Phew. I've finally reached the turning point in my diagnosis story, that being my appointment with Dr. I! After about two months of striving to get proper help, he was my last chance. I knew that if he couldn't or wouldn't help me, I would have to give up....because I was running out of patience and money :-/
Thankfully, though the receptionist at Dr. I's office was a bit...well, rude (seriously, what is with doctor's receptionists and their attitudes? they keep just about the easiest hours ever and all they have to do is not be jerks, but they can't even accomplish that)...Dr. I himself was great. We talked about how I'd been trying to find help, about Dr. Shady and his bullshit, about the things I'd discussed with Dr. A. I did have to repeat a lot of what I'd already told both Dr. Shady and Dr. A, but at this point I suppose I was used to having to repeat myself...and after a while Dr. I said that he was glad I'd decided to seek help, because he could see the ADHD tendencies in me - not just in the information I was giving him, but in the way I sat, jittered my leg, moved and wrung my hands...
And then Dr. I pulled out a sheet of paper. "Here is your thousand dollar ADHD assessment," he joked. It was a little questionnaire, on just one side of the paper, maybe 20 questions long at most. In fact, it was very similar to this questionnaire that I had found and taken online prior to my first appointment with Dr. A.
He left me in his office for maybe 5-10 minutes to fill out the "assessment". I answered the questions as truthfully as I could, but to be honest I toned down some of my responses. I didn't want this doctor to think that I was just being ridiculous. But when he returned and reviewed my answers, he still seemed shocked that things for me were...well, as bad as they were. To the point where he told me that the fact that I hadn't been on medication for my ADHD before was "exemplary".
Of course, he doesn't know about how many relationships I've failed because of my hyperfocusing, loss of interest, and cheating. He doesn't know that the only classes I didn't struggle in were the few that I took by choice (in college). He doesn't know that in just the past 7years I've held 11 jobs with 8 different companies and that I've been on the verge of losing my current job for months because I can't focus long enough to get even the simplest tasks done.
For right now, though, all of that is besides the point :) I'll get into those aspects of having ADHD at a later time. At the moment this entry is long enough, and next up I will write about the medication portion of my diagnosis. Hopefully it won't take me another week to find the time to post! The holidays are just such a crazy busy time of year.
Saturday, December 24, 2011
Saturday, December 17, 2011
Side Effects...
Oops! I keep meaning to write another entry, another piece to my diagnosis story, but to be honest I've been insanely busy. That, and I've absolutely hyperfocused on something new...a series of books, in fact, and when I'm not reading them I'm on the internet researching them. Silly me.
Anyway, in the past week or so I've really started noticing some side effects from my meds. I knew I would, of course. To be honest sometimes my heart flutters and that troubles me a bit, because it's not something that ever happened before. But the other side effects...well, I'm still deciding how I feel about them.
I know that my meds are appetite suppressants, but I'm a food person. I love it. I eat healthily and I exercise nearly every day, but I'm not a thin person and never really have been. I'm okay with that. So even though I knew that the adderall/dexedrine would lead to me not being hungry as often, I assumed it wouldn't really make a big difference...because I often eat when I'm not hungry. But the thing is, it not only makes me not hungry, I get so focused (on reading a book or doing stuff at work or writing) that I forget to eat. And then when I remember, I eat very little because after a few bites I feel...weird. Not nauseated, but off, unable to eat a full meal. I wasn't really prepared for this and though when I do eat I eat good food, and I take a multivitamin as well...I guess we'll just have to see. I suppose there are worse things than losing a few pounds, and on top of that I probably make up for it on the days when I don't take my meds.
The other side effect is...well, I guess one could say that it's more positive. To be completely honest my sex drive has always been above average (and I'll get into that another time, trust me), but suddenly I am just...well, horny. All the time. I had to ask around a bit to determine that I was right in thinking it was from the meds...because my doctor certainly didn't say anything about them giving my sex drive a boost. So although I don't have any definitive evidence that they are what is causing this sudden uptick, the fact that it started a couple of weeks ago - right around the time my meds were really kicking in, because I'd been on them for a few weeks - and because others who have been on similar medications have said they experienced something like this as well - I'm going with my gut and saying that this is a side effect.
Anyway, now that I've babbled on and on, I'll get on with my day :) And I'll try to write again - sooner this time, and probably the next part of my diagnosis story.
Anyway, in the past week or so I've really started noticing some side effects from my meds. I knew I would, of course. To be honest sometimes my heart flutters and that troubles me a bit, because it's not something that ever happened before. But the other side effects...well, I'm still deciding how I feel about them.
I know that my meds are appetite suppressants, but I'm a food person. I love it. I eat healthily and I exercise nearly every day, but I'm not a thin person and never really have been. I'm okay with that. So even though I knew that the adderall/dexedrine would lead to me not being hungry as often, I assumed it wouldn't really make a big difference...because I often eat when I'm not hungry. But the thing is, it not only makes me not hungry, I get so focused (on reading a book or doing stuff at work or writing) that I forget to eat. And then when I remember, I eat very little because after a few bites I feel...weird. Not nauseated, but off, unable to eat a full meal. I wasn't really prepared for this and though when I do eat I eat good food, and I take a multivitamin as well...I guess we'll just have to see. I suppose there are worse things than losing a few pounds, and on top of that I probably make up for it on the days when I don't take my meds.
The other side effect is...well, I guess one could say that it's more positive. To be completely honest my sex drive has always been above average (and I'll get into that another time, trust me), but suddenly I am just...well, horny. All the time. I had to ask around a bit to determine that I was right in thinking it was from the meds...because my doctor certainly didn't say anything about them giving my sex drive a boost. So although I don't have any definitive evidence that they are what is causing this sudden uptick, the fact that it started a couple of weeks ago - right around the time my meds were really kicking in, because I'd been on them for a few weeks - and because others who have been on similar medications have said they experienced something like this as well - I'm going with my gut and saying that this is a side effect.
Anyway, now that I've babbled on and on, I'll get on with my day :) And I'll try to write again - sooner this time, and probably the next part of my diagnosis story.
Wednesday, December 7, 2011
My Diagnosis Story, Part 5
Okay.
At this point I've now talked to my general practitioner and two psychologists about my situation, remember? Well, before I left my first appointment with Dr. A she told me that she wanted to refer me to an ADHD specialist. Apparently she hadn't had much experience with ADHD, especially in newly-diagnosed adults, and didn't feel comfortable prescribing meds for it period. Which was probably also why Dr. Shady had wanted to give me some ridiculously expensive computer assessment - he didn't feel comfortable prescribing most ADHD meds and therefore didn't want to have to shoulder that responsibility on his own. Of course, instead of telling me as much and referring me to someone else, he robbed me of $150 and then tried to convince me to come back!
Anyway.
Dr. A scheduled our next appointment for two weeks from that day and told me she would be referring me to Dr. I. She knew he was in my insurance network and said that his office would contact me. I honestly got a bit nervous that something else had gone wrong when I didn't hear from Dr. I that week - but 6 days after my appointment with Dr. A I finally got a call and set up an appointment. Unfortunately the first opening they had was in November :-/ Thankfully Dr. A was still helpful - I went to my second appointment with her, she made sure they'd contacted me, and after our talk she gave me some "exercises" to try. Basically she wanted me to be able to sit and do 20 minutes of work without stopping, breaking, getting distracted. I knew that usually I could rarely do even 10 minutes without one of those things happening, but I promised to try. I did try. I even succeeded a few times. But far more often...I didn't succeed. I honestly felt like crap when I returned to Dr. A for my third appointment, but she didn't seem very surprised that it had been difficult for me to accomplish that 20 minute goal on a regular basis.
"You don't need therapy, per se," she admitted. "I think that you're ready to take medication for your ADHD and Dr. I will be able to help you with that. If you feel the need to talk to someone, you can always come see me - but if not, this is where we part ways. I'm sure you'll like Dr. I, though."
Yes I felt a bit...abandoned, when she told me this. I know that it was silly to feel this way - I'd only sat with her three times, after all. And I knew that I had to go see Dr. I if I really wanted to figure this ADHD thing out. But Dr. A was the first truly helpful person I'd encountered in this journey, so yes - until I met Dr. I, I wasn't sure whether or not I wanted to completely move on and not see Dr. A at all.
At this point I've now talked to my general practitioner and two psychologists about my situation, remember? Well, before I left my first appointment with Dr. A she told me that she wanted to refer me to an ADHD specialist. Apparently she hadn't had much experience with ADHD, especially in newly-diagnosed adults, and didn't feel comfortable prescribing meds for it period. Which was probably also why Dr. Shady had wanted to give me some ridiculously expensive computer assessment - he didn't feel comfortable prescribing most ADHD meds and therefore didn't want to have to shoulder that responsibility on his own. Of course, instead of telling me as much and referring me to someone else, he robbed me of $150 and then tried to convince me to come back!
Anyway.
Dr. A scheduled our next appointment for two weeks from that day and told me she would be referring me to Dr. I. She knew he was in my insurance network and said that his office would contact me. I honestly got a bit nervous that something else had gone wrong when I didn't hear from Dr. I that week - but 6 days after my appointment with Dr. A I finally got a call and set up an appointment. Unfortunately the first opening they had was in November :-/ Thankfully Dr. A was still helpful - I went to my second appointment with her, she made sure they'd contacted me, and after our talk she gave me some "exercises" to try. Basically she wanted me to be able to sit and do 20 minutes of work without stopping, breaking, getting distracted. I knew that usually I could rarely do even 10 minutes without one of those things happening, but I promised to try. I did try. I even succeeded a few times. But far more often...I didn't succeed. I honestly felt like crap when I returned to Dr. A for my third appointment, but she didn't seem very surprised that it had been difficult for me to accomplish that 20 minute goal on a regular basis.
"You don't need therapy, per se," she admitted. "I think that you're ready to take medication for your ADHD and Dr. I will be able to help you with that. If you feel the need to talk to someone, you can always come see me - but if not, this is where we part ways. I'm sure you'll like Dr. I, though."
Yes I felt a bit...abandoned, when she told me this. I know that it was silly to feel this way - I'd only sat with her three times, after all. And I knew that I had to go see Dr. I if I really wanted to figure this ADHD thing out. But Dr. A was the first truly helpful person I'd encountered in this journey, so yes - until I met Dr. I, I wasn't sure whether or not I wanted to completely move on and not see Dr. A at all.
Thursday, December 1, 2011
Wait a minute...what am I taking?
Another quick break in my diagnosis story, because I had my follow up appointment for my meds this week and I left it a bit...confused. As it was supposed to be a short appointment and I didn't want to sound like I was just asking a bunch of inane questions, I decided to do my own (read: Google) research on the meds that have currently been prescribed to me.
What confused me is that my current doctor - we'll call him Dr. I - told me he was prescribing "Adderall XR" when the label on my bottle says something like (sorry, don't have it with me at the moment) "Dext-phetamine SR". I get that "SR" and "XR" both mean extended release, but the generic versions of Adderall I've seen in the past have all been "Amphetamine Salts". Of course, my prescription said "Adderall XR, generics OK" so the obvious conclusion is that Dext-amphetamine SR is simply another name for generic Adderall. Got it.
At this appointment I explained that I was okay with the current medication and dosage, except for the fact that it never seemed to last longer than 6 or 7 hours (and this seemed to depend on how much I ate after taking it). Obviously I don't have a 6 or 7 hour work day, so this was posing a slight problem when 3 PM-ish came around and it suddenly felt as if I'd hit a brick wall. I was honest worried that this was an issue with me personally, but thankfully Dr. I admitted that the extended release seems to have extremely varied results. For some people it lasts 4 hours; for others, 8 or 9 or even more. Some doctors will apparently prescribe two doses of extended release meds a day, but Dr. I said he doesn't like to do that. "Normally my first reaction would be to prescribe a small amount of instant release Adderall," he told me, "but as that's going to be nearly impossible to find until at least January, I think your best bet would be Dexedrine - which is just the instant release version of what you're already prescribed."
This is where I started to get a bit confused. If I was taking what is supposedly the generic form of Adderall XR, and "Dexedrine" is the instant release version of the extended release pills I'm taking...how is it different from instant release Adderall??? Why is there such a problem/shortage of IR Adderall if Dexedrine is the same exact thing?
Since I simply didn't have time to ask Dr. I the million and one questions racing through my brain, I took the first free moments I had and did a little reading online. I found the following descriptions of the "differences" between Adderall and Dexedrine:
From Wikipedia, "In the United States, an instant release tablet preparation of the salt dextroamphetamine sulfate is available under the brand names Dexedrine and Dextrostat, in 5 mg and 10 mg strengths, and as a capsule preparation of controlled release dextroamphetamine sulfate, under the brand names Dexedrine SR and Dexedrine Spansule, in the strengths of 5 mg, 10 mg, and 15 mg."
On the other hand, "Another pharmaceutical that contains dextroamphetamine is Adderall. The drug formulation of Adderall (both controlled and instant release forms) is:
An experiment with rats suggested Adderall’s inclusion of levoamphetamine provides the pharmaceutical with a quicker onset and longer clinical effect compared to pharmaceuticals exclusively formulated of dextroamphetamine. One study has shown that although the human brain usually has a preference for dextroamphetamine over levoamphetamine, certain children have a better clinical response to levoamphetamine.
Amphetamine exists as two stereoisomers that differ in effects. The l- enantiomer (levoamphetamine) produces more cardiovascular and peripheral effects than the d- enantiomer (dextroamphetamine). At low doses, levoamphetamine produces greater arousal than dextroamphetamine, acting primarily on norepinephrine. At higher doses, dextroamphetamine has stimulant properties that are three to four times as potent as those of levoamphetamine, and acts primarily on dopamine, although few clinical studies of ADHD, have documented differences among d-, l- and racemic amphetamine."
From a Yahoo Answers response by someone who is obviously well-versed in these drugs: "Difference in effect: Adderall is prescribed in approximately twice the dosage of Dexedrine. A 10mg pill of Adderall contains 2.5mg of Dexedrine but has similar effect as 5mg of Dexedrine. Due to the 4 different salts and increased dosage needed, Adderall is more likely to give side effects than Dexedrine. These side effects include increased heart rate, blood pressure, decreased appetite, inability to sleep, muscle tightness, and head ache. Ritalin is a another story and usually falls in between the other two as far as side effects go however, many parents and patients report a withdrawn effect from Ritalin that goes beyond it just being effective. Dexedrine also slightly acts positively on serotonin and can increase mood where as Adderall can make people more moody."
Other information I came across made connotations about Dexedrine having a more negative stigma than Adderall, because it is pure dextroamphetamine. One person made a comment that dosages were actually the same (i.e. 15 mg Dexedrine is the same as 15 mg Adderall) but that doesn't seem to coincide with the fact that Adderall contains less dextroamphetamine...I'm inclined to believe Mr. Yahoo Answers up there regarding Dexedrine being needed in smaller doses. Regardless...at least I'm now a bit more informed about what I'm putting into my body. Previously all of my research had been on Focalin/Ritalin, Vyvanse, Strattera, and Adderall...I had no idea that Dexedrine existed. But it does, and it's decidedly not the same thing as any of the above drugs.
Of course one last problem remains...why would Dr. I be able to prescribe me Adderall XR (despite the shortage, because according to the interwebz all Adderall is hard to find at the mo) and have me receive the generic, which is Dextroamphetamine and therefore must actually be the generic of Dexedrine XR...but then have to prescribe me Dexedrine as an instant release? I don't know. I guess I'm just stupidly confused :-/
What confused me is that my current doctor - we'll call him Dr. I - told me he was prescribing "Adderall XR" when the label on my bottle says something like (sorry, don't have it with me at the moment) "Dext-phetamine SR". I get that "SR" and "XR" both mean extended release, but the generic versions of Adderall I've seen in the past have all been "Amphetamine Salts". Of course, my prescription said "Adderall XR, generics OK" so the obvious conclusion is that Dext-amphetamine SR is simply another name for generic Adderall. Got it.
At this appointment I explained that I was okay with the current medication and dosage, except for the fact that it never seemed to last longer than 6 or 7 hours (and this seemed to depend on how much I ate after taking it). Obviously I don't have a 6 or 7 hour work day, so this was posing a slight problem when 3 PM-ish came around and it suddenly felt as if I'd hit a brick wall. I was honest worried that this was an issue with me personally, but thankfully Dr. I admitted that the extended release seems to have extremely varied results. For some people it lasts 4 hours; for others, 8 or 9 or even more. Some doctors will apparently prescribe two doses of extended release meds a day, but Dr. I said he doesn't like to do that. "Normally my first reaction would be to prescribe a small amount of instant release Adderall," he told me, "but as that's going to be nearly impossible to find until at least January, I think your best bet would be Dexedrine - which is just the instant release version of what you're already prescribed."
This is where I started to get a bit confused. If I was taking what is supposedly the generic form of Adderall XR, and "Dexedrine" is the instant release version of the extended release pills I'm taking...how is it different from instant release Adderall??? Why is there such a problem/shortage of IR Adderall if Dexedrine is the same exact thing?
Since I simply didn't have time to ask Dr. I the million and one questions racing through my brain, I took the first free moments I had and did a little reading online. I found the following descriptions of the "differences" between Adderall and Dexedrine:
From Wikipedia, "In the United States, an instant release tablet preparation of the salt dextroamphetamine sulfate is available under the brand names Dexedrine and Dextrostat, in 5 mg and 10 mg strengths, and as a capsule preparation of controlled release dextroamphetamine sulfate, under the brand names Dexedrine SR and Dexedrine Spansule, in the strengths of 5 mg, 10 mg, and 15 mg."
On the other hand, "Another pharmaceutical that contains dextroamphetamine is Adderall. The drug formulation of Adderall (both controlled and instant release forms) is:
-
- One-quarter racemic (d,l-)amphetamine aspartate monohydrate
- One-quarter dextroamphetamine saccharin
- One-quarter dextroamphetamine sulfate
- One-quarter racemic (d,l-)amphetamine sulfate
An experiment with rats suggested Adderall’s inclusion of levoamphetamine provides the pharmaceutical with a quicker onset and longer clinical effect compared to pharmaceuticals exclusively formulated of dextroamphetamine. One study has shown that although the human brain usually has a preference for dextroamphetamine over levoamphetamine, certain children have a better clinical response to levoamphetamine.
Amphetamine exists as two stereoisomers that differ in effects. The l- enantiomer (levoamphetamine) produces more cardiovascular and peripheral effects than the d- enantiomer (dextroamphetamine). At low doses, levoamphetamine produces greater arousal than dextroamphetamine, acting primarily on norepinephrine. At higher doses, dextroamphetamine has stimulant properties that are three to four times as potent as those of levoamphetamine, and acts primarily on dopamine, although few clinical studies of ADHD, have documented differences among d-, l- and racemic amphetamine."
From a Yahoo Answers response by someone who is obviously well-versed in these drugs: "Difference in effect: Adderall is prescribed in approximately twice the dosage of Dexedrine. A 10mg pill of Adderall contains 2.5mg of Dexedrine but has similar effect as 5mg of Dexedrine. Due to the 4 different salts and increased dosage needed, Adderall is more likely to give side effects than Dexedrine. These side effects include increased heart rate, blood pressure, decreased appetite, inability to sleep, muscle tightness, and head ache. Ritalin is a another story and usually falls in between the other two as far as side effects go however, many parents and patients report a withdrawn effect from Ritalin that goes beyond it just being effective. Dexedrine also slightly acts positively on serotonin and can increase mood where as Adderall can make people more moody."
Other information I came across made connotations about Dexedrine having a more negative stigma than Adderall, because it is pure dextroamphetamine. One person made a comment that dosages were actually the same (i.e. 15 mg Dexedrine is the same as 15 mg Adderall) but that doesn't seem to coincide with the fact that Adderall contains less dextroamphetamine...I'm inclined to believe Mr. Yahoo Answers up there regarding Dexedrine being needed in smaller doses. Regardless...at least I'm now a bit more informed about what I'm putting into my body. Previously all of my research had been on Focalin/Ritalin, Vyvanse, Strattera, and Adderall...I had no idea that Dexedrine existed. But it does, and it's decidedly not the same thing as any of the above drugs.
Of course one last problem remains...why would Dr. I be able to prescribe me Adderall XR (despite the shortage, because according to the interwebz all Adderall is hard to find at the mo) and have me receive the generic, which is Dextroamphetamine and therefore must actually be the generic of Dexedrine XR...but then have to prescribe me Dexedrine as an instant release? I don't know. I guess I'm just stupidly confused :-/
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