Category Archives: medication

It’s a girl! Baby Addled has arrived!

Baby Addled arrived via emergency c-section early in the morning on April 17.

Since then, I have been recovering from the surgery, adjusting to parenthood, and trying to get the hang of breastfeeding.

This is a quick post (after so many months!) because I’m also trying to finish my academic work by a pressing deadline.

In the meantime, has anyone heard of ritalin inhibiting the production of breastmilk? I had issues with my milk coming in and wondered if it might be because of methylphenidate. Apparently prolactin (the chemical that makes milk come in) is the opposite of dopamine, which is stimulated by stimulants. Too much dopamine = too little prolactin (and no milk), but there doesn’t seem to be any research on this. Anyone else heard of any?

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the reason for my long silence

At long last, I can break my silence and explain why I’ve been away from this blog for so long. It’s because I was afraid I would spill the beans before the time was right.ultrasound clipped

I am pleased to announce that Hubby and I are expecting, and I’m due at the end of April. The ultrasound pic at the right was taken about 6 weeks ago, during my 1st appointment at the High Risk OB (consultation regarding my ADD medication).

So far, things are going well for both me and the little one. Our offspring has a good strong heartbeat, and it danced around a ton during the ultrasound! We have our real ultrasound next month, and will have more information then about its development thus far. The pregnancy has been quite easy for me overall. I had very little morning sickness, other than some food aversions and mild nausea at odd times of the day. It only lasted for about 3 weeks, and the worst of it went away when I stopped taking the fish oil supplement (prenatal vitamin adjunct).

A note about fish oil that’s relevant for ADDers, pregnant or not: This might sound stupid, but do not try taking it at night. For a month, I took it with my regular prenatal vitamin at dinner, and I had insomnia for that entire month. It was miserable. The insomnia decreased when I switched to taking it in the morning, and it helped a little bit with concentration. Notwithstanding, a single capsule was murder on my stomach. Maybe it wouldn’t have been so awful if I hadn’t been in the middle of morning sickness, but I’m also not convinced that it wasn’t the cause of the morning sickness itself.

Medication has been a bit tricky, at least at first. I was switched to a new pdoc around the same time I had the positive pregnancy test. Amazingly, my new pdoc has ADD, and she’s been amazingly helpful and supportive with troubleshooting my medication. We tried various options: I dropped back to 10mg of ritalin 3x/day, then 5 mg 3x/day, on the way to the goal of 0 mg of ritalin 0x/day. I was frustrated and miserable at 5mg, and barely functional at 10mg, but I stuck with that dose for a month before going to the aforementioned high risk OB consultation. The three high risk OBs I’ve now worked with in that office have actually been the most supportive of my medication. One of them even said to me, “If you need this medication to function, you need it to function. Period.” Their acceptance was amazingly refreshing. Of course, the reality is that we won’t know for some time if my medication has done any harm… keep your fingers crossed for us, please!

Work issues have been resolving themselves. I met with my department chair today to let him know about our upcoming addition, and he was very supportive. It looks like we will be able to put some plans into place in advance to handle my inevitable absence at the end of the spring semester, and I have some decisions to make about using my summer funding, stopping the tenure clock for next year, etc. I have time to make these decisions, fortunately. This was a big relief, but it’s really the small things at work that have made it more stressful for me this semester. For example, I outgrew most of my work pants around 6-8 weeks of pregnancy, and now I’m starting to outgrow my work shirts. I don’t look particularly pregnant, just  a bit pot-bellied… The second “minor” issue is H1N1 flu. It’s going around on my campus, and I’ve had at least a dozen students out sick with it. I was able to get the H1N1 vaccine over a week ago, but still have a few days until I will have full immunity against all the nasty germs my students are sneezing and coughing all over the place. Yuck!

All in all, everything’s going far better than we’d anticipated, and I can only hope that things continue to go this smoothly between now and the end of April!

a clarification on my November post about knowing more than my doctor

I *loved* this comment from PreMedAA so much that I’m going to write a whole post in response to it. This comment followed my early-November post about my annoyance with my new psychiatrist.

The background for readers who don’t want to refer back to old posts (plus filling in some gaps I’ve previously omitted to help hide my real identity): I switched shrinks when I moved to a new state over the summer. Hubby and I knew that we wanted to start to try for a family sometime this autumn, which was my first in a faculty position after 3 years in a health sciences postdoc. Having discussed the issue of medication and pregnancy at length with my old shrink (a fellow in geriatric psychiatry at one of the best psychiatric hospitals in the nation who I very much  miss), I was keenly invested in seeking the best care possible in my new setting. My old shrink was supportive, and asked me to keep in touch with her about my treatment in this new setting. My old shrink appreciated that since Hubby and I have started talking seriously about kids, two limitations have been foremost on my mind: a) I’m able to work up to my full potential because of ritalin, and taking a 2-year break from it in order to conceive could potentially tank my chances for tenure, and b) having spent 9 years in pre- and postdoctoral training, I’m no longer a spring chicken. If we’re going to start a family, we need to start trying soon, or we risk running out of time.

S0, imagine my dismay when I called for an appointment at my new university’s med center specialty AD/HD clinic (in July) and found out I’d have to wait 2 months in order to get an appointment (September). My dismay was further magnified when I met my new doc and discovered how inexperienced she was. I brought up the pregnancy & meds issue at our first appointment in September. She promised to do research before our next appointment, and wrote me a prescription for the SSRI I take for PMDD (note: she wrote it for the bi-weekly dosing, which is quite standard for treating PMDD). When I came back in October, she hadn’t yet done any research on pregnancy & ritalin. I brought up the research I’d done on my own and with my old doc. She promised to look into it and get back to me. When I came back in November, she still hadn’t done any research and seemed to have forgotten about the bi-weekly dosing of SSRIs for PMDD (despite having written the prescription herself just weeks before). She promised to consult with her network of supervisors and colleagues, and assured me she would call me in a week. I had to call her a week later to remind her of our phone appointment. She was rather unprepared when she called me back, and asked me to come in before Thanksgiving for a short chat in person about the literature & promised to bring an important research publication. I made (& paid for) the extra appointment, for which she ran 30 minutes late. She forgot to bring the article (promised to fax it, but it still hasn’t happened & I’m not holding my breath), but still couldn’t say anything conclusive or provide me any strong evidence for any option during pregnancy. She pushed really, really  hard for my trying fish oil, which apparently shows decent efficacy with young children (alas, if I were only in the 2nd grade and just learning simple multiplication instead of spending my days doing matrix algebra…).  So I’m still on hold, and yet can’t get another appointment in the clinic until  early January.

So, my hubby and I have put off trying to conceive for an additional 6-7 months, and 4 months of that delay is due to my new shrink being inexperienced and inefficient. I’ve also wasted a total of 4 hours of my semester in the waiting room filled with people who function at a far, far lower level than I do… and to put this in practical terms, 4 hours = the preparation of 1 full lecture or 4 written pages of a research article.  The bottom line is that I sought a specialty clinic thinking it would save me time and effort, and I probably could have received better treatment from a GP.

(I suspect that quite a few ADDer readers have had similar treatment experiences. My situation is anything but unique.)

So, now I’ll deal with PreMedAA’s lovely comments…

Would you have preferred for the resident to attempt to cover her ignorance and simply take her ‘best educated guess’?

A physician at any level may not have confident answers on the tip of their tongue, especially if their patient has a keen grasp of pharmacology and medicine.

I agree with you; no, I wouldn’t want her to ‘cover’ by making a guess, but a competent medical professional in a specialty clinic shouldn’t need 3-4 months to come up with an answer to this sort of question, regardless of who the patient is, or how threatening the patient’s competence is to the physician’s ego. It’s not like ADD is a new condition, and I’m hardly the first woman who wants to get pregnant without tanking her career by going totally med-free.

Stating that you know more about something than a doctor may or may not be true. Your ‘knowledge’ may have been garnered from secondary sources or your educational background may be insufficient to properly digest the primary pharmacodynamics proposed by the manufacturing company. Your doctor is not a CPS or PDR, if they were, those compendiums wouldn’t exist.

Actually, I have a Ph.D. in the health sciences, and my research specialty is self-regulation, the set of skills directly impacted by the medical condition of AD/HD. It takes longer to get a Ph.D. in  my field than it does for a M.D. to complete medical school, and I have 3+ years of postdoctoral training on top of that. Furthermore, I’m 2+ years past diagnosis, and have been very actively involved in my treatment. This has included spending a great deal of my free time reading the literature on AD/HD and medication. Yes, I read the primary sources, and yes, I understand them, even the “yucky” stats part in the middle. In short, I have more years of research training in the field, and unless my doc has ADD herself, then most likely I also have more first-hand experience.

If you were particularly impatient, which you claim to be, then perhaps stating your acceptance of her consultation of her reference books in your presence would have saved you both time, as its likely that she didn’t feel dragging out the books in front of you would inspire much confidence, which you could have offered to alleviate.

For pete’s sake… the November post as just a blog entry, not a direct transcript of my conversation with my doctor. I actually would respect her more if she had dragged out her reference books. Of course I consented to allow her to consult with colleagues and do further independent research. I’ve repeatedly told her that I understand that residents are still training, and have also repeatedly expressed a desire to consult about primary references (i.e., current research). She’s the one who’s not been willing or able to meet me halfway on this. How much more open, supportive, and non ego-threatening can I really be? How long should someone be reasonably expected to wait?

You claim to know more about treating ADD/ADHD than your 1st year psychiatry resident-attending physician which is unlikely unless your a physician yourself and in the case of Adderall…at least a pharmacologist.

I’m not writing anything else about my specific academic credentials because I risk outing myself, and that’s  not a good thing pre-tenure.  Just a few points… a) she’s a 1st year resident, not an attending; b) it’s “you’re,” not “your,” and your sentence structure doesn’t make much sense; c) finally, if you’d bothered to read any of my other entries, you’d realize that I take ritalin, not adderall.

But since you don’t have time to permit your physician to ensure the validity of her counsel, then perhaps you ought to consult with a pharmacist about the possible effects of your drug regime on pregnancy…and perhaps they would be familiar with your atypical SSRI rotation.

The possibility that you havn’t done this already on your own suggests that such comments in regard to having a superior clinical knowledge of your diagnosis may not be advisable on your part, especially towards a medical professional.

Doctors are not gods, and the rest of us are not “lesser” beings.  Contrary to the belief of many MDs, they don’t know everything, they do make mistakes, their time is no more valuable than anybody else’s, and they don’t deserve to be treated any better or worse than anyone else.  I’ve given her plenty of time, and she’s wasted it. As a faculty member who is currently working 60+ hour weeks, I don’t have time or the patience to train somebody how to do their job OR remind them about how they’ve treated my condition at previous appointments. In these circumstances, I shouldn’t have to bend over backwards or jeopardize any aspect of my future in order to keep them from feeling badly about themselves or their abilities.

an ADD moment at my conference

I had an “ADD moment” at my conference over the weekend.

By some misfortune, I was scheduled to present a poster at 8 a.m. Sunday morning. This is the *worst* presentation slot, and I’ve now had it two years in a row. I’m a good sport, however, and prepared in advance so I wouldn’t have to scramble on Sunday morning.

I didn’t know about daylight savings time until I arrived at the conference on Wednesday afternoon. But, I still prepared in advance, set several clocks so I wouldn’t sleep in and miss my presentation time, etc. I even woke up on time, had a cup of coffee, and made it to the poster hall early. I was really, really proud of this, because I am not a morning person.
Five minutes after I put up my poster, I realized I hadn’t taken my medication. So on top of being really, really tired, I could barely string sentences together because I was sans-ritalin.

The punchline: I still didn’t remember to take my medication, even though I’d carried it with me to the poster hall! The 1-2 times I remembered I needed to take it I ended up getting distracted. The bottom line… I was too tired to remember to take something that helps me function like a normal person even when I’m tired.

I’m not beating myself up about this too much, and in fact, I’ve been laughing about it ever since. Fortunately only a few people came to the 8 a.m. session (my supervisor was not one of them), and I didn’t need to do any real deep thinking at that point of the morning. Plus, I could joke about not being able to think straight because I was so tired, just like everybody else at the session.

I did experience a cool “first” at this conference: multiple people recognized my name! I was greeted enthusiastically at one poster by name (“Dr. Addled! It’s so nice to meet you! I really enjoyed your article on French pastry techniques, and would love it if you attended my symposium later on croissants!”), and another person purposely found me to tell me how valuable they found my research. This has never happened before, and it’s pretty darn cool!

still nothing

I wish I could give a more exciting update, but I still don’t have any job offers. I did, however, receive a rejection letter on Friday morning (the “cooking” job). Not a big shocker, nor a huge disappointment. I’m starting to freak out because my options are becoming more and more limited. I leave for a final interview tomorrow at a small, midwestern liberal arts college similiar to my alma mater (Keep your fingers crossed for me, please!. I also just submitted an application for a position overseas, in Hubby’s dad’s current country of residence.

At this point, I’m just feeling resigned and flat. It doesn’t help that I’m in the thick of the PMDD blues (started taking medication again on Thursday, but it’s not working very well yet), and just feel like a distracted piece of crap while trying to prepare for this interview and cope with my phone’s silence.  It also doesn’t help that Hubby’s going through a crisis at work (i.e., is so frustrated that he’s getting closer and closer to walking away and finding something else), and would love for me to get the job in his dad’s current home country. The fact that neither of us really speak the language spoken in this area is not even on his radar, while I start to panic at the thought of having to lecture in a language I haven’t studied in years.

One thing at a time… one thing at a time…. one thing at a time….

pdoc troubles yet again

My Unkymood Punkymood (Unkymoods)

Sometimes I wonder if my pdoc needs her own ritalin prescription.

I had my regular appointment about two weeks ago. Med Shrink wrote my usual prescription for ritalin, and I barely looked at it before dashing back to the office. I wasn’t out and was pretty swamped with work, so I waited a few days to fill it.

I tried to fill it the following Tuesday, only to discover that a) she hadn’t written the actual dosage on the prescription (i.e., she’d written “15 mg 3x/daily” instead of “1.5 10-mg tablets 3x/daily”), and b) hadn’t signed the prescription itself. Naturally the pharmacy wouldn’t fill it, and the pharmacists probably now think I’ve swiped my doc’s prescription pad!

I called Med Shrink on Tuesday night. She called me back Wednesday afternoon, and said that she’d write a new prescription and leave it in “location a.” She called back a while later and said “I wanted to leave it in location b, but I couldn’t, so you can pick it up at location c sometime before 8 pm tonight.”

I went to location c at 4.45 p.m. on Thursday, and found that they’d closed at 4.30.

I went back to location c on Friday morning, and they said they didn’t have anything for me. I subsequently visited locations a and b in order to make sure I hadn’t misunderstood (keep in mind that I’m doing all this on foot, and it takes me 15-20 min to get from my office to location c). I hadn’t — they didn’t have anything for me, either.

I called Med Shrink on Friday afternoon to double-check the location. She didn’t call me back until Monday afternoon (Today), and was pretty testy with me about the whole ordeal. She called location c to verify that they had the prescription she’d written; it turns out that they did, and that the person I’d spoken to on Friday didn’t “know where to look.”

So, I stopped by location c on my way home this afternoon, and was finally able to pick up the envelope. I opened it on my way home and nearly had a heart attack.

It was written for 15mg 2x/day instead of 3x/day… and indicated that the pharmacy should dispense 45 10mg tablets.

Let’s do the math together: 15mg x 3 doses per day = 4.5 10mg tabs per day. 4.5 tabs x 30 days per month = 135 tablets. Not 45. The prescription I’ve now spent hours trying to pick up is enough for 10 productive work days, and my next appointment is 15 days away.

I’ve already called and left a message on Med Shrink’s voice mail. Given that it typically takes her 24+ hours to respond, it looks like I’ll run out of medication and waste several more hours of precious time before this mess is straightened out. At this moment, I have 4 tablets left, and I am hesitant to fill an incorrect prescription for ritalin.

But it does look like it’s time to find a new doctor, does it not?