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When you're having heart palpitations and you can't breathe. At that moment you realize your own mortality.

I've meant to write about this in my blog for a while, but I haven't, because the story is so long and complicated. (You've been warned.) I'm posting here, because just recently I started being around more than I have been for a couple of months, which results in people asking me how I'm doing, and how I've been. I usually answer "been better, been worse" because the real answer is much longer and more involved, and I don't feel like typing it out multiple times. If you want to skip the backstory, start reading after the first double carriage return. I don't know why anyone would read the whole thing, it's immensely long, but I want to get it out.

I was diagnosed with ADD about a year ago; I'm sure more than a few of you remember the thread. I was put on Ritalin, and then I asked to be switched to Adderall, because I liked the way it felt much better. The highs weren't as harsh, and the overall feeling was smoother. I knew I couldn't just use the immediate release because that only lasted me about 45 minutes(!). This is shocking because the half life of amphetamine salts is between 10-14 hours depending on urinary pH. Anyway, I started the XR (extended release) regimen, and I loved it. I started it just at the end of spring semester, and it helped greatly. I would sit in organic chemistry and carry on a conversation with Kim (my GF) or Adam, and take notes and wish the guy would go quicker. I would occasionally express as much, and this would get me dumbfounded looks from people who were usually perplexed. Whatever. I should have known then that what I was experiencing wasn't normal. I'll explain the hows and whys in a bit.

Finals came up on me, and I worked my ass off for them. I'd put in 16 hour days studying up at Harvard Med School and not really think anything of it. I was unstoppable when it came to mental endurance. 8 hour organic chemistry study marathon? No problem, bring it on. I had boundless energy. I could do six million things at once. Study, carry on a conversation (except in rare circumstances where I was so involved in what I was doing that I'd be oblivious to what was going on around me, but that was extremely rare). Anyone who distracted me from my study efforts got largely ignored. You see, I got a 39 and a 28 on the first two (of four) organic chemistry exams during second semester. There are many reasons for this, but the bottom line is that I wasn't doing what I should have been, and pledging fucked up study time. Whatever. I had to work my ass off, and I did. I went from those two miserable grades in that class to getting a C+ for a final grade. (I've never been so proud of a C+ in my life.)

I can honestly say that from the middle of March (when I started to get my academic shit together) up until the middle of June, I was happier deep down more than I'd ever been in my life. I was doing what I should for school; I had a girlfriend whom I loved (and still do :p). I was doing everything right, and I had all my shit together frat-wise, and was more social during this time than I've ever been in my life. And it was all do to the Ritalin, and later, Adderall, and the overall positive influence that Kim had on me. There is no doubt in my mind that the drugs helped immensely. Hugely. More than even I can fathom looking back. I loved life, school, everything. It was during this time that I wasn't posting on Ars much.

I signed up for two summer courses. I took three courses last summer, and I rocked the house at all of them. B in Biology (which I shouldn't have had to take, I still kick myself for that one), A in Calculus 2, and an AB in Writing 2. I knew I could kick Biochem 1 and 2's collective asses all over the map. And I did. Sort of.

I moved into an apartment with Adam and three girls. This was a bad idea, but whatever, I didn't know that at the time. I had a lot of stress on my shoulders, though I didn't see it as such. Adam didn't help because he'd be constantly sticking his head into my room bugging me or asking me how I was doing or what I was doing or if I wanted to go to the gym or… It started to wear on me more than a little bit, but I held my tongue. He had a lot of shit going on with his GF (who is one of the three girls I mentioned). So anyway, Biochem 1.

What a terrible class; the first one and a half weeks (think first exam plus half of the second exam in normal biochem 1 time) was fucking fascinating. After that, even my Adderall couldn't keep me focused or interested. Carbohydrates are just so goddamn boring, even if they are important.

Whatever I struggled through it, doing okay. (About a B.) We had our exams every Monday, and the Wednesday after the last test but before the final, there were about 5 days of lecture left. I had run out of my Adderall XR, so I had my immediate release. Again, I was on XR 20mg, and IR 15mg. Sitting in class, it started as normal, boring as fuck all.

Then I noticed my heart feeling funny. Usually when I take Adderall (or Ritalin) my heart rate goes up a bit higher than normal, which isn't abnormal (but in retrospect isn't actually that good; I did a lot of reading after everything posted below). Imagine the first beat after your heart skips a beat, that hard pound and then back to normal. Well, it didn't go back to normal, and my ticker hadn't skipped a beat… Boom Boom Boom. It was beating harder and harder. I couldn't see too well, my vision was blurry, tingling all up my arms, sweating. I couldn't breathe, I thought I was going to pass out and fall on the floor, even though I was sitting down. It got worse, and I slumped over in my chair, my mouth was wide open my eyes bulging. Everything was spinning, my heart felt like it was going to explode through my chest. I tried to grab Neil, the kid sitting next to me, but I missed the first time, I managed to punch him the second time. He's like "dude are you okay?" All I could do was shake my head. My mouth was still wide open and my eyes were still popping out. I was having muscle spasms in my pectoral muscles, and my hands were shaking violently. I was scared. My palms were sweating, and so were the soles of my feet. I did the only thing I could think to do, and that was write things down as they happened, the various sensations. I wrote down other things that had happened recently with my heart that didn't seem right, but I didn't really pay attention to when they happened. I still have this piece of paper, and I've scanned it for you because it's surreal for me to look back and see what I wrote. Maybe you'll find it surreal too or something. I don't know.

Click me.

Adam gave me some water, and slowly my heart went back to normal-ish. I had two more waves of this before the ten minute break in the lecture. I didn't know what to do when they were happening so I hit Neil every time it did. I think he was getting annoyed, but I was scared out of my mind. Shit, I'm 21; these things aren't supposed to happen to me. I decided to go home to the apartment to lay down. I was originally going to go to the ER but they didn't happen for about twenty minutes. I started to play Funny Balls on my cell phone to distract myself because I knew if I thought about what was happening too much, I'd be more stressed, and the palpitations would probably happen again. I vividly remember this lady sitting next to me that day asking for a note packet that she'd left at home by accident that we had recieved the day before. She's the One Person in class that pisses you the fuck off at every opportunity by asking stupid, irrelevent questions. You know the one I'm talking about. There's one in every class. Anyway, I gave her my packet, and I remember that vividly for some reason, though everything else from that hour is a a blur except for the exploding pain in my chest. I remember that all too well.

I walked home feeling like shit. My heart still wasn't right; not even back down to the "normal" elevated heart rate that Adderall usually has me at. I called my PCP, who is a pulmonary specialist. He told me to call my psych nurse who prescribed Adderall for me, so I did. She was *very* concerned and ordered up an EKG and some other shit. Whatever.

I was scared. Terrified. I had felt like I was going to die, and there wasn't a thing I could do about it. Right then, there, in my seat, I felt deep down that someday, I, too, would pass from this earth. If it wasn't then, then it would be sometime maybe soon or perhaps (hopefully) far in the future. That moment when you realize that you aren't immortal and invincible, and that you're basically an insignificant nothing in the vastness of the universe. Right then life seems so fragile and precious. And so totally out of your control. I always intellectually knew that someday I would die, but right then was the moment when I truly internalized it. And it was scary. Very scary. Looking back, I feel like I passed a milestone in my life, because I can honestly say that I don't really take my existence for granted anymore, because there isn't a day that goes by when I don't think of what happened during that biochem lecture.

Obviously I stopped taking my Adderall, and I still felt like shit throughout the whole rest of that day. I laid in bed and finished reading Harry Potter and the Order of the Phoenix wishing that Madam Pomfrey had something that would fix me up good as new. Childish, I know, but I truly longed for that, that day. I felt better the next day, but still not 100%. My heart still wasn't right, and it took almost two weeks for it to get truly back to normal.

After my heart went back to normal, my breathing took a nosedive. Maybe it was never completely there when I was having heart problems and I just didn't notice because I was so focused on the trouble with my ticker I ignored it. I don't know. That took another week to go back to normal. During this time my girlfriend came to visit me because she was apartment hunting in Brookline at Coolidge Corner. I tried to go with her to look at places, but my breathing was so fucked up I walked halfway there and had to turn around and come back. I had to rest at Brueggers Bagel Bakery by the Longwood Galleria before I could walk home. I wanted to cry because she wanted me to see the places, and I wanted to see them too, but I couldn't. I felt like an elephant was standing on my chest, and I was fighting for air. While she was up for the weekend, this happened several times, and put a damper on my doing things with her, and that kind of strained things between us for a little while. I wanted to be there, and she wanted me there, and that just made things worse. You can't help feeling what you feel, though, so I wasn't mad at her, and I don't think Kim was mad at me for not going. Just disappointed, which maybe was worse. When someone's mad at you, you can fight back, but when they're disappointed, there's nothing you can really do about it, you know?

I continued to get better, and I decided not to take Biochem 2, but to take the rest of the summer off instead and work and relax, and hopefully make the recovery a full one. My EKG was entirely normal, you see. The only abnormality was an elevated blood pressure (14x over something — basically about 20 higher than normal systolic, I didn't hear what the nurse said about diastolic). It was high, but not crazy high. Some of you might know that CNS stimulants can elevate blood pressure, but I hadn't had any Ritalin or Adderall in two weeks, so I know it wasn't that. The nurse asked me if I was stressed, and I was like "No," because stress has never affected me in my life. Ever.

But you see, there had been a change when I was taking my ADD meds. I actually gave a damn about things; I didn't have the "fuck it" attitude that I'd had for so long. My stress levels were much higher, and the more I thought about it later that day and the next, I had to think that it was stress. And right now, looking back, I think it was indeed stress more than anything else that triggered the episode.

Some of you might recall my altercation with the school Provost last year. To make yet another really long story short, I got fucked over by the administration earlier in the summer, and I was still dealing with that. Couple it to not having enough personal space with Adam popping his head into my room all the time, and Kim staying extra nights the first time she visit (apartment hunting was the second visit), and dealing with biochem 1, and the bullshit at home from my mom about getting the pool open, and worrying about money and the provost and just all kinds of other bullshit, I was, in fact, under a lot of stress.

So I moved home and have been working nearly full time since I've been here. And I've been getting stronger, and getting over my withdrawal symptoms. Going through withdrawal sucks. I was depressed about everything, I was physically weak, nauseous sometimes, and tired all the time. That's four of the eight listed withdrawal symptoms for amphetamines. Looking back, I'm not ashamed that I was addicted to them, but all the same, I wish I hadn't been.

That's not to say that I didn't need them, because I did, and they helped me tremendously. And I haven't given up on them either. I learned some things along the way, that perhaps should have been obvious to me, but weren't.

Imagine a six-hour high in which you can do more than everyone around you without breaking a sweat. Imagine being more social than you've ever been and having wonderful conversations with people that you've only ever said hi to in passing. Imagine being more loving and affectionate to your significant other than you've ever been in your life, and imagine being able to do everything you could before, only do it better, without effort. Whatever that may be. If you're feeling so wonderful, and you don't see any crash or what have you, you don't immediately think "Hey this is probably a little too good to be true." Especially when your grades are great, and everyone around you thinks you're the man for whatever reason. You just take the little capsule in the morning, and look forward to another sunny day. I just assumed that this was what it was like to be "normal." Those of you without ADD might think "uh yeah, I wish that was normal," but I've never experienced "normal" so I have nothing to base it on. So if you think I should have seen the glaring red light, keep that in mind. I even remarked to my girlfriend how people shouldn't be so gloomy all the time if this was how it felt to be normal. I honestly don't remember what she said to that comment. Truly the only irritating thing about Adderall was the ED associated with it. It's like you can use your head or your dick, but there's not enough blood to run both at the same time. Heh.

It took almost two weeks to get through withdrawal. I didn't want Adderall because I knew it would make me sick again, but my body did. So I started thinking what I was going to do about school this fall, and what measures I would take to ensure my continued academic success. So I went back to my psych nurse, and we talked about stress, about everything that happened, etc., etc., and then we discussed what I wanted to do. I said I wanted to cut my dose way down. She agreed. We hemmed and hawed back and forth about dosing, and we finally settled on Adderall XR 10mg (down from 20) and Adderall IR 5mg (down from 15) up to 10mg if I needed it.

I took an Adderall immediate release tablet a couple of days ago with food. A small effect, I was able to socialize more easily, but there was no "high" feeling like before, and concentrating was much easier. Today was my first experimentation with the XR, and it went almost as well. I took it just before work (work is one of the lowest stress environments for me to be, no matter how much of a zoo it may be), and I felt like crap. I felt my blood pressure go up (yes I can feel it go up), but it all evened out in about 45 minutes. I was really apprehensive about taking the XR because I was worried that if there was a bad reaction, the fact that it was delayed release might fuck me up badly, so I was stressed there. Again, though, there was no high feeling, and after I got over my worry, it was smooth sailing, with the same effect as the IR I talked about above. No racing heart, no doing six million things at once. Just steady.

So *this* is what it's like to feel normal.

So yeah. Does anyone know offhand how to raise urinary pH? That would be nice to know.

And that's the end of my super huge post.

(Some of you might wonder why a lower dose (15mg) would trigger a reaction more than a higher dose (20mg) would. The answer is that peak blood serum level is reached more quickly, and is actually higher between a 15mg immediate-release tablet and a 20mg extended release tablet. The higher comes quickly, and the effect is basically more jarring. The XR is a smoother release. Why anyone would take exclusively IR is beyond me.)

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