Notices by Don Romano 🍹 (thj@mastodon.cloud), page 19

Correcting for astigmatism with eyeglasses is a bitch. Your eyes have muscles that tilt them sideways, and if they don't tilt your eyes to the correct angle, the image will be blurry.

The way I discovered this is that I noticed that my visual acuity would change if I tilted my head sideways. Your eyes will tilt to compensate, and this will bring the optics in the glasses out of alignment with the optics in your eyes.

It should hopefully get better in a few days.

@jack I'm kind of doing that stuff on my own. I'm gradually learning how much time I actually have for different tasks, and how to pace myself, do the urgent things now and the less urgent things later, etc.

@jack I suspect drugs like Concerta and Ritalin LA do the upward slope for a reason. But it mustn't be too upward.

@jack It just seems to keep me at "I have more to do".

@jack The thing is, I've noticed that, at least if I take it so it works until bedtime, the reward never comes.

@jack That's interesting, because one of the good days I had quite a while ago on Ritalin was like that. I kept the levels rising all morning, let them peak in the afternoon, and fall after that.

I think the pattern I've been seeing is something like this:

Rising: I am going somewhere. I'm ticking all the boxes. I'm almost there.

Steady: I must try harder. I'm not quite there yet.

Peak: I got there!

Falling: I'm satisfied.

@jack Hydration is something I work hard on, yes. Same with sleep. Already doing the vitamins.

@jack I may re-try Aduvanz at a later time, because I suspect it, too, was affected by stomach issues. I shouldn't have changed my diet so drastically while taking a new medication.

@jack What I'm trying to investigate now is what rising, stable and falling levels imply. I've noticed that when I merely keep the dopamine levels steady, I'm in constant reward seeking mode, but I never actually get the reward itself. I never feel satisfied. I am hoping there is a dopamine curve that produces a three-stage response:

1. Keep going.
2. Almost there.
3. Excellent!

It's possible that another chemical is involved that I can't control, but we'll see. I'm researching right now.

@jack It involves always having a small snack with the Ritalin, plus avoiding food that slows down my stomach, such as fiber. I have always had some degree of gastroparesis and my stomach basically becomes extremely slow if given hard-to-digest foods, such as high-fiber foods, and this is apparently common, and they recommend *avoiding* fiber to people who already have slow stomachs. So, those two things suddenly made the effect predictable.

@jack I had a bit of an a-ha moment this week, as I finally found a regime where Ritalin produces consistent results.

@jack Yes, but that, I already knew. What I didn't quite become aware of until maybe 6 months ago was that dopamine mainly controls reward *seeking* behaviour.

"In popular culture and media, dopamine is often seen as the main chemical of pleasure, but the current opinion in pharmacology is that dopamine instead confers motivational salience; in other words, dopamine signals the perceived motivational prominence (i.e., the desirability or aversiveness) of an outcome, which in turn propels the organism's behavior toward or away from achieving that outcome."

It's not the "oh yes" chemical, but the "keep going" one.

@byllgrim I mean, it makes complete sense if you think about it. Elevated dopamine basically dials up your determination. Elevated adrenaline puts you in survival mode:

@byllgrim Except autists aren't mildly pissed off for a few hours, with a stoned feeling in their head.

@byllgrim And at the far end, cynical business executive turns into autism/OCD in a way. Too focused, too obsessed, too cold.

@byllgrim Contrast a young child with an extremely hard-working and cynical business executive. That's the kind of scale were talking about. Too much in either direction isn't good, so you have to balance it.

@byllgrim I'll use better words and include the middle of the scale this time. Maybe it will make more sense then:

Lazy -> Determined -> Obsessed
Scattered -> Focused -> Tunnel vision
Emotional -> Calm -> Cold
Tired -> Energetic -> Stoned

When you're on the high end of the scale, the only emotions you're able to feel are anger and frustration, because that's what having high dopamine and adrenaline levels does to you. You get very determined (dopamine) and irritable (adrenaline).

@clacke In that analogy, ADHD, as I understand it, is more similar to type 1 diabetes than type 2, except there is no sign of pathology in the tissue; just an incorrect homeostatic set point encoded in the DNA.

@clacke You could draw an analogy to the two main types of diabetes.

In type 1 diabetes, there is a congenital malfunction of the pancreas, and too little insulin is secreted, causing elevated blood glucose levels.

In type 2 diabetes, the pancreas functions properly, but a reduced sensitivity in the fat tissue due to over-saturation. Fat cells inflate like water balloons and once they are full, they no longer absorb glucose in response to insulin secretions.