Monday, 24 November 2014

To Medicate Or Not To Medicate; Is It A Question?

There's so much controversy over whether or not a child needs medication.  I believe I've blogged about this before, but I need to do it again.

So many parents out there are afraid to use medication to help in the symptom management of ADHD, aggression, and anxiety, all running comorbid along with autism spectrum disorders.  I happen to be one of those parents.  So when I hear someone is struggling with whether or not to put their child on medication, my heart breaks for the parent in turmoil.  There is nothing scarier than being responsible for someone else's health and wellness, especially when that someone else is a child you love beyond words.  If anything were to happen to our children because of the choices we've made for our babies, we would never be able to forgive ourselves.  I know for myself, I certainly wouldn't.  My children's health and safety come first and foremost in my life.

Some of you already know I'm a pharmacy technician, and some of you are just learning this now. You would think given my career choice I would be comfortable in administering any new medication a professional prescribed for my children.  I'm not.  Knowing about medication makes it even harder to administer it to your child.  Sometimes ignorance truly is bliss.

ADHD has been diagnosed and overdiagnosed for decades now.  Things really have changed since I was a little one in elementary school.  While growing up in a strict Eastern European land required children didn't speak until spoken to, we were still children.  We wanted to run, jump, scream and climb our way out of the classroom.  Summer time was filled with the village children (yup, I wasn't always a big city gal) running through the corn fields, up and down our steep hills and mountain terrain (no hill billy bashing now) and climbing up fruit and nut trees, with many falls to the ground. No need to make fun of me, we've already established I'm not the most graceful gal in the city.  My point is, our behavior at the time was considered normal, yet if these same children who were considered normal 25 (give or take a few years...  fine, 30!) years ago were still children today, they would be labelled as having ADHD.  Today's classrooms have no room for the fidgety kid who's body is telling him to shake his leg or interrupt the teacher because she's afraid she will forget her idea if she waits any longer, or the kid who's constantly leaving the classroom for "bathroom breaks," fully understanding the cute little girl doesn't really need to use the washroom seven times an hour.

Our kiddos school curriculum has changed drastically from what mine was in elementary school, and not just because I grew up on a farm folks.  It's really, really changed.  I think there's a reason why we now can watch "Are You Smarter Than A 5th Grader" on TV.  How many of you are laughing at the adult not being able to answer the question, being outsmarted by a little kid to save face, meanwhile thinking to yourself, "oh my...  I'm stealing my kid's textbooks, they gotta sleep sometime, right?" And teachers...  My youngest daughter is seven years old.  Her teacher happens to have taught her older sisters too...  The oldest is twenty years old folks.  And she's no where near ready to retire.  She has been teaching for a very long time.  And she's kept up with the changing curriculum and had to teach herself along the way too.  They didn't have computers in classrooms twenty years ago, but they sure do now!  I have a lot of respect for teachers, they go with the flow and learn as they go.  I'm not sure I can say the same for me.  I got my first computer in 2006.  Yup, that's just eight years ago.  I'm one of those people like my grandmother:  "Oh, it's just a phase, it won't last long.  People won't be able to afford this gadget down the road."  I had the same thoughts for mp3 players, iPod's, blue ray disks...  Anyway, I'm getting off track here.  The point I'm trying to make is children's expectations have been raised to a whole new standard.  I really, truly believe this new standard demands our kiddos sit still and pay 100% attention, because if they don't, they will get lost.  Big time.  Teachers don't have time to spend individual time with 30 students or more, unlike our teachers who had maybe 15 to 20 students (shaking my head at you, I know exactly what you're thinking). And so could this be the reason why there is a rise in ADHD diagnoses?  If so, parents out there are fearful their own child must have been misdiagnosed; and if their child has been misdiagnosed why give them medication that may be harmful...  How could they possibly live with themselves?

I hear a lot of stories of middle aged men, telling me how they used to be on Ritalin, and they hated it.  But then why do they come to the pharmacy to fill a prescription for a different brand or Ritalin? It makes me want to scream:  "Ritalin is Ritalin people!!!"  And some of these men (yes, there is a higher percentage of males diagnosed with ADHD then females) I've met through PACE and they no longer take anything for their symptoms because they didn't feel great on their medication.  But even as the kid's curriculum has changed over the years, so has Ritalin.  It comes in different brand names now, because the manufacturers have tweaked it.  They've made it last longer, then they made another one with two releases of Ritalin a day, then yet another one with three releases a day... Longer lasting, smaller dosing, tablet to capsule full of little capsules and even smaller capsules, caplets, patches, etc.  And you better believe the makers of these drugs are making a ton of money. Sure they are.

I suffered through some bouts of dizziness about two months ago, and felt I needed to see a doctor. My 16 year old daughter Katie had been coughing for a bit, so I decided to take her with me for a check up as well.  Katie has a hard time describing symptoms, she just tells us she's sick and then it's up to Mike and I to try and figure out what her ailment is.  The doctor examined Katie, and agreed Katie was fighting through a virus, but she saw quite a bit of discharge in the back of her throat.  She was also concerned of Katie complaining of chest tightness.  A Ventolin inhaler was prescribed.

Ventolin is typically prescribed as "inhale 2 puffs four times daily as needed," so at 200 puffs per inhaler, the ventolin should last a patient at least 25 days.  The key words here are "at least."  The key words in the prescription are "as needed."  This means you only use it if you need it!  So when a patient comes back to the pharmacy for a refill two weeks after they filled their first fill, we become concerned the patient is abusing their ventolin.  Yes, I said abusing.  "What the...  how on earth would someone abuse a prescription medication used to treat breathing problems, especially in people with asthma or COPD???  It's not like it's a controlled substance like Ritalin, right?"

True, Ventolin is not a controlled substance, but it CAN have a STIMULATORY effect.  (Ritalin is a stimulant).  Stimulants CAN increase blood pressure and heart rate.  Because Ventolin in a sense is a stimulant, it has been abused to lose weight and increase athletic performance.  Obviously it is not approved for either of these uses,  Overuse of Ventolin may cause some serious medical side effects: hypertension (high blood pressure), tachychardia (very fast heart beat), and arrhythmias (irregular heart beat),  In turn, these "side effects" increase your chance of stroke and heart attack.  Key word here is OVERUSE.

Given my knowledge on Ventolin, I hesitated and wanted to wait until we saw Katie's pediatrician. Maybe her cough would clear on it's own.  As you know, it takes time to get it to see a pediatrician.  I was hoping to see if her cough went away on it's own.  It didn't, and the pediatrician informed us Katie had mild asthma, and recommended we go ahead and try the inhaler.

I know about Ventolin, but I also trust Dr. Goldberg knows about Ventolin too.  I trust him to know how Katie's health would be affected without the Ventolin, and trust him to have considered the Ventolin therapy to outweigh the medical side effects.

My responsibility as a parent is to work within Dr. Godlberg's guidelines and closely supervise Katie's use of Ventolin to ensure she doesn't overuse it.  Overusing the Ventolin will put her at health at risk.  I am not micromanaging my daughter, she is quite impaired by her autism and I need to ensure her safety.  Am I scared?  Absolutely!  I'm keeping a close eye on my girl, and she can't stand it.  Katie is 16 and whether she is delayed or not, in her mind she is almost an adult.  Having mommy and daddy watch her like a child is just not cool.  We try to be discreet, but we're not always successful.  We're not perfect, but we love our Katie very much.

So, if you're a parent on the fence about how to go about treating your child with ADHD, I have a couple of questions for you.

If your child was diagnosed with asthma, would you fill her prescription for Ventolin?  Would you take your chances with a potentially fatal asthma attack?  What would a good mom do?

If your child was diagnosed with juvenile diabetes, would you give him his prescribed insulin? Would you let his blood sugars sky rocket out of control and discipline his blood sugars down to a healthy level?

A health professional will not suggest the use of medications without weighing the benefits of therapy versus the risk of side effects, nor will a health professional suggest medication if he or she didn't think your child needs it.  I know it's hard, it feels like you're giving up on your babe, and that's an impossible feeling to get comfortable with.  I've been there and struggled with my children.myself in the struggle to medicate or not to medicate.  It's not an easy decision.  But it's also not your to make.  "Say whaaaaaaaat???"

You can not just pick a doctor out of the yellow pages (do those still exist? You know, the book ones?), see the doctor and demand Ritalin.  I suppose one could demand it, but I assure you, no doctor will risk his license and trust you when you bat your eye lashes at him and tell him your child or you yourself have ADHD, therefore he should do as you say and write out a stimulant prescription. There are laws against this type of behavior.  Doctors are governed by the College of Physicians and Surgeons, and they can revoke a doctor's license.  I can not speak of doctor's requirements in writing a tripplicate prescription, but here is a link to check out what we do in pharmacy when we get a tripplicate prescription:

Pediatricians are met with numerous times, schools are often involved with their reports and concerns on said child, checklists are completed both by schools/daycares and parents before a diagnosis of ADHD is given.  Even with a diagnosis, a pediatrician may decide medication is not necessary or the medication would put a child at a higher medical risk then giving him none, even if the parent feels their child should be prescribed something to "calm them down."

If you're struggling with the decision to medicate or not to medicate, speak with your child's pediatrician.  Let her tell you her professional opinion on risks versus benefits of using medication for YOUR child.  That is why we have medical professionals, otherwise we would all hold an MD.

I'm not a professional, so I'm afraid I can not comment more than what I've already written, nor can I advise you on what to do.  What I can say is you're not alone.  I've shed many a tears on this subject. I've felt like a failure to my babes, felt like I was betraying them to "big pharma," but in the end, it wasn't my decision to make.  I didn't go shopping for the ADHD part of my childrens' diagnoses, just as I didn't go buy my girls' hearing loss.  God created my children in his image.  He tells me this in his word.  I don't particularly like it, but I have accepted it.

Consider yourselves hugged,

Lou, Mike and family