So we made a doctor's appointment. Almost two years after our move, we have yet to find a pediatrician or primary-care doc who 1) we like AND 2) is taking new patients. I have a good dermatologist, but for most of our ad-hoc medical needs we go to the clinic down the road, where the bedside manner tends to be rather...brisk, and the quality of care varies wildly depending on who you get.
MG's doctor-of-the-day was predictably to-the-point. She asked a barrage of questions about the circumstances of both the headaches and MG's life in general: When do the headaches come on? Where in the head do they hurt? How much sleep does she usually get? What does she eat? etc. etc. I was bristling that she persisted in addressing me rather than MG herself, who was increasingly fidgety and monosyllabic: she didn't like the doctor, she was anxious about the outcome, she didn't like being pulled out of school where they were having a party. All in all, not the most auspicious of appointments.
I was fully prepared for--and halfway convinced myself of--a diagnosis of Dramatic Child Syndrome, but the doctor said she thought it was migraines, even though MG doesn't throw up or get dizzy and sometimes the headaches are only a few minutes in duration. She prescribed--rather scoldingly--more sleep and fewer additives and dyes in MG's diet. The main thing MG got out of this experience was that the mean doctor said she couldn't have any more chicken nuggets. I was similarly freaking out because even though the doctor seemed more concerned about orange dye than the cheese itself, cheddar cheese, a common migraine trigger, comprises about 90% of my child's protein intake.
We went home and calmed down a bit. The Renaissance Woman suggested that rather than dramatically changing MG's classic Picky Kid Eater diet, and putting the whole family through a morass of power struggles and behavioral and sensory challenges, we focus on cutting out dyes where we can (like, getting white cheddar rather than the orange variety) and on sleep.
Ah, sleep. Like her parents, MG is a night owl. She has had terrible insomnia for years, and it seems to be getting worse as she got older. I blogged a while ago about our decision to start giving her melatonin at bedtime, but I have to say now that this was pretty half-hearted and occasional, because we were afraid of her developing a tolerance and of unknown long-term effects. So it didn't make that much difference.
But in the face of possible migraines, and of the brusque chicken-nugget-hating doctor's assurance that MG would not develop a tolerance, we doubled her dose of melatonin--to 1 mg, still pretty low overall--and started dosing her religiously every night about an hour before bedtime. We figured if sleep deprivation was triggering the headaches (as well as the overall crabbiness, jumpiness, morning agonies, and circles under the eyes that we already knew it was causing) then that would be enough right there.
There followed a month of relative bliss. Every night, MG willingly popped two melatonin sometime between 8:30 and 9:30 PM, and, about half-hour later, fell over as if klonked on the head, begged to go to bed, and was asleep almost immediately. No more pleas for glasses of water and cold cloths on the head. No more plaintive calls from the bedroom at 10-:30, 11:00, 11:30, long after lights-out, asking for someone to change the disk on her nightly (and, theoretically, soporific) book-on-CD. No more irritable confrontations with a restless child who insists that she's TRYING to go to sleep, really TRYING, but her body just won't LET her.
And no more struggles in the morning with a pathetic lump who pulls the covers over her head and begs for just a few more minutes of sleep, just one more minute, she's so, so, so sleepy, she feels sick...Nope! Instead, we suddenly had a kid who popped out of bed at eight, often on her own without benefit of parental alarm clock. She was even on time to school sometimes.
The headaches didn't disappear entirely, but they lessened, in both duration and frequency. I started keeping a headache log, and determined that they mostly happened when MG was hungry (or at least when she hadn't eaten for a while-- she didn't always recognize it as hunger).
Then, suddenly, the night before last, just as RW and I were settling in to watch our nightly DVD episode of "Big Love"...we heard it. The dreaded cry. "Mommmmm! I can't sleeeeeep!" Despite the doctor's assucances, the melatonin had stopped working, just like that. In the morning, we had to drag MG out of bed, just like old times. Last night, since she was exhausted from the night before, she went to sleep easier, but this morning was just as hard.
I was surprised by how upset I was-- to the point of crying. We'd gotten so used to MG's struggles with sleep that they just seemed normal, until we didn't have them any more. Sure it's easier for us grownups when she goes to sleep quickly and easily and gets up on her own in the morning, but I also had a chance, in the last month, to see what MG was like with enough sleep, something she hasn't had on a regular basis for years. It wasn't a total personality transplant--she was still very much recognizeably herself-- but her temper was mellower, she was more willing to laugh at herself, she could deal with frustrations and challenges with more equanimity, and she seemed sunnier overall. Her life was better.
I'm not sure what to do now. Oviously we need to find another--better--doctor, to deal with both the headaches and the insomnia, and we're working on that. I also consulted Dr. Google (and his/her/its friend, Dr. Facebook) and determined that it's not unusual for melatonin to stop working after a few weeks, and that many (better!) doctors suggest running a schedule that's some variation of two weeks on, one week off. So we're stopping the melatonin for now, in hopes that it might be effective again for a while when school starts.
One of my favorite parenting bloggers, whose son has autism, used to have a tag line on her blog that read "Our special needs are just more obvious." And while I knew that was true, intellectually--everyone has quirks, needs, differences, no one is cookie-cutter "normal"--after the last few months I feel like I get it a little more.
MG needs enough sleep. I mean, she won't die without it, but for her intellectual and emotional and physical well-being-- and ours!-- she needs more sleep than she's been getting until this past month. We've been avoiding sleep specialists, partly because we've had the impression that the conventional medical wisdom holds that Bad Parenting (late bedtimes, lax routines, late TV-watching) is behind most childhood insomnia, even though that's not our experience, and we're not interested in being scolded or spending months on "solutions" that have nothing to do with whatever the causes really are. We'd been sort of limping along, figuring things would work out.
But when I frame MG's sleep issues as a genuine Special Need, suddenly it looks different. I find myself geared up to advocate for her, to brave the lax clinic pediatricians and the imagined sleep specialists and the contradictory recommendations and whatever is out there.
I feel like I should have some rousing finish for this, but I don't. Just hope that we'll all get a good night's sleep tonight.