Sunday, October 28, 2007

Is It Worth It?

In a number of posts lately, commenters have been talking about a trade-off: is the potential to get better worth the risk of possible side effects? And if the treatment actually does effect improvement, is that improvement worth it when side effects do happen. As our commenters have pointed out, that's often something that only the patient can decide....though we psychiatrists will add that in certain conditions (mania, disorders with a delusional component, disorders where violence is a symptom) that insight can be impaired and sometimes it's good if the patient gets a little input from others. Mostly, though, especially when the issue is one of subjective distress, the patient is uniquely able to make the "Is It Worth It?" determination.

Okay, so Judith Warner has a neat post on the New York Times Domestic Disturbances blog where she talks about The Migraine Diet, food, meds, and
lifestyle issues pertaining to the treatment of her migraines. She talks about the recommendations of David Bucholz, the Hopkins migraine Guru (and my neighbor...) -- avoidance of medications that can lead to rebound headaches and a diet devoid of...food (--I'm kidding of course, but apparently caffeine, pizza, beer, and chocolate--the foods Shrink Rappers love-- are out). Ms. Warner writes:

Some people do manage, through diet and exercise, or by protecting themselves from their worst “triggers,” to free themselves from their drugs. But many can’t do it. Many find they can’t accept living in the compromised condition that drug-free existence requires.

A smart high school girl I know switched a few years ago from a mainstream school, where she was struggling with dyslexia and ADHD, to a school that specializes in teaching kids with severe learning disabilities. Being there has permitted her to function without her ADHD meds. But now she’s bored. She’s dispirited by the lack of academic challenge and she wants out, because she’s afraid that, without academic challenges, she won’t be able to get into a mainstream college.

That’s the tradeoff: taking daily drugs, or living a life that feels not quite worth living.

The story ends with a prescription for Topamax and a snickers bar, result pending.

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If you haven't been following Foo Foo's blog, Turn Your Head and Scoff, by all means, visit. He tells a moving story about a young woman's death from colon cancer-- I started to comment, but just didn't know what to say. He tells about life in San Diego with the fires burning, and of course, there are those lovely pics he posts of the interior of his own GI tract.

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I think the Red Sox will clinch it tonight.