Posted by: DD | January 27, 2009

HALF OF THIS AND SIX OF THAT

Pharmacist vs. Physician.

Ok, here’s the poop.

First of all, it had nothing to do with a medication that is to be taken at night or day or with food or without food. I used that example because I didn’t want to give specifics since your responses might be less partial.

We have started XBoy on ADHD meds.

There. I said it.

You have no idea how we agonized over the decision, including whether or not we should have waited or started it sooner.

We followed a course that led us to making what we now believe was the best choice for him, which started with seeing the pediatrician, a counselor, a psychologist, teachers, and principal and yet another pediatrician. He had counseling. We had counseling. He had testing.

We tried punishments, rewards systems, fish oil. We did not try diet modification as we cannot realistically maintain a particular diet for a child who spends a majority of the day NOT in our home.

And so, we are here. Treating a child with stimulants to help him focus. To help him excel in school work. To help him create and sustain friendships with his peers.

There’s more. So much more…but I myself am drained of energy and motivation and only now, with just a few minutes before I must go to pick up ZGirl from daycare, do I allow myself to elaborate more on why I think pharmacists are a royal pain in my ass.

The second pediatrician we saw specializes in behavioral issues. He examined the reports by the psychologist and LMHP. He talked with XBoy. He talked with me. He did not talk TO us, and for that I was incredibly appreciative. He recommended that XBoy start The Patch (which reminds me of another story I must share with you).

He specifically  said to cut the patch in half . When my husband went to pick up the script, the pharmacist specifically  said NOT to cut the patch in half; however, she did say it was OK to remove half the backing and apply.

Think about that for a moment and tell me if that makes any bit of sense at all.

When I googled it (of course I did before I did anything else), I realized why the pharmacist may have thought she was giving Mr. DD good info. It’s because she thought the patches still looked like this:

daytrana-old

But in fact, they have since altered the design and now they look more like this:

daytrana-new

As you can see, the old design was more like a bandaid: adhesive on the outside, med in the middle. You cut that and well, yes, you alter the delivery. The new version is in fact designed so that the med is actually embedded into the adhesive from edge to edge. Cutting the first one in half could actually cause “leeching” (which, again, would then make no sense to only remove half the barrier).

My husband took the side of the pharmacist. I obviously, did not. Now if the doctor did not specifically say we could cut it in half, I would have followed the pharmacist’s instructions. I even mentioned this to our regular pediatrician who said quite bluntly that it’s all a matter of money. 10 – 20mg patches are cheaper than 20 – 10mg patches.

Of course.

Then to top it off? My husband, who then had to return to the pharmacist a couple days later to pick up ZGirl’s script for her ear infection did not ask, nor was reminded, to add flavoring. Therefore, the next day, after I had given one dose to ZGirl, I had returned to the pharmacist to have them add the flavoring, I was told that there was no way for them to calculate how much flavoring to now add since I had already used some.

Me? Not happy. At all.

Seriously. Simple algebra would have solved that problem. Rx mg – %mg = Flvr mg – %mg. Duh.

Speaking of which, do you think that when X-amount of medicine is to be distributed they take into account that a baby will spit out approximately 50% after they’ve fooled you into thinking they swallowed so you move the wash cloth away from their face? Because I’m pretty sure that at least that much has ended up on my face, clothes, carpet and sleepers. And that shit doesn’t wash out.

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Responses

  1. I feel precisely the same way about nurses. Seriously. And props to you for finding a solution. You’ll have to let me know how it works.

  2. first of all… lol on the previous post.

    Secondly, I am hoping that medication helps XBoy. I know how difficult that decision probably was.

    Oh, and the cheapness of drug companies? Oh yes. I am reminded that when just recently I had t cut a tablet IN FOURS because the drug company doesn’t think it’s cost effective to make a smaller mg. Sheesh…

  3. I agree, the old definitely should not be cut but I think you are fine with the new ones.

    Hey, if the meds help use them!! If they don’t, ween him off. Give them a shot. There is no shame.

    As a woman with royal screwed up hormones, I know how horrible it can be. There is no shame in a little help.

    And the flavor situation – if there are 80 doses in the bottle and you used 3, why can’t they just add a bit of flavor? Like half of what they normally would have added. That way it at least has a BIT of flavor.

    Chalk it up to the obvious knowledge of the pharmacist.

  4. Ok, I will say it out loud too….Middle son is on Concer*ta. I always swore I would never give my kids ADD meds but ya know what??? It worked so well that I am kicking myself in the ass for not doing it when he was younger.

    He had NO self control, NO fear and nothing including treats and/or punishments made any difference. Now he only takes the meds when he is in a particularly hard class and for exams. (BTW, they are sold freely on campus at testing time..kids get their parents to call the docs and the kids sell them instead of using them…I had a looooonnnnngggg talk with S2 about that and a little thing call FELONY)

    Oh…giving little ones gross medicine.. It absolutely SUCKS. I shouldn’t admit this but when I had to do it (the pharmacy at that time didnt offer flavoring) I flavored my own. I would measure the dose out then add a few drops of cherry juice or other flavoring. The medicine still sucked but it was easier than doing nothing at all.

    Try Oxy*clean and soak over night…it may work.

  5. Hope the patch helps XBoy – no fun trying to figure out what works!

    And Tessa is taking Zantac. If she doesn’t get her full dose, she arches and cries. I often have to give her an extra 1/2 dose after she has spit out 90% of what I put in her mouth. I run out of meds before I can refill – why does no one understand it is like trying to bathe a cat.

  6. Assvice alert!!

    I find (and this is coming from one of those assholes in the medical profession- did i ever mention I was a nurse?? that I used to work for a pediatrician?? heh) the easiest way to administer medication to a baby who spits everything out, is to get some medication syringes. (basically a needle without the pokey-part) Eye-droppers work too, but not as well. It may seem cruel, but basically, what you have to do is lay the child on their back, hold em with one hand, and shoot the liquid a little bit at a time towards their cheek, as far back as you can go (like, almost in their throat)… they might sputter, and they will likely pitch a fit, but they WILL NOT CHOKE on it!! The liquid will go down the proper tube, and this method GREATLY reduces the amount of medication being worn by mom.

    As for the ADHD meds. I’ve seen my fair share of kids who actually needed it, and parents who quite frankly, should have been the ones being medicated instead. Considering the amount of time and thought you put into this decision, I would definitely place you in the first group. Don’t feel guilty for genuinely wanting to help your child!

  7. Um so I guess I’m going to out myself here and say I started taking add*erall as a weight loss drug prescribed by my doctor. And although I don’t have ADD, even I have noticed that I focus a lot more intensely.

    Like Heather said, if it works, it works, and if it doesn’t, he can stop taking it.

  8. It’s hard to say who’s more up on the latest medication – the doctors who are solicited by the pharm. sales people, or the pharmacists who work with the stuff every day. I still would have made the pharmacist call the doctor, so she would have been educated too.

    Sounds like you completed your due diligence on the ADHD medication and your son’s state of mind. Don’t beat yourself up for making an informed decision in the best interest of your child.

    As to the flavoring…I’ve noticed that that kind of thing is handled by pharm techs and they do not improvise. And, how many people do you know who will willingly do algebra?

  9. Hopefully the meds will help X boy, as long as you feel like it’s the right decision then that’s all that matters. We don’t know what you’re going through and we can’t make that decision for you or judge yours.

    And WTF with your former co-worker? Get a life!

  10. Email me which med he’s on. I’m not sure if the kinds we’ve tried come in patch form, but I’m interested in how it’s working. If the patch is worn for more than a day, it would alleviate our problem with kids not taking their pills.

    And you’ve just reminded me of how I get to go through the medicine battles ALL OVER AGAIN. Ugh. I still remember giving Eldest her cough medicine, only to have her just open her mouth and all of it dribble out. BRIGHT red, staining her clothes, the towels, etc. UGH.

  11. Good luck with all your meds. Hope all goes well!

  12. I used to have a great pharmacy. Now I have a bunch of idiots that happen to have the same logo on their shirts as the wonderful ones I used to have in my old city. Makes me sad.

    How long has he been on the patch? Did they mention how long it will take to see if it helps? Keeping my fingers crossed for you both! I know that’s such a hard decision, but you have done a great job of doing your research and trying lots of techniques.

    As far as baby medicine, good question. I have found that medicine syringes have worked best for us too. Not perfect, but better.

  13. Yayyy!

    As you know, I am huge fan of meds for ADD since I have been through so much with them, and they have truly utterly completely changed my life and my kid’s lives for the better.

    I am fascinated by the patch discussion simply because we don’t have that one in Canada yet. It’s coming, but not just yet.

    20 mg of methylphenidate isn’t much though. Are you seeing any results? Is he getting calmer and more focused? The dose seems to have no relation to weight. Only to personal brain chemistry.

    There is a theory I’ve heard from a number of places that in order to determine the right dose, you gradually increase it until they have had just a bit too much—which you can tell by the fact that the kid is too serious, too flat, too calm. Then you go down a level.

    Which is pretty easy to do considering that one dose of ritalin wears off in 4 hours, and even the time release ones are completely gone from the body in 24-48 hours.

    I’m so glad they had you use stimulants the first time. My poor friend had an idiot doc who insisted that she take Strattera for over two years, and keep trying it, even though it wasn’t working at all, and has lots of bad side-effects. (If it works for some people with no effects, maybe, but when it doesn’t?)

    Reality is that even though stimulants are controversial to the public and the media, there is over 70 years of safety data on it. Whether its a patch or a pill, it’s the same old safe and effective stuff, you know?

    Anyway, blathering now…but if you ever have a weird question like that again, go check out the Additude magazine site. They have so may links to so many studies and blogs and FAQs and everything, they are amazing.

  14. Ditto Mrs.Finn on the syringe. Only think that works for us….

  15. Sounds like you have made a well informed decision. Hope it all works out!

  16. I hope you find the right med and dosage for X. It’s a real process, but the nice thing is that you can stop these things w/o withdrawal. I recently went through the process after working on my doctor for over a year to allow it. She prescribed two amphetamines first; one made me a verbose bitch and the other made me verbose fun girl. Neither were an option. Then she started writing scripts for real ADHD drugs. I’d go to the pharmacy and laugh at the cost. Even the old, generic version was over $100/month. I can’t do that. So this personal void which included longing for treatment is still empty and it’s so dumb it’s financial. I know how much I need the focus. I wish I had real insurance. Good luck to X.

  17. Our pharmacist always asks if we want flavoring in children’s medicine–that seems pretty simple to me. And yes, it would seem that you could solve the “how much flavoring to add?” problem pretty simply. But that’s just us. Who can apparently do basic math.

    I know that ADHD meds have helped many, many children and I hope they’re just want XBoy needs to help him out. I would imagine it’s every bit as frustrating for him to behave that way as it is for you and his teachers to have him behaving that way. He’s a smart kid so maybe this will help him focus the way he needs. I really hope so. And definitely don’t beat yourself up over it. You and Mr DD went through all the proper steps in the decision-making process for this. If you’d just gone to his pediatrician and said “We want some Adderall!”, that would be a problem. You did everything you needed to make sure that this was the right choice for XBoy.

  18. Sounds like you have done the right thing, talked to all the right people, tried a few things and now moving on to another thing. Sounds like excellent parenting to me.

    Optional flavour for kids medicine? We have no such luxury here. The OTC stuff all tastes of strawberry but anything on prescription is just as it comes. Z’s stuff tastes of aniseed. Good thing he likes it. Oh and syringes are the thing definitely.

  19. Holy shit batwoman! When it rains, it pours. You can’t make shit like this up! Seriously, WTF? The pharmacy should be glad you didn’t go in there dressed as the unibomber.

  20. AHHHH, medical stuff. Always a trial. We have medicines for a reason. I’m just glad they’re available for when they’re needed.

  21. I’m with the syringe idea for z-girl too. In fact in the UK they always give a syringe with the meds if the kid is under 5.

    Re x-boy, it soudns like you’ve made absolutely the right decision for him. If it doesn’t work, you can try other things, but for now, this will hopefully make all the difference to him.

  22. I will second or third the syringe idea for meds if you don’t think she’s swallowing enough of a dose… just shoot it towards the back of the mouth or into a cheek…

    As for X-Boy, don’t second-guess yourself or beat yourself up over the decisions to try ADD or ADHD meds. Some children NEED them to succeed in school and in life… and eventually, you may be able to wean him off of them once everything starts to click in his head and in his life.

    I really hope they make a huge difference for him and for you and your family.

  23. I think it sounds like you made an extremely educated decision and that’s all that matters. 😀 Hopefully this will offer XBoy the help that he needs.

    Considering a pharmacist should most definitely know how to do a math problem as basic as that I find it a bit astonishing that they wouldn’t add the flavoring. Just not right.

  24. […] school. I credit the daytrana patch. While we resisted until the bitter end accepting he might be ADHD and need medication, it has been a godsend. He even lost five pounds, which moved him from “husky” […]


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