Tuesday, March 18, 2008

to medicate, or not to medicate?

That is the question. We go to the pediatrician on Thursday for E's 4-year-old checkup appt. So, in the meantime, I'm running through every possible scenario in my mind, of how it'll be when we discuss the dreaded 4-letter acronym......ADHD.......and what to do about it.

We haven't seen the ped in quite a while, since my boys have the annoying habit of only getting sick on weekends, when the ped is obviously unavailable. We end up at urgent care, which works fine, but means the ped is WAY behind the times on what's up with E these days.

It seems pretty clear to anyone who spends time with E that there is a hyperactivity/impulse control/aggression issue. Is it officially ADHD? Guess that remains to be seen. For a while before A got diagnosed on the autism spectrum, I had my suspicions and my "mother's intuition" telling me that something wasn't right, and leading me toward autism once I began to research and read. Well, same thing here. The more I learn, the more I think ADHD. And it's depressing. I know I have blessed little to complain about, if ADHD is the worst thing that my formerly 1.5 lb baby has to deal with, but still it's not something you'd wish to have.

All along, even when it was just talking hypothetically, I've always said that modern medicines exist for a reason. They do help people, and have a benefit in many cases. So many people go into "crotchety old person" mode when discussing these kind of medicines.....you've heard it, stuff like: "well, in MY day we didn't have those newfangled drugs. We just had to discipline our kids and make them behave" etc etc etc. But I've always said that if it ever was necessary for a child of mine to take meds, and it would help them, we'd do it without question.

Well, can I take back the "without question" part? Because the closer it gets to the time in which meds might really be prescribed, the shakier I'm getting about the concept. Is it a cop-out? Isn't there more I could have done, or could be doing, before resorting to a chemical solution? Will he have to be on these meds forever? What are the potential side effects? Are the long-term effects even known yet?

Part of me just wants to go in to the doctor on Thursday, throw myself at her feet and say "DO SOMETHING, HELP ME!!!!!!!" Then I'll gather up my prescription for mind-altering drugs and be on my way, right? But the other part of me is worried, thinks that I might be pushing too heavily and too quickly for meds for only selfish reasons......because I'm tired, because I'm stressed, because I'm at my wits' end with him and am just giving up. In other words, don't expect me to work hard and bring about improvements in his behavior on my own, just let the chemicals do it.

And even if we do choose to try meds, which one? I dread the thought of having to go through (possibly) several different drugs before finding one that seems to work without turning my little bundle of joy into a zombie, etc. And going back in for follow-up blood tests to check levels, etc....oh joy, won't that be fun for a 4 year old?

I guess the only redeeming fact in all of this, if you can even call it that, is that preemies have been proven to have a higher incidence of ADHD. Therefore, maybe it is NOT all in my mind, maybe I'm NOT just a lazy mom, maybe there is a true, real, physical reason for his behavior and his struggles with control. We've dodged so many bullets with him in 4 years....IUGR, PDA, failure to thrive, being on a vent, inability to eat, etc etc etc. Today, other than these behavioral/aggression problems, he is a healthy, smart and thriving little boy. And I never hesitated to let NICU docs give him indomethacin for that PDA, right? So if his difficulties have a biological cause, they might respond to a biologically-based treatment......?

Well, I'm not really any closer to deciding what to do yet, but it helps to talk it through. I do know that if we end up choosing meds for him, I'm NOT going to be broadcasting it in our social circles, etc. There's still a certain stigma attached, at least around here anyway. Guess that's another post for another day.


lyndsey said...

((((big hugs)))) I know EXACTLY what you mean as we are in the same boat. It is so hard. It makes you feel bad/guilty either way-- IS there a right answer? I don't know. I hope you will have a short journey in medication and you'll find something to help him right away with no side effects. ((((hugs))))

tafkalorelei said...

((((hugs))) IMHO...you have to do what you have to do. Medicine might be the answer now but not on down the line. I agree that with the behavior that it seems like you have more on your hands than just a rowdy 4 year old...you've said time and time again all of the things that you are doing. It's not your fault. I would talk with the ped and get their opinion and if you trust your ped then go with what they say and don't worry about anyone else. In the end what matters is how you are all functioning with him (home, school, church, etc). (((((hugs)))))

Anonymous said...

Jen - as E's mom you know what is best, even when you might question yourself. Sometimes thinking on it can only play to wreak more havoc, so I hope when you do see the ped tomorrow that you find the answers you seek. Big hugs to you and E!

Jen said...

Jen, I have a younger brother who had severe ADHD as kid. He is now 22, and the most calm, pleasant person. I can still vividly recall his behavior when he was 4, and I know you will take care of Ethan's needs...whatever they are.

The meds help the brain to regulate the messages being passed in the frontal lobe. Preemie brains are wired differently. E's brain just needs a bit of assistance, with the help of your love and frame work of boundaries.


Snicker said...

I went through much of the same agony you are now facing. My daughter was driving me crazy! I read many books and faithfully used the behavior mod techniques they taught, and while it helped me to feel like my world was not totally out of control, none of them got to the heart of the problem or made any significant difference in my daughter's behavior.

WHY was she terrible some of the time and fine other times? Why was she so much calmer when she got sick? Why would she seem to be at her worst after I had rewarded her....ungrateful little wench! I had gotten past the part about blaming myself and gradually began to suspect that the problem was with her....some chemical imbalance in her brain, even though I really didn't know what that meant.

She was clearly bright, and precocious, reading at 3 and sounding out new words at 3 1/2. So the small comfort was that at least some part of her brain was working well, but I just wanted a kid that behaved normally.

I tried to speak with one pediatrician, and after listening patiently to my tale of woe, she gave me a pamphlet on discipline.

If any doctor had told me there was a medicine that would have helped Laura behave, I would have knocked him out of my way as I ran straight to the nearest pharmacy to have it filled. But that was 1975 and ADHD had not yet been coined, troublesome kids were caused by bad parenting (translate that to bad moms), girls were not "hyperkinetic", and everyone knew that kids grew out of it in a few years.

It was just a fluke that my husband discovered his migraine headaches were being triggered by some of the additives in the foods we ate. I would learn that the brightly colored dyes and some of the preservatives in our food came from coal tar oil (and now from petroleum). The fake vanilla (vanillin) was being made from the waste products of paper mills and that the preservative TBHQ is related to butane (lighter fluid). Take a look at www.school-lunch.org for a real eye-opener.

I never wondered why the cherry Tylenol I gave her so often was bright red and never read the ingredient label on the back of a box of Jell-O. I never considered how little juice was in the Hawaiian Punch or asked myself about the grape Hi-C I enjoyed. (If they bragged that it contained 10% real grape juice, then what was the other 90%?)

Anyway, when my husband stopped eating these chemicals and I went back to fairly basic food, his migraines ended and Laura's behavior was normal. If either of them had even a small amount of the petrochemicals, the awful symptoms would return. Eventually, they lost this extreme sensitivity.

Today, I know how to find any food we want, but minus the petroleum. I'm healthier now than I was in 1975 and we are blessed with two bright, healthy grandchildren.

I have written two books on the subject and could supply you with information on the down side of the ADHD drugs if you wish. But my objection is not so much to the use of medicine, but to the fact that few doctors try to identify the reason(s) for the symptoms. What is being called ADHD is a cluster of symptoms whose cause is unknown. But we do know that there are many things that can produce hyperactive behaviors and inattention. These include: exposure to heavy metals like lead, deficiency in vitamins and/or essential fatty acids, food or environmental allergies, lack of sound sleep or of enough sleep - which can be linked to nasal problems/enlarged tonsils, fluoride, vision deficits, sensory integration deficits, drug reactions, and even the eruption of new teeth can be at the root of disturbed behavior for a small number of kids. And, of course, exposure to petrochemicals in our food and environment. Most fragrances today are made from petroleum so breathing it in can result in "brain fog" or acting-out behavior. One little girl couldn't spell correctly in the classroom but did fine at home; the teacher had put a "plug in" near the child's desk. One mom told me her son's "ADHD" started after she changed her brand of laundry detergent.

Happily, it's not really hard to figure this out once you know where to look for clues. I work with a non-profit parent group that helps families do this. Today, I find most of the foods and non-food products I want in my local supermarket. The food tastes better we all feel better, and my husband hasn't had a migraine since 1975.


tafkalorelei said...

Hey chica...you've been tagged!


Sharon said...

I've been there myself. I literally made an appointment to get medication for myself because I was stressed and depressed. The neurologist said I could not get medication until my son was 6 and I needed something to get me by. Plus my husband and I were disagreeing over the use of medication.
In the meantime I found the Feingold program, which is basicly just removing artificials from your diet and some testing of foods. I didn't think it would work, but I was making hubby happy by trying something diffrent.
Wow! was I surprized when it worked. It took about 2 weeks to notice a difference. My son started sleeping through the night, sitting through meals, walking in hallways. He started to learn and focus. He could do the things I asked him to do. His loud high pitched voice became normal. He didn't look like a skeleton anymore, and he gained muscle tone. I finally started to enjoy him.
I can't understand why diet was never mentioned to me by the neurologist or my pediatrician.
Hopefully that will change with recent approval of the lancet studies by the American Academy of Pediatrics.
Just wanted to share what helped us. Sharon