Work With Your Doctor

Dear Dr. Kenny,

Thanks very much for sharing your experience with us readers. I can imagine how frustrating it must be for a doctor when you want patients to take charge of their health, and instead, you see them suffering because they let things slide and then want you to fix everything quickly.

It’s interesting that in my case, I had almost the opposite experience throughout 2009 searching for answers until I finally found an excellent family doctor and surgical team who wanted patients to be as you described you prefer. For me, I needed to find a solution to a pituitary tumor, but I don’t think it matters what type of health need you have to relate to your story above. I would like to share excerpts from my experiences on the flip side of things.

Until I found the right doctors who wanted to have a patient who asked questions and worked with them as a team, below are just three of the many frustrating comments (paraphrased) I had along the way from other health professionals.

“It does not help to read anything for yourself. You came to see me because I am a specialist. Did you notice I used the word ‘I’? That is because I am the expert.”

That particular specialist told me I only had an enlarged pituitary gland and not a tumor, which is kind of ironic, since I had the tumor removed successfully in October with incredible relief of symptoms afterwards!

“We don’t want you to read the MRI results, because most of the time, a tumor isn’t present and you might get upset for nothing.”

That comment was from an office manager who told me not to worry that I hadn’t received the MRI results in several weeks after I said I was going to pick up a copy for myself so I would know what was happening. In this case, the doctor was wonderful, but it was almost impossible to get an accurate message to him or from him due to a challenging office staff.

“You can’t be tired if you can still go running. Come back to see me again in six months.”

The above comment was from an endocrinologist. In my case, I was exhausted all the time, but still tried to maintain some exercise at the advice of my family doctor. I was able to run, but had to rest before and afterwards to have the energy to run and then recover from running.

In the situation you described above, the patient did not follow through as he should have through no fault of yours. Yet, I am wondering how many patients do not ask questions because they have gotten such awful responses from doctors or office staff in the past.

For awhile, I was ready to give up because I was not being heard. When I finally found a doctor who not only listened, but wanted to have a team approach, it was the most incredible relief. He helped me to achieve the wonderful results I needed. I owe him so much, and unfortunately, he passed away in November, just two days after I gave him a thank-you note for helping to change my life. I will always be grateful to him for showing me how awesome a doctor can be.

Thanks and warm regards,
Susan

American doctors will have the receptionist call the day before and remind you of the appointment. They do not call or follow-up if you do not come.

I am in the position that I know exactly what you are talking about. We have no regular doctor because we have no insurance. I recently took my son to the doctor because he had been vomiting at night time for over two weeks. The doctor told me it was a stomach bug and put him on a bland brat diet. I questioned this but decided he knew best. A week later my son was still vomiting. I was mad and upset and called back and asked to see the doctor again. He told me I needed to give it more time. I walked out of the examine room and went straight to the desk and asked for a new doctor. The new doctor did blood work and discovered some abnormalities in his blood (we are still testing) She also discovered that because of his night time medication so relaxing him the spinx in his throat was opening up a little and allowing the food to follow back up causing the vomiting.

My point is that if you do not feel comfortable with the doctor find one that you do feel right with. I do not blame the first doctor or believe he wsa wrong. I simply feel he did not take me as a mother seriously. I was the same way with my son AD/HD doctors and counselors. I searched until we found the right fit for him.

People need to wake up and realize that they are responsible for theirown medical cares. The doctors see to many patients a day to remember a person they saw once 9 months ago. They are also the ones respondsible to ask questions. That is also why it is so important to find one doctor and stick with them. You find that eventhe smallest missing piece of information can make the difference.

This is my experience as a wife with my husband’s ADD. While his medication is working, he is ‘normal’ when frustrated. When it is not, or when he is super-normally stressed (like Christmas) he is unreasonable and everything is my fault, much like your young man above. I try not to take anything he says to heart at those times as they reflect more his state of mind than anything I could have said or done, but it’s hard to forget too.

Hi Dr. Handelman,
As a therapist, I genuinely shared your frustration and struggles in dealing with clients who are not actively involved until there is a crisis. Perhaps, this is one of the issues that may not have been addressed much in dealing with ADHD patients, i.e., the issue of anxiety. Apparently, the patient you mentioned earlier was preoccupied with anxiety by which his ability to focus on other things are incapacitated. I remembered having a brief discussion with you at your workshop dated back in May around this issue. I believe that patients having ADHD for a period of time are more susceptible to anxiety than to inattention itself. Although many paediatricians I have spoken with believe that anxiety is a secondary issue. Some believe that the treatment approach should focus on treating what is immediate at the time patients are seeking help. In my own practice, I pay a great deal of attention to my clients’ level of anxiety, so that I can adjust my own response especially of the rate of my own breathing. I learned that patients having ADHD are very sensitive to others rate of breathing. For example, I saw a family last night where the eight-year old boy has readjusted his tone of voice a few times when his mother was learning to pay attention to his level of anxiety to adjust her own breathing as well as her own tone of voice.
Dr. Handelman, I hope my feedback is not being a long script to read.
Thank you for sharing your ‘rant’.

Sincerely,
Ben

I’m in the U.S. My son is the one with ADD – he’s 33, brilliant intellectually, but the ADD “gets in the way.” His doctor, who was very cooperative with the medication management (he is also a licensed pharmacist), dropped him as a patient without notice because he missed a couple appointments. He was NOT a psychiatrist (my son has no coverage for mental health issues), but this doc was just as good with meds, so there was not the isues with “talk therapy” or missing out on that like your patient. However – by the very nature of the “disease,” the ADD patient needs and wants the reminders. If it doesn’t come “naturally” like in the dentist’s office you mentioned, then the doctor himself could, if he understood the ADD thing, call and remind the patient himself, or make a note to the secretary to do so ALWAYS. Being dropped as a patient was devastating to my son, because it took several months to find a doctor who would prescribe the meds. It was like starting all over again. The appointments were missed because my son is hyper-involved with his own business, and it was hard to fit in the appointments (30 miles from home!), let alone to remember to call to cancel. He lives alone, and doesn’t involve us or his girlfriend in his appointmetns, etc. I’m quite surprised that you were so disappointed by that experience in your office. I totally understand your frustration, but you are “THE ADD Doctor.” I would think this happens so often that there would be a syatem in place to reinforce the importance of keeping appointments. Not “chasing them down,” of course, but letting them know from the start that “2 missed appointments equal the assumption that they don’t want the help,” or something like that. And be sure their significant others know that and their appointment dates as well. We all know that ADD folks are mostly scatterd and self-centered. “Blaming” them for missed appointments won’t sink in for sure. Keep in mind that adult ADD patients are a lot different from ADD kids – they don’t have mommy to fall back on.

Sounds like a lot more going on with this young man than just ADHD. Mood issues?

Dr.Kenny,
I applaud you for all the work you do. Getting the information out there to people like you do is a very helpful tool. I raised an ADHD child who is now 25 yrs. old, and it was extremely challenging. I had to search for information myself and was lucky enough to get help way before tools like the internet were at our disposal. My husband was a member of the US Air Force for 26 yrs. I was lucky to find a psychologist in the community where we lived who helped me greatly teaching me about behavior modification and medication therapy. When my husband was assigned to Europe my son was placed in a program for exceptional children. This team consisted of a developmental pediatrician who had experience with ADHD, a child psychologist,and other physicians who deal with children’s disabilities. I followed their advice and kept the treatment plan that they advocated for the 4 yrs. we were in Europe. I became confident and increaingly able to understand and deal with ADHD. It is all about educating oneself as a parent to help a child to achieve the best case scenario in life, especially with an often misunderstood condition like ADHD. One of the main points that the doctors always stressed was taking resposibility for one’s own behavior. I know only too well that this can be a challenge with ADHD individuals, and a parent must be committed and vigilant when raising a child to teach them in this regard. This, of course, includes the respect one must give to health care professionals. I have since worked with many ADHD children in the educational system here in the US and understand the time, tact, and diplomacy one needs to have dealing with ADHD children and their parents. Your patient in question, who has now aged out of your practice, most likely could have benefitted and thus comprehended better if he had had much more therapy at an earlier age. Maybe the parents were unaware of an ADHD diagnosis and what it entails, I don’t know. I still believe that they could have done a better job with this boy with early intervention. It seems like the parents were enabling his behavior to continue on into adulthood, which makes it more difficult to manage. My son still struggles somewhat with ADHD. He is a gifted individual with a very High IQ that failed out of college. This hurts me greatly, but I understand what he has to cope with and that he has to make his own way in life. I feel confident that I educated myself the best that I could and that I followed through with the guidance and wisdom of professionals like you. Keep up the good work Dr. Kenny. You are doing an awesome job!

Work With Your Doctor.

Hi
I found that after my dr left and i had to see a new one things have gone down hill.
I saw the new Dr and was told after a 30min appointment that he didnt believe i was ADHD and that i would need the 12 months to ween myself of the meds and that i didnt need to see him again. I can get the meds from my family Dr, but have to see the psychiatrist for the first script. So how do I deal with that? He doesnt believe in Adult ADHD, why is it so hard to get help as an adult?If he doesnt understand that it doesnt take 12 months to ween yourself off the meds how can he be believed about anything.

You are such a thoughtful doctor. I can tell by reading your e-mail you are obviously concerned about this individual. Our child is ADHD, and takes Concerta for it and is doing very well. We see a child psychiatrist here in Jacksonville, Florida. I know from experience with my family (my mom, who passed away a couple of years ago, suffered from schitzophrenia and depression and had several different doctors). I realized as I took her to appointments that the real key to long term success is working with the doctor and discussing your side effects/feelings,etc. Some people are naturally more sensitive than others but an individual has to be willing to
work with the doctor for the best outcome. It is nice to hear stories from a doctor such as yourself who is so passionate about his field of study! Many doctors would have probably just written off this patient…even if they didn’t tell you I’m sure they are appreciative of your help. Thanks for sharing with the community :~)

In the U.S. system, I haven’t yet seen a doctor (other than gynecologists, where an annual exam is standard) send reminders or follow-up more than once. My doctor does call me if we arranged it that way. Normally, if on a new medication, he’ll only prescribe 30 days’ worth and then I need to call after 3 weeks to let him know how I’m feeling, and discuss whether to lengthen the prescription. That’s how he keeps patients in contact to be sure he gets feedback. I don’t get more meds without seeing him or talking to him. I don’t have ADHD, though, so we’re talking other medications.

Most ADHD medications are tightly controlled by the DEA here in the U.S. and you cannot have refills on them. Usually you are limited to a 30-day or 90-day supply at a time by insurance, and thus can’t go more than 3 months without at least calling the doctor’s office. Most reputable doctors will then require at least a phone conversation to check in or a visit, to be sure they’re monitoring the situation appropriately. Some do just write a new prescription without personal follow-up though. I hope that helps!

Yes, that was a little rant – it should have brought some relief. It was good to read, though, as it shows a very human (as apposed to medical) side and I guess that any doctor will recognise what you say. And perhaps we’re all guilty of frustrating our doctors from time to time…
What you describe about your absent patient doesn’t surprise me, though. Aren’t lack of drive, self-motivation, ability to stick it out all part and parcel of the problems associated with ADD/ADHD? As well as blaming others for their own mistakes? And that age around 18 I find very tricky (my son is 18) as one moment they’re children, the next moment they behave like adults. I cannot help but wonder if in the case you describe it’s the boy’s parents who could (should) have done more. And earlier.
…And in case you’re wondering, I do leave my son to organise his own life, but I do slip in the odd, and ever-fewer, intervention!

best wishes,

Esther

I think you handled it like a PRO! I would be more apt to blame the parent in this situation who must be responsible for the implementing the proper follow up plan for a 17 year old. Maybe the only improvement could be creating a written document that the parent (and child over a certain age) signs committing them to being a part of an action plan.
Listing the recommendations…
Spaces for follow up appointments with other specialist info…
to the follow up visit date…etc.
You can’t help people who aren’t listening to your advice but you may be able to make a difference with a written action plan for each patient strengthening their commitment to wellness with a contract. In our business, we were accredited and had to follow a continuing quality assurance action plan for our Respiratory patience to make sure they understood and documenting we were doing all we could to assist them in complying to Doctors orders.

Teresa – excellent ideas.
Karen – from my experience, I would suggest that you offer to go with your son, and explain that you’d like to sit in the appointment for some of the time to help him out. See what he says…
Dr. Kenny

Christine,
It seems I’ll be meeting you soon.
I don’t think I was clear. He didn’t ‘no show’, he just didn’t book for follow up. The only impact on my schedule was that this crisis made me late for the rest of my afternoon appointments – which is bound to happen now and again in a hospital clinic.
Dr. Kenny

Tedd,
Great to hear from you again.
Your comments are very wise.
Now, if we can only get the teens with ADD to absorb them…
Dr. Kenny

Thanks Theresa. I appreciate your kind words.
Dr. Kenny

Darlene,
Thank you for your comments. You are right with what you say.
And I also have compassion for this patient and his family. That’s part of the reason I was so frustrated (even though that may sound a bit weird).
Your advocacy for your son will go a long way. Although it may feel thankless at times, it will go a long way.
And doing it early (i.e. before he is an ‘adult’) is very important…
Dr. Kenny

Thanks, Stan for sharing that. I believe that this clear and well articulated plan is very helpful.
I like the idea of a signed contract. That really reinforces the responsibility – and where it lies…
Dr. Kenny

While I understand your frustration, you describe perfectly the behavior of someone with ADD. I have all too frequently put things off, tucked them away in a corner of my 67 year old mind and then panicked when a crisis arose. I forget my second dose of medication several times a week and have not managed to develop a system to remember. When I was younger, I had an extremely good memory and I’m sufficiently smart to have been able to juggle things, remember before it was too late and compensate for my ADD. Only as I got older did I realize that I’m easily distracted, rarely finish things and no longer the wunderkind who could get away with some of it. Step back and remember what you were treating this young man for.

PS. I just got a pop-up from you: it’s “receive” not “recieve”. And I have more grammatical nits to pick.

PS.

As an adult with ADD, if I mess up it is my own fault. We all need to be accountable for what we do. You seem to handle this person quite well. My doctor is wonderful to work with so I guess I am very lucky. I wish the rest of the world understood ADD as well as you do.

CM – thank you for your comments.
The fact that you’re struggling with getting the information you need is exactly why I created this blog, as well as my podcast, and other websites. To address that exact issue.
If you read some of the comments above, several parents shared a need to push the healthcare providers to get the information they need… That is a real issue – that I wish wasn’t there.
I’d like to say that it doesn’t happen in other areas of medicine – but it does. Maybe a little less in areas like oncology or cardiology, but it does still happen.
Keep on learning, and keep on advocating.
Best,
Dr. Kenny

WOW! It’s amazing how many people on This blog alone who don’t understand ADD.
I submersed myself in literature from every imaginable angle surrounding the condition, after my child was diagnosed. They all included “inability to complete tasks on time.” We tried many nutritional and structural changes as well as medications, but it was years before I was able to focus on something that had been obvious to me from the start of my research: I had the same condition for all of My 45 years.
And I, too, made my first appointment because I was in crisis!
The therapist soon convinced me to talk with another about trying medications- so I could focus long enough to even begin counseling. But it was weeks before I was able to make another appointment, and Only because they were persistent. It was clear to both that I could not focus long enough to do even that. They Never threatened to terminate me for late or missed appointments.
They didn’t have to lecture about their lost income- I was already beating myself up for my behavior, and what I know it costs them. My ADD has cost me, too- countless uncashed paychecks, stale checks, expired giftcards, late fees, surcharges, etc… and several jobs. Even my education was affected because I couldn’t complete work on time. It was costing me my marraige. The ADD, though, was still so overwhelming, that it took even more to get me to seek help.
I’m not stupid and I’m not lazy. My current therapist sees that all too well. He books his appointments with a cushion for lateness, because many of his clients have ADD or ADHD. This is textbook behavior for the condition, and he wants to Help us!! Threats don’t work. We need to learn- and diligently practice- strategies that most people don’t ever have to think about. Our success begins with that understanding.
Now, I’m not bothered by waiting in the Dr.’s office. I know that someone else needs this time. I appreciate that the Dr. affords me the time when I need it. I pay a fortune for decent health insurance, and I wish that he would bill them accordingly. He is worth it!

As a mom with 2 kids with ADHD and also finally being diagnosed myself at age 46 I have had my share of Dr. visits and the dance done before the right solution for each person’s individual needs are found.

First from the other side of the fence as a parent putting a child on a drug for the first time and seeing the child respond unexpectedly in a very emotional breakdown hiding in a closet crying his little eyes out. We didn’t know about the symptoms that can occur coming off of a stimulant at the end of the day. It scared the heck out of us because he never did that before and we thought the drug would help him not make him worse. We discontinued and lived with his inattention. Fast forward a year when the inattention got the best of him at school we went back to the Dr. Not in emergency mode this time because I had also been Dxed by then and my Dr had given me an extended release stimulant which I thought would work better for him. Had I spoken to his doctor when the first medication had not worked perhaps we would have found this much sooner and he would have had a much better first year of middle school. TALK TO YOUR DOCTORS when you do not get the anticipated results the firs go round as it takes time to find a good match for each individual.

The next experience was with a psychiatrist who was treading my daughter 16 who had just been dxed with ADHD, depression and anxiety by a neoropsych. Our pediatrician would not treat her as he does my son because of the depression so we had to seek out someone who would see her that took our insurance. After calling 25 people off of the insurance list I received one call back so I took an appt. with her. This doctor was a wrong match from the get go but it was close to her school, our home and she was the only one to call us back. So we endured a year of experimenting with DD. My experience told me that yes she was depressed however it could very well be brought on by the results she was getting from the untreated ADHD. However the Doctor did not want to treat the ADHD because she felt her forgetful behaviors were being brought on by the depression. Hey she was the doctor and we (tried) to respect her decision. About a year of this yeiled a more stable young lady who still had ADHD symptoms which were still not being addressed we pushed the doctor to reconsider. Now I come from a family with 3 generations of ADHD and the apple does not fall fare from the tree but this woman seemed to almost think we were shoping for ADHD medications from the way she acted. We endured her suspicious nature and daughter tried the Adderall ER. They worked. However my DD discontinued all of her medications without my knowledge over the summer as we were working out lowering the antidepressant and anti anxiety medications which were too strong once the ADHD medication was added. Took my daughter about a month and a half to hit rock bottom and we then took her to a different doctor who understood adolescents, ADHD, anxiety and did not act like we were shopping for drugs. My dd is now on a more appropriate antidepressant that does not where off and make her crash if she takes a little late and she is also finally getting her ADHD addressed. My daughter looks back at the year she was being seen by the psychiatrist as a very dark time and she feels it stole a year away from her being improperly medicated. The doctor does not accept our insurance but the cost of an honor student almost throwing it all way in her senior year due to lack of treatment is priceless in my eyes. FIND A DOCTOR THAT SPECILIZES IN YOUR AREA OF NEED and if they show any signs of being a poor match run like hell and find another.

Last I want to also mention how important it is that even though the boy in your story was 18 that you did not turn him away and you took the required time to see him and come up with a plan. A recent incident with my daughter just turning 18 and coming down with a staff infection or abscess under her arm made me well aware of how important it is to plan to find a new dr for your new adult child because our pediatrician just told us to go elsewhere when we called to have her seen. I thought it was pretty rude as they had been treating her since her birth.

I live on the other end of OC otherwise we would of considered your office for our treatments but I enjoy the info you share.

Thank you. Katie

Karen,
This is Stan Carder, MS, LPCC
If your son lives in the USA he can be placed on a 504 plan which will allow him to have adaptations which would benifit him during his college years. I have ADHD, take meds, and was on a 504 plan for all seven years of college. I even had it for taking my State exam for my license. You may want your son to check out what is available to him to help him in schoo. It has to be hard on your son but tell him not to let his disability become a handicap. If it takes one course at a time to get through, do it. There is no law that says you have to complete college in four years. Give him my hope and my best.

At 18 – his brain is still very adolescent – aren’t the current estimates that brain doesn’t “settle” so speak till around age 25? And I’ve read that ADHD brains develop slower in some ways. So much of the behavior you’ve described sounds very teenager.

And as others have noted – ADD comes twined with shame, anxiety and energy issues (since it takes so much effort with ADD to try again which cranks the anxiety which triggers the shame and if it fails – intensify all feelings the next cycle). And because you avoid dealing with things in order to avoid the huge energy drain, anxiety, and shame – it may be crisis mode that triggers action – so the anxiety is overwhelming and you just want it to stop – NOW.

I’ve just read Riding is My Ritalin
http://www.bicycling.com/article/0,6610,s1-3-12-21050-1,00.html

Adam, in the article, went off Ritalin because it made him emotionally flatlined. My sister went off Ritalin because it made her very anxious. My teenage niece wants to go off the meds, – even though they’re helping. She’ll deliberately not take them even though she call tell she struggles off them. At present she’s not willing to go the hard exercise route instead of Ritalin.

And as others have noted – experiences with doctors are so mixed. My favorite phrase has become “so help me understand” when I have to defuse a defensive medical professional who thinks questions are challenging their competency, when the reality is there is simply too much new medical information coming so fast for any one person to stay on top of. And no one will ever be as vested in my health as I am.

A friend, who is an MD, told me I’ll be marked as a pushy patient for referencing studies and statistics and asking complicated questions – he really didn’t understand when I replied that I’d rather be considered unpleasant and get meaningful answers and results than considered nice and not getting the proper diagnosis and treatment. The first situation is no fun but survivable – the latter might not be. As an MD he’s never been patted on head, dismissed, and told “I’ll let you know when you’re sick” – on the other hand I have. (I have to be suffering mightly to actually go to the doc).

@Katie – your post resonates strongly. We have 4 generations of ADD – grandmother, son, grand daughter, great grand daughter. My cousins show classic ADD traits as well. So it’s all over the family tree, clearly genetic. Grandma will be 90 in 2 months and still has nights where “her brain just won’t let her sleep”.

ADD and middle age female hormones is a special hell as I’m discovering. Finding a doc that has any clue much less specializes in adult women with ADD and understands the additional challenges added by menopause? At this point in time I don’t think it exists.

But to your point – finding the right ADHD doc/therapist in the U.S. is so difficult because most practitioner’s treat a range of things and ADHD is 1 of their 10 “specialties”. Marriage, depression, OCD, ADHD. Usually turns out they specialize in family therapy with ADD on the side and they often have a broad but shallow experience that’s quickly insufficient.

I fantasize about finding a practice that is fully focused on ADHD, can work with adults, and understand the particular issues for girls and women (Sari Solden and Kathleen Nadeau’s writings have literally saved my sanity). Oh, and that I can afford it – since it seems everyone wants to charge $150 and up an hour – out of my ability to afford at present, and few US insurance plans will cover it.

P.S. Kenny, maybe this experience will give (or renew) your appreciation for what it’s like to live with a person who has untreated ADHD, who takes no responsibility for his/her problems and who blames everyone in his/her line of site: It is galling, dispiriting, frustrating, and unfair.

Hi Jo, and thanks for the rant, Dr. Kenny!
Jo, there is help with your hormone hell: If you would like some solutions that worked for me, please read on:
Step one: Read Suzanne Somers books on Hormone crashing, ‘the Sexy Years’ or ‘Ageless’ as well as “What your Doctor does not tell you about Menopause” by Dr. John Lee MD
Step 2:
Go to ZRTlabs.com and order your self a full saliva test hormone panel.
They will mail you a kit, which you mail back, and ZRT will email you a comprehensive analysis of your results in pdf form of what is going on with your body’s endocrine and hormonal system. Most problems can be solved with Bio -Identical Progesterone, which you can get made for you (once it is prescribed by an MD that is up to speed and is not terrified to prescribe medication not produced by ‘Big Pharma’
Bio-Identical progesterone is made from plant sterols (not Mare’s urine like prescribed estrogen) and is identical to what your your body used to produce before you stopped ovulating. Like Vitamin C, it cannot be patented, so the pharmaceutical companies try to discredit it and would like to shut down its production because they can’t make a buck off of it. Because there is no profit in it, generally only university medical schools have tested it, because generally pharmaceutical companies pay for testing. (Dr. John Lee is the source of these comments, and was instrumental in getting stopped the Women’s Health Initiative Study when it was proved that the Pharmaceutical hormone therapy was causing cancer in women that were part of the study.)
Hoopers Pharmacy is a compounding pharmacy that can make it for you, or what ever other hormones are recommended for you.
Dr. Alvin Pettle of North York, On., is a specialist in this area, and Joe Hsu, the Pharmacist at Beaches Hoopers can fax or email you a list of other physicians whose knowledge in this area is ‘current’, as it is hard to get an apt. to see Dr. Pettle, and sadly, not enough Physicians have bucked the trend to learn about this therapy.
When I hit the brick hormone wall, I was on a six month waiting list to see Dr. Pettle, and to accelerate things, had a consultation with Nina Filipczuk at Hoopers pharmacy in Mississauga. After reviewing my saliva tests from ZRT labs, she then wrote a letter with recommendations for bio identical hormones, and a list of supplements, that I took to my understanding Family Doctor. (I learned that taking Magnesium totally eliminates those chocolate cravings!) I was such a mess, not sleeping, ADD making me scattered, depressed, itchy skin, no libido, no memory, irritable, hot sweaty flashes and chills…. after 4 days on the new program of bioidentical progesterone and a lot of supplements, the symptoms were almost gone. My mental focus, and emotional and physical balance came back into balance significantly, within another couple of weeks. That was five years ago. I continue to monitor my hormones, and take supplements that support my brain, liver and endocrine system, and avoid foods that I am allergic or sensitive to.
A good chunk of ADD issues for menopausal women can be relieved by having one’s hormones balanced. I occasionally take Ritalin, but am not finding it very effective. I tried Concerta as well, and found it made me feel like a speeded up focused stupid person.
Dr. Kenny,
I want to bring my son into see you, particularly after your honest and cleansing rant. He has just turned 18, and is struggling with his studies in first year Electrical Engineering at U. of Toronto. He is also a classical music singer, and got a choral scholarship at U. of T. We meet the address requirements. I have been giving him neutriceuticals since he was diagnosed 8 years ago. He was tested by
Felicia Travis, a Psychometrist and Psychologist recommended by his school, RSGC. She did a great job writing the report, and our son now has the accommodations and extra time needed to increase his chance for success with exams at university. He barely passed his first term, using neutriceuticals, Ritalin and Concerta, and found the latter to be of only minor use with focusing and organizing his day and work. He lost weight and became quite upset and agitated, and was having disturbing thoughts while on the meds. He is seeing a Psychiatrist, who is next prescribing Strattera and Dexedrine to see if that helps. Dr. Kenny, my sense is that you have an expertise in prescibing meds that would help our son to find the right one.
I have also ordered some neutriceutical products I found from a link on this website of yours,Dr. Kenny, called “ADD-care with Bacopa”
This product can be used with meds, apparently, so we will try it out.
Thanks again for the rant! Transparency with Physicians like you is uplifting, refreshing and a reminder we are all human. I also empathize with the frustrated disorganized behavior of the patient, as I have seen this in my son, and is part of the ADD syndrome, it seems.
By the way, do you recommend supplements, such as GABA, and Pantothenic Acid,to help your patients on Concerta sleep? We have also found Ghanda (www.aor.com) to be a very good anti stressor supplement for the nervousness generated by ADHD meds.
My feeling here is that there is a synergy to be found with each individual, in the use of meds, supplements, exercise and cleaning irritants and allergens out of the diet that make our kids worse. (worked for us anyway) and I would like to work with you, Dr. Kenny in finding that solution for our son and to improve my own focus consistently. Thanks in advance for reading my long tome, and I look forward to your reply. Best wishes, Marilyn L.

Dear Dr.Kenny,

As a psychologist and mother of two sons with AD/HD, I too, have been in similar situations many times. After I get fed up with the latest missed appointment, explosion, blameshifting episode I try to get myself hopeful again. To try to see that this is part of the process and to have faith (literally) that this person will usually rise again to their best. I also know that this cycle will occur again…

Thanks for your open and honest “rant”. Be well, Dr. Kenny.

Here are some responses to the comments added recently:

Gina, excellent points. Your first comment is really dead on in many ways. Your second comment is also quite insightful. Thank you for your contribution. As an aside – someone emailed rather than commented, and said ‘Gina’s comment is great – makes me want to read her book’

Rachel – I’m sorry to hear you’re shocked. Yes, you’re right, you haven’t heard the family’s side of the story. The reality is that you haven’t heard my full side of the story either. When I wrote this article, I did it for two reasons – one – to let it out (I was frustrated, as you know), and two – because I thought it could be helpful for my blog readers, and create a good discussion. Certainly, we’ve had a good discussion, and several of the comments have appreciated the discussion and found it helpful.

Dr. Frank – thanks for such a well worded explanation. That is what I mean

Marilyn – Thanks for sharing your insights for the other reader who had issues in her comment. Regarding your son, as I mention in this post – the clinic I am currently working in only goes up until teens reach 18 years old. Then they go to the adult side. So, your son is too old for my clinic. We stick to the age ranges and guidelines for two main reasons (in my interpretation) a) that’s what we’re funded for, and b) we are constantly getting urgent and emergent referral from the emergency department, as well as community referrals – so to meet the needs, we have to stick to our mandate.

David F – That is quite a story. I’m glad to hear that a good doctor and his team literally saved your life. I hope that persistence around the ADD treatment will also change your quality of life, and the quality of your relationships with your kids in particular.

As I have read the comments and responded to many of them over the past 2 days – I am glad in many ways that this blog post has created such a dialogue. Some people have appreciated my transparency, and taken a lesson from this situation. Others are ’shocked’ and expressing concern that I would write such things.

One other principle that I like to use in my life and in my practice is to not waste a good crisis.

Yes, you read that right – don’t waste a good crisis.

When it comes down to it – when a crisis happens, it creates a situation for real, serious deep learning. The ‘real life lessons’ kind of learning. The kind of learning that can really make a difference in someone’s life and future.

When this young man (and his father) came in to my office in the way that they did – I got frustrated. That’s a fact, and a human reaction. As I reflect back on what I said and how I handled it – it was because I didn’t want to waste a good crisis. I had the opportunity to share information and make some points which I thought were necessary- around taking responsibility for one’s health, etc. And I truly believed that our discussion would be helpful for this young man. It wouldn’t make him happy or pleased in the moment – but it would be helpful in the long run.

When I first wrote this article, I don’t think I realized how much of a risk I was taking when I did. Doctors are trained to be right, and to present ourselves in ways which show that we’re right.
I didn’t do that here…
I shared a situation, which didn’t portray me as right – in fact it could be interpreted (and was by some of you) that I was wrong. That’s practically against the hippocratic oath.

In many ways, I’m glad I did, and in some ways, I’m not.
I will continue to write lots on this blog, and share much news, ideas and opinions.
I’ll spend some time reflecting on whether I’ll write a post like this one again.
When I think about the reasons that I wrote this article – as stated right in the beginning – 1) catharsis, 2) learning for you. I will definitely continue to post articles that meet the second criterion. I’m not sure I’ll write any more which meet the first criterion (i.e. catharsis).
We’ll see…

And with that – I want to thank all of you who have contributed to this discussion. It is much appreciated – whether you appreciated what I wrote or didn’t – I have benefited from your insights.

And now, I’m going to exercise my right as owner of this blog, and close comments on this post.

Best,
Dr. Kenny