regain my ability to concentrate

After lots more googling over the last couple months, I’ve hit on a new hypothesis about my itching: it might be caused by Cheyletiella blakei, a mite that lives and breeds on cats but is “highly mobile” and occasionally causes intense itching in nearby humans.

Some facts in favor of C. blakei:

• The most easily visible sign of the mite is “walking dandruff” along the back of the cat, especially in the lumbrosacral region. (I think the dandruff is skin flakes being carried by the mites, which are almost impossible to see, but one or two sources say that the walking dandruff is the mites.) My cat Shedubi has dandruff mostly along her back, concentrated at the lumbosacral region.

• If I put my hand or face near some cloth where Shedubi has been sleeping, I feel the itching almost immediately. This is another common sign of Cheyletiella.

• Cheyletiella is most active at night and the itch it produces often feels like a “crawling sensation”. That’s how it’s been for me. Often the itch feels to me like grains of cornmeal on my skin.

• In my diary, I found that I had brought Shedubi to a veterinary clinic for the first time on July 5, and on July 7, I had itching so intense that it “shut me down”. I had itching before this, but it was not nearly this intense, and Zyrtec usually shut it down. Sometime after this (I have no exact record), the itch became most intense at night (starting almost exactly at 12:00 a.m. standard time) and neither Zyrtec nor any other antihistamine had any effect on it (suggesting that the itch is not an allergic reaction). Before July 5, there is just one note, on June 26, about feeling itchy and being annoyed by cat-hairs. Also, before July 5, I don’t have any record or memory of proximity to Shedubi causing me to itch (I first got her in July of the previous year). I did record that she was itching a lot before then, though; that’s partly why I brought her to the vet. Bottom line, it sounds like Shedubi may have picked up some mites while at the clinic, though it’s not completely certain.

• Shedubi sneezes and itches, though not a whole lot. When she sneezes or scratches herself, usually I am feeling especially itchy right at the same time.

Some facts against C. blakei:

• I haven’t seen any of the dandruff flakes on Shedubi’s back move. I’ve stared at black specks of dirt on my skin, where I had this itch and where I thought I saw the speck move, but I never saw a speck move while I was looking at it carefully (watching to see if its distance from something nearby changed).

• Normally, when a person suffers from C. blakei, they get little red skin lesions. I don’t have the characteristic red skin lesions. However, I read in one place that sometimes people get “pruritus without lesions” (that’s what I’ve had), and actually, I think I did have a few lesions on my scalp, or at least some really bad eczema. Also, the literature says that even though the person’s face typically itches and they have an urge to rub their face, no lesions appear on the face. That’s exactly what’s been happening.

• My main symptom is actually not itching, it’s this weird “wound up” feeling. (Does anyone know a medical term for feeling so wound up, you can’t slow down or focus on anything for more than a couple seconds?) The itch is always accompanied by the wound-up feeling, but the wound-up feeling is usually not accompanied by the itch. I’ve had the wound-up feeling most of the time I’ve been in Indiana, including the two years before I got Shedubi. It has subsided within 48 hours each time I have gone out of town.

Some other facts of interest:

• The mite is highly contagious, but most cats and most people don’t have symptoms. My other three cats don’t itch, sneeze, or have dandruff.

• The mite cannot reproduce on people; it needs a cat for a host. Without a proper host, Cheyletiella mites usually die off within two days, ten days at most.

• Nobody knows how the mite causes itching or lesions in humans. The presumption is that the lesions are from bites, but no one’s caught a mite in the act.

• The mite is extremely difficult to see with the naked eye even though it’s about 1/3 of a millimeter long (big enough to resolve with the naked eye). They’re rather translucent and, I think, they tend to blend in against most backgrounds.

• I’ve only come across one documented case of a C. blakei mite being found on a human. Usually veterinarians can find some of the mites by scraping the skin on the cat’s back and putting the mites in alchohol, but I’ve repeatedly seen articles say, “But we were unable to recover any mites from the person.” The presumption is that the mites are “highly mobile” and are long gone by the time you start looking carefully for one that has caused an itch.

• Most doctors don’t know about Cheyletiella mites, which also have zoönotic species that infest dogs and rabbits. The literature says they’re probably much more common than reported, due to the difficulties of identifying them or even suspecting them. Most people suffering from them do not suspect that the itch is coming from a pet. They consult an ordinary people-doctor or dermatologist, who of course can’t figure it out. And when I told my vet that it seemed to me that Shedubi was making me itch, she didn’t want to get involved with trying to diagnose and treat a person.

Shedubi and I have an appointment at the veterinary clinic tomorrow morning. I told them that I’d like them to check for C. blakei, and they said they’d try. I’m going to print out some of the journal articles I’ve found and summarize the main facts as above. I hope I don’t appear to be a crackpot. Or rather, I hope I get to talk with a veterinarian who enjoys solving an unfamiliar mystery (or one who already knows all about Cheyletiella).

Since early July, I’ve been itching all over most of the time on most days. It’s very hard to focus on anything. I’m not sure if the itching is related to my other difficulties with concentration, or a separate cause also making it hard to focus.

I’ve talked to a couple doctors. They think it’s probably pollen. They say that Southern Indiana is really bad for people with allergies. I’ve never had an allergic reaction to much of anything before, but I’ve had some itching from Spring through Fall every year I’ve been in Indiana.

I have no respiratory symptoms (watery eyes, sneezing, that sort of thing). It’s just itching. Itching is extremely annoying because it’s a distraction. Itching is just like grad school: it keeps me so wound up, I can’t think. It’s most intense at night, peaking around 4:00 a.m.

Antihistamines haven’t helped much. Benadryl has no effect: it doesn’t even make me drowsy. (Sleeping is at least not the agony of constant distraction!) Vyvanse does help.

It occurred to me tonight that I’ve spent most of my time in grad school stressed out and unable to concentrate. That’s about 2½ years of low productivity, nearly always rushing, nearly always craving rest and quiet.

Short of quitting grad school, I don’t know what to do about it. Well, I have done a few things, which have improved my state of mind noticeably although not enormously. Taking Vyvanse has helped a bit: no more yelling out in agony for hours, and I think it’s actually lowered my blood pressure. Turning down my tuition waiver for one semester so I can go without teaching has helped, too. I still find it difficult to really focus on anything, though.

At this point, it’s difficult to even imagine focused, satisfying work or just enjoying a day. I figure, though, my only hope is to work toward those things, even if I can’t imagine them very clearly.

I figured out that after this semester, I could take just six units per semester and finish the Ph.D. in three more years. That’s a total of six years, which is not too bad. I even have funding for all that time, though the funding depends on teaching.

I asked around, and found out about a couple classes where I could do fairly easy grading instead of assistant teaching. The teaching is way more fun and gives me a chance to do something meaningful (actually, the teaching has been satisfying work), but it’s also used up most of my mental energy.

I waived my teaching assistantship for one semester. The trade-off is that I pay for tuition (very expensive in grad school) and get no stipend, but I can focus on classes and research. The five semesters when I taught, it was wonderful, but it chewed up an awful lot of my attention.

We’re now three weeks into the semester. I ended up taking four classes, which puts me in some danger of yet another semester of attention overload, but even so, my mind is much less frazzled than during the previous semesters.

I think the Vyvanse has become a lot less effective in the past couple weeks, but it still seems to be making some difference. I may look into increasing the dose.

Last Monday, I saw a new doctor about ADHD. She’s a huge improvement over the first two that I saw. For one thing, she knew what she was talking about! She knew the difficulties, she knew the trade-offs, and she explained options to me and let me choose. This is what I want from a doctor. (Did you know that “doctor” is Latin for teacher?)

I chose Vyvanse. It’s expensive but I’ve got insurance. Previously, I had rejected it, because it’s just amphetamine (same as Adderall), but with an amino acid added so it won’t work if you snort it or inject it. I didn’t see any point in paying a much higher price for the same drug. But she explained that unlike the Adderall I tried last year, this has a very slow release so the effect lasts about 14 hours without peaks and valleys. That sounds excellent.

First day (very low dose): I didn’t notice much, but I definitely noticed something: I was calmer and less scattered.

Second day (higher dose): Extraordinary result: I had an ordinary sort of calm and focus the whole day. None of the feeling of running a little hyped up that I had gotten from the Adderall. Usually (at least in grad school) I’m constantly jumping back and forth between things, losing my train of thought, and feeling too overwhelmed to plan out a a task of a few steps and execute them. Today, though, I had none of that feeling of overwhelm. I could even gather thoughts and say them coherently during a conversation instead of blurting out a bunch of tangents all mixed together. I was able to carry on a conversation and speak coherently about moderately complex matters when at the eye doctor. A friend noticed that I seemed unusually calm and steady.

Third day (same dose): About the same as the first day.

I still haven’t reached the recommended dose. So far, things are promising.

Made a move to reduce my distraction level: I arranged to do an independent study with my research advisor next semester (Spring 2010). This will mean that I have actual time to work on what I came to grad school for, as opposed to trying to slip it in in odd moments.

I’ll still be taking two other classes and assistant-teaching one. That is a problem. The assistant-teaching is fun, but it pretty well ensures that I never have a full day to work on anything during regular working hours. That does not sound to me like a recipe for success.

I finally got a Ritalin prescription. Tried it (20 mg) 4-1/2 hours ago. Not much effect, as far as I can tell. I got a bit of a headache, felt a tiny bit dizzy, and felt somewhat calm. I’m not sure my concentration improved, but I wasn’t frazzled and I only once forgot what I was doing while in the middle of it. I didn’t get annoyed by slow-loading web pages. I was kind of sleepy (I didn’t get much sleep last night), and got a little hungry. I did not feel any great improvement in my ability to consciously direct my attention, though perhaps there was some; hard to say.

The plan is to try Ritalin for two weeks, and then Adderall for two weeks. Then the semester begins. Hopefully by then I’ll know what works.

It’s been about six weeks since the end of the semester, and I’m still not fully recovered. Much improved, but still finding concentration for more than five minutes or so difficult. That’s a big improvement over 2 seconds, so this is progress.

My feeling after two semesters of grad school is similar to how I felt for about nine hours after an agonizing pair programming session with someone who jarringly interrupted every few seconds. A horrible sort of internal rhythm, where no flow can ever get going.

I’m not sure what to do about this. Ideas so far:

1. Sleep a lot and do nothing for weeks or months until the agony goes away. (What I’ve been doing.)

2. Participate in an in-depth discussion on an email discussion list. (I’ve been doing this, too.) Writing doesn’t require more than short bursts of focus, and you can easily pick up where you left off. Spending a couple hours on one long message is helping me get out of that mode of “expect to be interrupted the instant any flow gets going”.

3. Listen to Kraftwerk. (I started this about a week ago.) I tried listening to Kraftwerk a year or so ago, and thought they were dull and repetitious. Indeed they are. But right now, dull and repetitious is good therapy.

4. Take some sort of job that’s not too demanding. A little focus, a little something completed, a little more focus, and so on, ought to make a nice feedback loop to bring me back to my normal ability to concentrate.

5. Get diagnosed with ADHD-I and try Ritalin or Adderall.

6. Brainwave entrainment. Supposedly you can externally force your brain waves into “beta”, inducing the high-attention state. Sounds iffy, but it also sounds harmless if it doesn’t work, and it costs essentially nothing.

7. Watch movies. I watched recordings of a TV show during the semester, and I think that helped regain a little concentration. It’s completely passive, and you follow one coherent thread for half an hour.

8. Spend some more time in San Francisco. Just a few days back “home” brought rapid improvement.

Has anyone else here lost their ability to concentrate? If so, how did you get it back?