You have had asthma as long as you can remember--since childhood--and have been seeing the same pulmonologist for at least three years. Your doctor has had you on theophylline, a pill you take three times a day, and a Flovent inhaler (which you use twice daily) for the past year. You went to the pharmacy today and dropped off your scripts, as you do every month, only to be told you can't fill them. Why? Because your insurance company won't approve a prescription for more than 60 theophylline. Nor will they fill a Flovent inhaler for more uses than once daily.

Comorbidity. Interesting word, isn't it? If you were new to the English language and without your dictionary, you might guess it to mean something like "dying together." And you wouldn't be altogether inaccurate.

Continued from Part 1 As you may have guessed, the large dog, startled by the remote control car fast approaching it, bolted--knocking its elderly owner off her feet and dragging her along the sidewalk before she was able to regain control of it. (The only witnesses to this were the kids, the victim, and the dog--but the victim's neighbor came to our door the next day looking for the glasses she lost in the scuffle and reported she was "pretty bruised and scraped up.")

cont. from Allergies and Psychiatric Illness (part 1) Actually, I don't wonder about a possible link between inhalant (i.e., "seasonal" or "nasal") allergies and psychiatric diagnosis--I know such a link exists; there is clinical evidence to support it. What I wonder about is the mechanism of the link; how the link could be used to treat psychiatric illness in children (and adults); whether the link can explain some of Bob's difficulties.

As another (less-successful-than-last-year) school year draws to a close, my family struggles to keep it together without losing it on each other, and my firstborn seems to be moving further and further away from me, I start grasping at straws. Something, anything, for an answer somewhere. A clue. A hint. (Why I think I may be able to find The Big Answer when research teams and psychiatrists much more learned than I cannot is beyond me. Maybe because, having more at stake than they do, I might look harder.) I haven't found The Big Answer yet, but I have come across some information I believe deserves further examination--the connection between inhalent (a/k/a "seasonal" or "nasal") allergies and psychiatric illness.

Parents--answer this question: How many times today have I asked myself, "am I doing the right thing here?" I'm guessing most of you answered "at least once." And if your child has a psychiatric diagnosis, I'm guessing your answer was closer to "at least once every half-hour."

After next week, I will be responsible for Bob's appointments--psychiatrist (which I already attend) and therapist (which my husband currently handles). The question I'm asking, however--given last week's observations by the therapist--is should we even bother continuing with talk therapy at this point?

It seems Bob has officially won this round of "Stump the Therapist." She admitted today she isn't quite sure what to do with him at this point; that she can't determine how much of his problem stems from impulse control issues, and how much is just an "I don't give a s**t" attitude.

I recently made the decision to send Bob, my son with bipolar disorder, back to his last therapist. I don't have high confidence in talk therapy for a variety of reasons, as I have previously discussed. One of those reasons was brought to light after Bob's second session: therapists don't always get the whole story.

After several phone calls and missed fax transmissions, I finally had Bob's most recent lab results in my hand and his psychiatrist's. His lithium level was surprisingly low. His BUN, however, was high--enough to generate concern he may be developing lithium sensitivity. His psychiatrist suggested the labs be reviewed by his general practitioner prior to making our next move. I had forgotten long-term lithium use can lead to kidney failure. I have since added that to my list of Things to Worry About at 3 AM, and asked myself the question: Am I sacrificing my child's physical health for his mental health? Can't he have both?