Okay, technically, it was for difficult child 2 since difficult child 1 had been pulled in last week because of his escalating beligerence at home, so he really didn't need to be there again so soon. And just when I thought difficult child 2 would be safe to take to the appointment since his fever was normal all morning and at lunchtime... I took his temp at 4pm just before we were getting ready to leave for the appointment and it was back up to 99.9. And he was coughing more. So I went alone and left husband to pick up difficult child 1 from lacrosse practice and hold down the fort for the evening (he survived). We discussed difficult child 1's slightly improved irritability since starting Tegretol last Friday. husband says he's not as prone to pushing/provoking us, and backs down from an argument sooner than before. And he's been less violent. So that's all good. But it's still not ALL good, yet. He is still emotionally fragile (started crying last night when I got on his case for lying to me (again - oh, big surprise!) about homework and skipping lunch), he is still very impulsive (see the lying comment), and he is still fairly irritable as kids his age go. Those three pieces improving within the next week or so will tell us if Tegretol is doing what it's supposed to do for him. difficult child 1's personal observation is that he feels a little tired from the medication and slower (although I don't see this, it's probably more an internal thing for him). He said he feels like something is pressing down on him -- but couldn't elaborate. We think it has to do with maybe the sedation, or possibly his impulse control? Time will tell. He'll probably need to go back by the end of the month or mid-March instead of waiting our usual 3 months. Then we discussed difficult child 2, how his window of stability seems to be pretty narrow and easily thrown off by things like sleep, level of novel excitement in his daily life, and stress. Over the holidays he got fairly hypomanic for a week or so and then settled down once we got back to the structured bedtime/school schedule. I told him how I'd observed these little blips of increased hyperactivity and agitation every so often, as well as his recent need to sleep around 5pm (this is way before his flu bug this week) -- he would get home from school by 4 or 4:30, be bouncing off the walls and telling me his head was buzzing "a little" and then want to go sleep at 5:00 for an hour or two -- before even starting homework! So psychiatrist is concerned about overall stability not being that reliable yet. If after he's recovered from this flu bug and I continue to see these blips over the next two or three weeks, we'll check his Depakote levels again and then decide what to do from there. We also talked about how the Namenda is working for his focus and attention -- which is better overall, but still has a lot of room for improvement. psychiatrist said we're already at the highest level he'd be willing to try, so now.... (drumrolllllll) We're going to experiment (and it is truly an experiment) with Intuniv (long acting version of Tenex/guanfacine). And I got a pretty good lesson on why this might -- MIGHT be helpful for his focus/attention. And also why it might be very bad for his bipolar disorder if it turns out to not work the way it's supposed to. According to the psychiatrist, (and hopefully I'm translating this right), there was a Yale study that showed Intuniv works on norepinephrine receptors by actually mimicking norepinephrine rather than increasing the levels like other medications do, so it doesn't amplify the signal, it just helps the flow of information go more smoothly. AND it appears to ONLY affect the receptors in the prefrontal cortex (which is the big bad zone that impacts pretty much everyone with ADHD/executive function issues), unlike other norepinephrine-influencing drugs (like tricyclics) that mess with the norepinephrine receptors in the limbic part of the brain (which is the big bad zone that impacts pretty much everyone with bipolar disorder). For a kid at difficult child 2's weight, he said the usual dose for improving focus/attention issues would be 3mg. BUT it would not take that much at all to mess him up if it impacts his bipolar disorder. So we're going to start out at 1mg instead -- low enough to know quickly if it's going to have a negative impact. And if nothing bad happens, we'll work on titrating up. See why I love this guy?