Please help---worried about nephew

[Guest Julia59]

I hope some of you can help me if you know anything about these medications-----especially some of you health professionals-----

I did call the pharmacy and he was not happy about one drug in particular.

Fluoxtetine 10mg each morning for "panic attacks"--sound familiar. He said no 7 year old child should be on this drug unless as a last resort. He said his health issues are not managed properly at all.

My nephew David was diagnosed with ADHD---or so they say. He is a very bright child as he has a high school reading level in the 2nd grade. I'm guessing he is too advanced for the class, and the teacher doesn't want to deal with it.

He has been put on D. Amphetamine/Salt combo 10 mg.--------and he also takes breathing treatments with Albuterol Sulfate twice a day, so one treatment is going into his little body at the same time he takes his ADHD meds--"I call it speed" and then the generic prozac.

Wouldn't the D. Amphetamine be a bad mix with the albuterol? Especially since he is already wired as it is, and has had irregular heart rates in the past. My nephew is in a constant hyper adrengic state, and is afraid of everything---and he NEVER was like this before the ADHD meds. He is never able to eat, and is skeletal. He won't even eat what kids love---chicken fingers/fries, mac and cheese----candy ect. The only time he eats is when the ADHD drug wears off. He may eat a little more, but I am telling you what I see when I see him. He tells me he is not hungry almost every time I see him.

He has been through a divorce, so no doubt he needs more TLC, and some gentle counseling and guidence. He could also have some genuine health concerns that are being dismissed----you all know that song and dance. It's hard to tell if it's the meds, or he also has something else going on. I talked with my brother---DAVID's FATHER, and both my Mom and Dad---HIS GRAND PARENTS---they all have the same concerns. My ex-sister in law has custody, and has all the faith in the world with David's Doc.

The pharmacist is also concerned and thinks they should be with a physician who can manage his health concerns more properly.

Any input would be greatly appreciated.

Julie :0)

[MightyMouse]

That's one heck of a cocktail for a little guy. I have autistic kids in my classes that have no meds... and a few on meds, but WAY less than him... for hypercativity and behavior problems, some for sleep too.

If a child truly has ADHD, amphetamines and albuterol often have a calming effect (a paradoxical effect since in the normal population, it would send you through the roof). If that's not what's happening, then those meds probably need adjustment by a physician.

Also, SSRI use for children is HIGHLY discouraged due to side effects such as increasing depressive and/or suicidal thoughts. The FDA released a warning about this last year.

Most of my students meds are managed by either:

developmental pediatrician

child psychiatrist

neurodevelopmental pediatrician

The parents tell me that their local ped practices send them out to the above specialitlies. Almost none of the kids I've served over the years (hundreds) are managed by a family doctor. Most general peds practices refer out when a child is needing multiple meds, especially psychoactive ones. The local peds handle the ear infections, bumps, and bruises, etc.

[nantynannie]

Juilie,

I'm no health care professional, but anything that is making him more wired than he already is sounds like bad news to me. I was put on a beta blocker for my high heart rate and it made me so wired that I thought I was literally going to lose my mind. I cannot imagine what that feeling must be like for a 7 year old who probably cannot adequately communicate what he is going through. Maybe his mother will listen when she is alerted to the fact that this pharmacist is concerned about the medication? I hope so. Don't give up!

Ann

[Guest Julia59]

Thanks Nina and Ann,

I actually called my pharmacist who is so very sweet, and is always willing to help answer any questions. He once offered to drop off a prescription to my house! My husband and I forgot to pick it up and it was like 5 minuts to 9:00pm. We told him we could get there in two minutes---so he waited for my husband. He's a real nice guy.

Anyway, my brother and parent's are also interested in any advice or help from this posting.

Julie :0)

[Sophia3]

Julia

i am totally outraged about this situation the more I think about it. I am sure you saw my post at NDRf.

I really do find it criminal what is being DONE to this poor little kid. Way too many meds. His HR must be unreal and the fact that he has personality changes?!?!? HELLO! Poor little guy.

I re-iterate the ADD adhd DOES exist but is way over diagnosed, exaggerated and over medicated. It's very sad what is being down to this little 7 year old with no voice of his own.

The doctor should be horse whipped to dope a little boy so much....His mother needs a SERIOUS WAKE UP CALL.

She has faith in the doctor? Well, many folks have faith in snake charmers and quack healers...but at the expense of an innocent child. It's not right.

He sounds like he has a lot going on with the divorce and all but so much stuff in a kids body....NEEDS another medical opinion from a GOOD M.D. AND psychiatrist FAMILIAR with ADHD and not just a pill pusher.

Keep us posted.

[Eli6596]

I would strongly urge you to have these questions answered by the patient's PHYSICIAN. If possible, accompany your nephew to his appointment. If not, write a list of your concerns/questions and give them to the child's parents so they can have them answered at the next office visit. A PHYSICIAN, in partnership with the parents/patient, should decide upon the most appropriate medication for a patient, not the pharmacist, not the insurance company, not a neighbor, etc.

The pharmacist does not see the ENTIRE clinical picture. He has not clinically evaluated the patient. There are many, many things that a physician learns about a medication outside of a pharmacy textbook. With experience the physician knows practical everyday knowledge about a medication that a pharmacist may not be aware of. Drugs are very commonly used "off label", and can provide great benefit.

For example, mestinon for POTS is not FDA approved for anything besides myaesthenia gravis. Yet, many of us have benefited from this medication. Most pharmacists would be totally unaware of this "off label" use. As another example, midodrine is not approved for POTS, but our physicians have commonly prescribe it for us.

I do have great respect for pharmacists and most of them are very helpful to physicians, and patients. We just need to fit their knowledge into the overall picture with the help of our physicians. I hope I don't sound too preachy. I hope your nephew gets the best care possible, whatever that is.

Sincerely yours,

Karyn

[morgan617]

I think I have to agree with Karyn on this one. I have a really helpful pharmacist, but he will never comment on whether something is appropriate or not. If he has concerns, he usually calls the doctor with questions. It would be nice if you could accompany your nephew to his next visit and discuss these treatments with the doctor to try and figure out his reasoning. If that is not possible due to the relationships, there's not a lot you can do. My son had a lot of anxiety at his age and even got stomach ulcers, lost weight and was vomiting a lot, on NO meds. We found out finally he was getting picked on every day at school by a sixth grader and was just very traumitatized. (sp) I am not familiar with the amphetamine drugs he's getting, but I do know prozac can affect appetite and cause weight loss. There just seems to be a lot of stuff going on here that can't be answered by just his med intake. It sounds to me like there is just more to the picture and unless his mom is open to discussion, you're kind of stuck. I've been there, where I was really worried about someone and it's a pretty helpless feeling I know. Is there a way to approach her without her feeling like you are second guessing or questioning her skills at mothering, or is she very defensive? I'm not being very helpful here so I will shut up, dang steroids. Just throwing some stuff out there. I will say I think kids today in general are too over medicated, but that's just a personal opinion....morgan

[Guest Julia59]

I'm glad the pharmacist stepped up to the plate and had the guts to give his honest opinion. Pharmacists know extensively about medications and what other kinds of meds can be crossed with them. The pharmacist is only giving his opinion, and specifically told me this should be addressed by a Doctor. He is well aware of off label use of medications, as they are required to know that as well. He does not know the clinical picture, but did say that this needs to addressed by a "specialist". I can't tell you how many people I have talked to that are "overmedicated"----by their own Docs. I'm not bashing Doctors here, i'm just being honest in the fact that they make mistakes too. Karyn/Morgan, I do understand what you are saying, but the pharmacist was just giving his opinion---nothing more. I'm glad you gave your honest opinions, as this helps me kind of even things out a bit in my mind.

The boy was already too thin, then got even thinner on his ADHD meds. He is OVERMEDICATED---no doubt in my mind. He has already had heart arrithmias in the past---and then you add an amphetamine and albuterol to the mix-------common sense is telling me that is dangerous. And then prozac causes more weight loss----??????????? That kid needs some proper nutrition in the first place---if he continues on this path the long term affects could damage his health permanantly. Many on this board know what lack of food can do to us----it only makes all our symptoms worse, or causes new ones.

I really think my brother and his ex-wife just want the best for David, but they just aren't aware of the ignorance of some of the doctors out there. A lot of parents trust their childrens Doctors. I'm not saying they should not, they just need to advocate for their child more---especially when they see red flags such as this. I'm not going to say anything to the mother as I think she was upset with me when I voiced my concerns about his arrithmias and the ADHD meds that are stimulants---and the FDA warns about this mix, and states anyone with any heart issues should not take these types of meds.

Actually, David see's his doctor today. My Dad is taking him, and he is going to bring this up to the doctor. My brother is not able to take him today because he is in school working on his teaching degree, and his mother is working. David really gets the best of care and has lots of love from many family members. He is the youngest of several grandchildren. My son is the oldest of them-(the first grandchild). When my son was 7 years old he was also on ADHD meds, but I carefully watched him. I took him off the meds when he was 14. He was healthy, but still had a lack of appetite. Even as a young mother, I was keenly aware of medications and would have never had him on this combo. I have always been sensitive of meds, so naturally I have these concerns.

Like I said, my main concern is the Amphetamine/albuterol mix as he has had arrithmias in the past. My aunt is a nurse, and has listened to his chest on several occasions.

Thanks for your advice I really appreciate it---it was very helpful by putting things into perspective for me. My gut feeling is that he should not be on this combination, and that he is mis-diagnosed with ADHD. The only drug he should be on is the albuterol. Even then it's too much---twice a day for bronchitis/mild asthma? The pharmacist's opinion was that he should only take this when needed. I am certainly no Doc by any means----this is strictly my opinions, and I just want the best medical care for my nephew. I could not live with my conscience by ignoring this. Maybe I am putting my foot in my mouth, but I would much rather look like a fool, then my nephew's health being at risk.

I think the problem here is the DOC. The parents/grandparents really do the best they can as they love this little guy with all their hearts. Unfortunately as you all know too well----DOCS arean't always right.

Both parents are very loving parents and have done a wonderful job raising David. David is the star of the show in our family and is loved so much by his parents, grandparents, aunts, uncles, cousions and the many friends which are extended into our family.

Julie :0)

[morgan617]

I am glad everyone's on board with the right thing to do for him. I didn't mean to offend if I did. But as I did state, I do think too many kids are given drugs they don't need. Also, I totally agree with you, as a nurse I found many people voicing concerns with me rather than the doctor, either because they were AFRAID of his reaction, or they didn't want to bother him, or felt how dare they question a doctor. I use to say, He's not doing you a favor, you're paying him for a service! And they are human and make mistakes. Or sometimes don't realize they have mixed drugs that shouldn't be. I hope your dad gets some answers for you. Bad enough we fall apart, but when it's kids, it's unbearable. morgan

[kare]

Strattterra is new ADHD med that is a non stimulant. It enabled my ADHD tired brain to take 2 classes this last semester. It doesn't take away appetite. Maybe your nephew's mom could ask Dr. for this instead of other.

[Guest Julia59]

Well as it turns out, my Dad had to run my Mother to the ER today---chest pains.

So I was appointed to take little David---named after my Dad to his appointment today. Imagine the joy! Anyway, I did talk with the doctor about the albuterol/amphetamine-(generic for adderol) mix and she changed his breathing treatments to something without stimulant. I left the prescription at my Dad's house---so I don't have the name right now.

The Doc was very nice, and suggested that I go to his psychiatric appointment with David and his Dad and discuss the meds further. Apparently he is the one who diagnosed the ADHD and prescribed the meds, but the albuterol was prescribed by his PCP---who I think realized just today that she did not see his ADHD meds were changed, a BO BO as she thought he was on a non-stimulant meds for that.

She said I should speak up for David since I seem more aware then his father, and that is why I should tag along to the appointment. I think she does not agree with his treatment for David. I know that this is not normal for David, and he doesn't have TRUE anxiety---and that it is more of an adverse affect of the ADHD meds----and then he prescribes another to handle that. This is not ethical.

Well at least he is taken off the albuterol.

My mom was admitted to the hospital for chest pains---I think she'll be OK as this has happened before---but you can't be too careful with something like that.

Julie :0)

[Sophia3]

Julie,

My, you have your hands full with worries about your nephew and now your mother. I hope things go ok for her.

I am very tired and not sure I followed your post. Does your nephew have a female and a male doctor? I take it the two docs didn't know what the OTHER HAD GIVEN your nephew? This is good that is was DISCOVERED but very bad the lack of knowledge about this...THANK GOODNESS YOU GOT INVOLVED and one of the doctors does not like the protocol either.

I hope I interpreted the above correctly but I have had a long day and my cognition isn't terrific. But again, I am glad you went to the doctor to hear things with your own two ears as it EASILY makes the issue YOUR BUSINESS! as far as saying things to the mother via whomever.

So I will be curious how things pan out and I hope your little nephew gets his appetite back since you said he was a skinny kid to begin with.....

Good luck with the situation with your mom.

Positive thoughts and generic prayers to you and yours in the Toledo area.

P.S. I would like to know in what amount of time the shrink "determined" your nephew has ADD.

[morgan617]

Julie, glad things are happening, and sorry to hear about your mom! Hope she gets better very soon. I never worked for a doctor that didn't have me ask all the meds a patient was on and don't like to think it happens, but after last week end, I guess I can believe anything. It's very important for doctors to communicate with each other. In my case all the doctors I saw made recommendations to my pcp and he took care of all the meds, that way, no one had to wonder what I was on. Maybe they should do that for little David. The psychiatrist could make the recommendation and his primary could decide what to do. Sometimes you just get a case of the left hand not knowing what the right is doing. I will say we ran into our fair share of patients that never mentioned they were seeing other doctors and didn't tell you the meds they were on, so it goes both ways. And of course anytime someone is having significant side effects, the doctor, the primary doctor, needs to be informed. Hope he starts feeling better real soon! morgan

[lindaf]

Julie, I think it would be a good idea for your brother to accompany your ex-sister-in-law to the pediatrician and not leave that office until he is satisfied. This poor little guy does seem to be way over medicated and on some serious drugs that can have dire consequences. He is obviously malnurished on top of the way he is feeling. Maybe even your parents could accompany them to the pediatrician. Keep us posted. Linda

[Guest Julia59]

Thanks so much for all your understanding and support on this.

Today was also David's birthday---he turned 8 years old.

I picked him up from school today and before we left the school, he wanted to give all the people in the office a cup cake. The principal was not there, so David put a cup cake on his desk---it was so sweet.

We are celebrating all our birthdays together this weekend, along with mother's day. David's is today, my mothers is the 13th, mine the 14th. Hopefully, my mom will be discharged from the hospital and everything will be OK. David is also having a party at chucky cheese-(spelling ) with his friends Saturday.

Today he forgot to take all his medicines. Well what do you know-----he was a different boy today---happy, not afraid, and his nerves were intact. He was also HUNGRY! I took him to the nearest Taco Bell! His Mom didn't pick him up at my parents house today because she has a bad virus and didn't want to give it to him. His dad was in school, and my Dad was with my Mom at the hospital, so I sat with him and we ate together. We also watched sponge bob. We had a mini birthday celebration-----

I finally had to go home as my back/neck was killing me. My Aunt said she would be there until 10:30pm before she had to leave for the night shift--she's a nurse. She lives with my parents. By then my brother and Dad would be home. My brother also stays there until he is out of school.

Now I have to help my Son, as he is still reeling from the roll over accident he had a couple weeks ago. He and his girlfriend are going to have to find another car for her to drive, and Mike is going to have to help her pay for it. Her father got the insurance company to pay for most of the car. There was wind shears that day, and that may have been why he lost control. I brought this up to Mike's girlfriend and she told her parents, and that may be why they covered it. Mike's driving record is good, and there were no other cars involved, plus he wasn't sited.

My family, and my husband's family sent him cards, and my father & mother sent him $200 bucks in theirs!

He still has to drive to Michigan everyday---and I worry. Tonight he get's off at 2:00am. I sure have my fill lately-----

I postponed my MRI for tomorrow at 7:00 AM to next Tuesday at 2:45pm. I think the MRI that early in the morning would have been too much on top of all the stress I had for the last couple of days. I'm telling ya----my upper back is just killing me----crushing pain.

Wishing you all well.

Julie :0)

[Guest Mary from OH]

Julie-

I'm glad you were able to go to the dr appt. Once again, fate/God stepping in. Anyhow. I'm a little late on the thread, but I think my info may still be valuable.

When I practiced Psych one of my specialities was ADHD. And I would like to point out that ADHD is actually correctly usually underdiagnosed when done properly (statistically speaking).

The meds that your nephew is on are common for ADHD Prozac and a stimulant. However, the dosages do seem a bit off and with the asthma meds, perhaps a possible dangerous combination. I totally agree with the pharmacist. And, a pharmacist has MORE knowledge about meds than a dr. does. Especially about interactions, etc. (I think you are aware of this, that's why you contacted them.) They are an excellent resource and should be heavily used by everyone!!

I was going to suggest to you to ask your brother or sister-in-law about going to an appt. But, that took care of itself.

Meds should be determined by weight and age. If your nephew is losing weight because of the meds, another med should probably be chosen.

From my experience, it sounds like he may be gifted in addition to having ADHD. Does he have both hyperactivity and inattention or just one of the symptoms? Did they try him on only one med first. Also, there are several "newer" meds out there that work for 24hrs that are not stimulants that may work better with his asthma medicaitons. It sounds like his family dr. is treating him. Perhaps your brother or sister-in-law can request a 24hr non-stimulant medication trial to see if it is more effective for him.

They have found that Prozac is a very dangerous drug for young children. I would be hesitant to leave him on that drug unless there is serious problems that can not be addressed in other manners. Just my .02

Feel free to email me privately.

You sure have your hands full. You need a break!! I am sending you a virtual bubble bath through the computer - please enjoy!!!

[Eli6596]

Hi Julia,

I am so happy for you that you were able to meet your nephew's doctor. I have a few ideas of how to make sure that both of his doctors know what the others are prescribing even between visits. Whenever one doctor adds or changes his medication, I would suggest calling the OTHER doctor's office to notify them. Also, I would suggest reminding the doctor at each appointment to please send a copy of his dictation to the other doctor.

You have a lot of stressors going on. I hope you will make sure to take care of yourself too.

Karyn