessions with her therapist, and would sit in stony silence. Her mood became increasingly despondent. At one point, she attempted suicide by eating flowers from the school garden, thinking they would be poisonous. She also self-harmed whenever her feelings became too big to bear. I can’t tell you how painful it is to see scars on your young child’s arm, and knowing that there is nothing you can do about them except to apply balm and remind your child that there are safer and more constructive ways to emote. I can’t tell you because my way of coping has been to build a wall around those feelings and focus on finding solutions to the issues at hand.

After discovering several notes in her room about wanting to die, I decided that we could no longer wait to see if therapy would work, and scheduled an emergency appointment with the psychiatrist. I showed him the notes we had found, and he agreed that it was time to start Girl #2 on medication. She now takes the same medication as Girl #1, but in a lower dose appropriate for her age and weight. Thankfully, she hasn’t felt the side effects as keenly as Girl #1, and her mood has improved considerably. She can now converse with relatives and has gained confidence in doing things like buying things at shops. She even spoke during her oral exams at school, which was an immense relief as we thought she would not open her mouth when it was her turn in front of the examiners. Her smile is back, and so is her goofy sweetness.

Anxiety disorders run in families, and anxiety and depression often go hand in hand. While neither the husband nor I have been diagnosed with anxiety or depression, we’re well aware that we exhibit some of the traits associated with these conditions. Unfortunately, there’s nothing we can do about the poor genes we appear to have passed down to our children, so the best we can do is to ensure that they are both fully supported and to keep close tabs on how they are from day to day. We are deeply thankful that both girls’ schools have been very supportive and their teachers actively work with us to ensure that they get the help they need at school.

I am now keenly aware of how society views people with mental health conditions. I never used to find it offensive when people said they were “OCD” in reference to their desire to keep their stuff in order, but I do now. A person living with OCD is tortured constantly with overwhelming thoughts that they cannot control – what they go through is sheer hell. It should never be trivialised and compared to mundane thoughts like the need to spring-clean an overflowing closet. Perhaps it seems fashionable to claim that one is “OCD”. A conversation with an actual OCD sufferer would quickly disabuse you of that notion.

Likewise, a person with social anxiety disorder is not “just shy”, they are actually struggling to breathe at the thought of having to socialise with others. Before she went on medication, Girl #2 would visibly shut down when she was placed in situations with people outside her comfort zone.

I’ve also realised that mental health conditions in children, unless severe from the outset, often escape unnoticed until they boil over and become full blown problems. After I described what the girls had been going through to a friend, she noted that she knew of someone who had a child who seemed to be exhibiting the same behaviour as Girl #2. I asked that friend to gently encourage the child’s mother to consider seeking help.

If you have young children at home, don’t hesitate to see a child psychologist if your child seems worried and anxious all the time, suddenly becomes angry or volatile, or expresses thoughts about wanting to die. Conditions like OCD and anxiety or depression are highly treatable, and the earlier a child is diagnosed and gets the help that is needed, the better their long term prognosis.

Having said that, I’m not thinking too far ahead about the girls’ health and their future. There is some concern about the impact of long-term medication on children’s growing brains, as well as future developments such as pregnancy. But for now it’s more important that my children are stable, happy and safe, than to think about what-ifs that are far off on the horizon.

So there you have it – what’s been going on for the last six months. The husband and I decided to cancel our planned trip to Taiwan at the height of Girl #2’s crisis as I didn’t feel comfortable leaving the girls at home while we travelled. We are now on an even keel (touch wood!) and I hope that the rest of this year will be good to my girls. After all that they have gone through so bravely, they definitely deserve it.

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