Damn psychiatrist....arghhh!

[Californiablonde]

So I go and pick up difficult child 2's prescription for Focalin yesterday. I find out that he was given the smallest dose and his has to be given twice a day, meaning he would have to take it at home and at school. I do NOT want to go through the hassle of giving a pill in the morning then having him pulled out of class or on his lunch break so the school nurse can give him another. Further more, medications at school require a doctor's note. I can't just send him to school with a bottle of pills and tell them he needs to take them. psychiatrist is a child psychiatrist. Shouldn't he know this already?

There are plenty of other long acting stims out there that he can try. Why give him one that has to be taken twice a day? I know he's not a mind reader but doesn't he know how difficult he makes it on the parents and school if he prescribes something with those instructions? Oh, and on the bottle, all it says is to give it to him twice daily. So what does that mean? Four hours apart, six hours apart....what? I am not about to guess at this and just give it to him whenever I damn well feel like it.

So I called psychiatrist last night and told the receptionist he needs to call me back ASAP because I am not going to give him one damn pill until I get these instructions right. He never called me back. Not last night and not this morning. I called the pharmacist to see if there were more instructions that they had that I didn't. The pharmacist had the nerve to tell me that I was supposed to give him one dose in the morning and one dose in the evening. I reminded her that this is a stimulant. I am NOT about to give my kid who suffers from insomnia a stimulant before bed time! The pharmacist argued with me and kept telling me that this was the doctor's instructions. Well I think she's full of ****. What kind of reputable psychiatrist would give a kid a stimulant at bedtime??

So I email doctor right away this morning. Let him know that I am not happy with the whole taking medications at school thing, plus we don't have a doctor's note so how on earth can we do it anyway. Then asked him exactly how far apart I should space the pills because I would like to at least try out this medication on the weekend with him just to see how he reacts to his first try with a stimulant. I still have not heard back anything. We have been seeing this psychiatrist for several years now and I have never had a problem getting ahold of him promptly. Who knows, maybe he had an emergency last night, I don't know. I could be jumping the gun. Still, I want answers and I'm not getting any so I guess difficult child 2 will remain medication free until I get some.

 

[keista]

in my opinion you can still try it over the weekend. Try just one dose and see what it does. If it lasts for X amount of hours then you know when to re-dose (and what to expect). Stims are supposed to be fast in, fast out without the need for a "build up" over weeks, so morning and night does not make sense.

 

[Californiablonde]

So if I just give him one dose without giving him the other one you think it should still be okay? I figured it would but I want to be extra safe. I guess there's no harm in giving him one pill to see how he does. I am not going to give it to him on Tuesday at school until I hear back from psychiatrist though. I really hope he will save me a lot of driving and just call in another prescription for a longer acting medication. I really don't want him taking this medication at school. There are plenty of other options out there, including Focalin XR, which is a long acting form. So now I just got through reading about the side effects. I knew I shouldn't have done that. It says that sudden death can happen accompanying heart problems. difficult child 2 doesn't have any heart problems that I know of, but I know that some problems can go indiagnosed until something bad happens. I guess I should try and stop thinking of worse case scenerios. My anxiety is in over drive right now. I wish I could just relax and trust the damn doctor.

 

[InsaneCdn]

CB... Folacin has similar side effects to the ritalin family - concerta, etc.

difficult child is on the MAX they will allow for Concerta... has been on that or Ritalin for years... and the only side effect we've had is... "some" appetite suppression. Appetite suppression is the most likely side-effect.

Not that my kid and your kid are the same, just saying that... lots and lots are on this stuff without any problems. It's kinda like Step's thread about the call from the OB office... "risk risk risk"... but we don't need to see you for 8 more weeks...

 

[Liahona]

You could give one in the morning this weekend and then wait and see when it wears off. It might wear off at lunch or not until right before school gets out. It probably just depends on how his body metabolizes the medication. Or it could be such a small dose you don't notice anything. You won't know until you try, but I would try over the weekend.

 

[Californiablonde]

Well psychiatrist just emailed me back and told me to give him one pill before school, which would be a whole hour before class because I have to be to work by 7:30. Then he says give him his second pill after school before he does his homework. WTH? psychiatrist knows I'm a working mom. We don't get home till 5:30! I am not about to give him a stimulant at night time! I'm just using my common sense here. My kid already has insomnia and I'm not about to make it worse by giving him a stimulant that late. Besides, difficult child gets all his homework done at daycare afterschool. Rarely does he have any to bring home, unless it's a special assignment. Usually I trust this psychiatrist to know what he's talking about but right now I'm seriously questioning him on this.

 

[InsaneCdn]

Besides, difficult child gets all his homework done at daycare afterschool.

Which means, when he really needs the second one is at the start of daycare... which is probably the same problem as getting it at school!

 

[Californiablonde]

Yep, you're right. I would have the same issue with daycare. As a matter of fact, even with a dr. note, I don't think daycare is able to give medications. What a hassle. I wish he'd just call me in a prescription for Focalin XR and it would make everything a whole lot easier. I emailed him back reminding him that we don't get home till 5:00 at the very earliest. I asked him what other alternatives there are. Suggested the longer acting Focalin. He has not answered me back. It's just about time to shut everything down and leave work for me. I don't think I am going to get my answers this weekend. I am going to give difficult child one dose of it tomorrow and see how it goes. I'm praying for the best outcome.

 

[helpangel]

If psychiatrist doesn't prescribe the XR ask him for the school permission to give the medication at 3:00 or the end of the school day. I'm really hoping he prescribes the XR medicating at school is a pain once had a problem with missing ritalin from a daycare, hope it works out.

 

[TeDo]

difficult child 1 has taken his ADHD medication in the morning and then another after lunch at school for years. Our school faxes over the permission form to the doctor and the doctor faxes it right back. We found that his medication lasts for 6 hours at the most. The booster at school gives him enough to get through homework time. It's never been a big deal for me or for the school nurse.

 

[buddy]

Some thoughts just to consider (because it is not complicated enough, is it??? sorry)

1. The idea of trying one and seeing how long it lasts is really good. Your child may only need one or may react to how it wears off and then you will want to make sure that you cover that by giving the second before this time. see #2

2. Sometimes there is a rebound effect when the stimulant (especially the short acting ones) wear off. The child can become more revved and inattentive and impulsive than before the medications at all. So, some kids need to take a tapering off dose. For us, Concerta (long acting) does not do that but ritalin does.

What we do if he takes Ritalin is because it lasts 3.5 hours for my son (every person is different but I think it i s avg. of four hours), he gets the next dose at 3 hours so that he doesn't go into that rebound period. then the next dose is half. of that and he does ok.

3. Daycare should be able to give the medication if they are a licensed center. I owned one and we had forms to use just like schools. It was no big deal. But you can have school give it to him right before he leaves. I have the nurse bring it to his class so there is not a transition deal and staff just brings it to him and quickly hands it to him with no one even seeing the nurse was in the hall. My nephew prefers to just go on the way into school and on a break when no one would ever know the difference. If you do any doses at school ask that it be during a rest room break or between classes etc. Not so big a deal then.


And, NO they dont realize....I only have ONE doctor who does and that is his neuro who has an aspie. even his psychiatrist doesn't think of i t and she has three special needs kids.... some with serious medical issues, sigh.

 

[Californiablonde]

To have him take this medication at our school he needs a note from the doctor brought in to the school by me and given to the nurse. To be able to do this, I would have to take a whole hour off of work in the morning to get down to the school and give them the letter. I would not be able to do this until Wednesday when we have his IEP meeting. I am already taking a whole half day off of work to attend his IEP. I cannot take any more time off than that. So difficult child will have to wait until then to start taking this medication. I suppose delaying his treatment a day or two wouldn't hurt. I will call the doctor on Tuesday and see if he can fax the stupid note instead of driving all the way the hell down back to his office after work to pick up the note. Hopefully faxing will be good enough. psychiatrist's office is not close to where we live. If I have to do it I will but I will not be happy about it. He shoulda told me AT the appointment that he has to take it twice a day. Then I coulda told him right then and there that I wanted something long acting. Right now my stress is at an all time high and I'd prefer to alleviate as much added stress as possible.

 

[buddy]

OH heck no... I just have our docs fax a note to the school!

 

[Californiablonde]

Well hopefully faxing will do. But still, my whole point to this is: wouldn't a long acting stimulant be the wiser choice?? Let's just keep the school out of IT. Give me a long acting damn pill that can be given in the morning ONLY and then problem solved??? He shoulda known ahead of time how much of a hardship this would be on me. I am a single hard working mom. Enough said. He shoulda discussed all this c-r-a-p at the appointment! Not having me to go through this c-r-a-p afterwords!

 

[InsaneCdn]

CB....
You're stressed out. Probably need more than just Calgon to solve it... but...

I've been dealing with stims (for 3 of us) for lots of years.
And... they ALWAYS start with short-acting.
Because IF there is going to be a reaction, it is the fastest out of the system.
It's the lowest-risk trial.
And you're not 100% sold on stims due to prior experience...
I can see where he's coming from. Some valid reasons for going this route.

BUT.
Yes, all of this should have been discussed AT the meeting, AND (in my opinion) the psychiatrist should already know about the need for doctor's note for school and have had that ready, etc.

 

[buddy]

I was going to say what IC said, as soon as you know it is the ticket (or not)....THEN you would want to switch to long acting. There is a big benefit to short acting and it is just what IC said, quick in, quick out. If there is a problem you are not going to see him suffer for so long. It is also easier to figure out what dose you need then they can better calculate the long acting. For my nephew, there have been times that long acting could not be done because that seemed to affect his sleep a nd eating so much but by switching to the short acting, he had times of day he could eat and it left his system better and he was able to sleep. Even if you go with long acting, it i s nice to have the short. My son will sometimes sleep in REALLY late. I then may use short acting all day. Usually I use the short acting just for after 9.5 hours after dosing the concerta, and then we use Ritalin to get through the rest of the day (you know how they say when a child needs it you dont see it affect them as much for side effects? My son is a dramatic case of that, he DOESN"T eat off of it and has never had issues with sleep. I can give it to him at 9 and he can fall asleep....like if we are out at an activity or something, he will fall asleep in the car. crazy...and ---well disclaimer he has an enzyme issue that affects absorbtion--- he takes 105mg of Concerta in the morning and 40 mg of Ritalin once or twice in the evening. I always try to lower it and it can cause such impulsive moves there is danger...we tried in the hospital too and no way).

 

[DammitJanet]

I was also going to say what IC said..which was also what Buddy said. Look, most schools have their medicine notes on their websites. Go there and see if they have one posted. If they do you can download it and then email it to your doctor and ask them to Fill it out and fax it to your school. Thankfully when my kids were in school this wasnt even an issue. Can you believe my kids just took the bottle to school and the teachers kept the bottles in their desks and called all the kids up to her desk at lunch time and handed out the medications to every kid who took medications? Its a wonder they all got the right medications! After they got old enough to be responsible enough to make sure they took them, they just carried the bottles in their pockets. Now they did have a note in their files that said they took medications.

Normally it isnt a huge deal to get the doctor's notes.

 

[Liahona]

Just an idea; dr. faxes it to school, school secretary hands it to you, you hand it back to her. There, you have just hand delivered it to the school.

 

[Californiablonde]

I work till four. I work a half hour away from the school. By the time I got to the school, they would be closed an hour and a half. The best possible solution for this would be for the doctor to prescribe the long acting form. I don't see any other way around this.

 

[buddy]

Well, now there will be a wait anyway, so either way you are going to have to get a new rx or the permission right? If the school wants their specific form used they can fax it to the doctor and the doctor can fax it back. I have had to do this with an hour left before dosing time, it is stressful but can be done.