Thursday we had The Boy's six month check in with the developmental pediatrician (Dr. B). I always dread these appointments. All we do is focus on the negative (which I know is why we are there...but still, it is depressing). Amazing Daddy and I always leave there feeling very down; asking ourselves if The Boy is really that fucked up...
This appointment was no different than the ones before it, even though in many ways The Boy has made huge strides forward. At one point I was in tears during the appointment, and after it was all I could do not to start sobbing.
Two appointments ago The Boy was taking Adderal for his ADHD. It was helping him in some ways, but it was also causing him to be very emotional. And he was having pretty intense episodes of anger and rage. He was also talking about some pretty serious things, like blood, killing, knives, etc. It was quite scary for us, as we started to worry if we were raising a serial killer. The Boy's regular pediatrician had prescribed the Adderal after TB had showed some adverse reactions* to Metadate (Ritalin by a different company). At this appointment with Dr. B she explained that she didn't like to use Adderal, that it was too harsh, and often caused the type of rage we were seeing with TB. She also expressed concern about his talk of knives, blood, etc. and called them "ideations." She wanted us to see a colleague of hers, a forensic psychiatrist (Dr. S). And we decided to give the Metadate another try.
I contacted Dr. S., who was now in practice by herself, and we spoke on the phone and via email several times. An evaluation by her was going to cost us approximately $2500. And she was about a two hour drive away. She works with seriuosly disturbed children. She wasn't that concerned about TB, and felt that we didn't need her services...at least not yet.
I checked in with Dr. B via phone and told her this. I also told her that another therapist (Dr. W) she had recommended (to help with behavior management) we see was not taking new patients and they told us to call back in three months, but we were going to go back to our attachment therapist who was willing to work with us even though attachment wasn't his main concern now. So Dr. B told me she thought that would be fine and not to worry about Dr. W.
At our last appointment (in June I think) we tweaked the dose of his medication and added a short acting Ritalin dose in the afternoon. Fortunately the eye tic didn't return when we retried the Metadate. And the "ideations" were no longer an issue. TB had a great summer, and was even able to go several weeks at daycare without a TSS.
In September he started to show some of his old behaviors again (but not the aggresive talk/ideations). So we increased his dose from 1 1/2 capsules to two capsules, which seemed to help him. Again, he was doing fairly well.
Some where around this time we were supposed to go back and see Dr. B., but when I called to make the appointment I was never able to get ahold of anyone. I was either on hold for extended periods of time, or I would leave a voice mail but no one would return my call. Since he was doing so well I just gave up on trying to get the appointment. Not to mention this was around the time my pregnancy was really exhausting me, physically and emotionally. I admit that I wasn't as on top of things with TB as I had been in the past, with all aspects of his life.
Well, at Thursdays appointment she reamed me out for not being back to see her earlier. What could I say? I told her I wasn't making excuses, but getting an appointment was practically impossible, and that he was doing great, so it just didn't seem that important.
So she let that drop and we started talking about our concerns. I told her that I thought his medication needed to be tweaked a bit, and she jumped on me that he was already taking a large dose for his age and why did I think he needed more. I responded that I wasn't saying he needed more, but that I thought he needed something adjusted...and then told her what I was seeing to make me think that. Things like how rough our evenings were, and that it was obvious the medication had worn off by about dinner time. And about how he often wakes up in the middle of the night and won't go back to sleep. And, how wild he is in the morning...like a caged animal in some ways. So she suggested we try him on Strattera, in addition to what he is already taking. Since that was one of my thoughts going in to the appointment, I agreed.
Then, she starts talking about his "ideations." I had to tell her several times that they weren't a concern anymore. That I felt very confident in contributing that to the Adderal. She had a hard time dropping it though. And then started back on why we didn't see Dr. S. So I had to tell her the reasons, which I had already told her last summer. And also, why we hadn't seen Dr. W, but were seeing the attachment therapist.
And then she wants to know why we saw an attachment therapist. By then I was getting pissed...and confused. So I reminded her that The Boy was adopted, and was in an orphanage, and we saw an attachment therapist because he had problems with attachment. I think I may have been a bit condescending in my tone by that point.
Is it too much for me to expect her to remember, or if she can't remember, at least look through his chart before she see's us, some of the major factors that impact The Boy ? Come on...his adoption and time in the orphanage is a major part of his history.
I came out of there feeling like she thinks AD and I aren't doing enough (or maybe anything) to help TB. I don't think she understands just how much therapy/help he is getting. But because we didn't see the doctors she recommended, we aren't compliant.
I'm going to start looking for a new doctor. Unfortunately it is not easy to change to another doctor in that practice. I actually have to get permission from Dr. B. to see someone else. And since I'm a wimp when it comes to conflict like that, I'm dreading having to tell her I don't like her.
* TB developed an eye tick (basically he was frequently closing his eyes...kind of between a blink and a deliberate close and open of his lids). It was beginning to bother him and he was unable to control it.