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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on July 8, 2006, at 22:00:32
In reply to Re: Doc won't treat ADD, posted by rjlockhart on July 8, 2006, at 21:56:48
Matt did you know there's a self-esteem board now? Check it out. Love Phillipa
Posted by rjlockhart on July 8, 2006, at 23:06:14
In reply to Re: Doc won't treat ADD » rjlockhart, posted by Phillipa on July 8, 2006, at 22:00:32
thanks i posted here.
Take care
RJ
Posted by llrrrpp on July 10, 2006, at 13:31:27
In reply to re provigil » llrrrpp, posted by saturn on July 7, 2006, at 12:58:48
>
> > I am doing well on seroquel 25 mg at night and provigil 200 mg in the daytime.
>
> Hi ll,
>
> Do you mind if I jump in here and ask if you'retaking the provigil for ADHD, and if so how it works and/or side effects? Thanks. Peace. Saturn.
>
Hi Saturn,
I take the provigil because I have a lot of daytime sleepiness due to AD (cymbalta, 90 mg) I was odosing on caffeine and feeling like crap. even on the provigil I can still get in 2 good naps a day. but the difference is that I don't NEED them :) who knows, maybe I have ADHD. More likely I'm just disorganized and slacking.
-ll
Posted by laima on July 19, 2006, at 10:42:07
In reply to Doc won't treat ADD, posted by curtm on July 6, 2006, at 9:19:55
Personally, I wonder if you might want to consider a new doctor, even for "a second opionion". Why so reluctant to treat ADD? Also, the drugs such as zyprexa can be complicated, themselves. Not to mention that the right benzodiazepine might be another helpful to "quiet" your brain while leaving you more "natural feeling" and functional. (I'm no doctor- this was just how it went iin my case.) When I tried zyprexa, it actualy made my attention much worse because I entered an almost hallucinogenic fog-state, and became very sedentary and strange, floaty feeling-save for persistently obsessing over eating and running out to buy more icecream. I am on my second doctor now- and he's radically different and smarter than the first one who I had. The first one was eager to prescribe in a way that sounds like what yours is doing- but the second addressed my ADD immediately. Personally, I think part of my depression and anxieties have stemmed from the utter frustration of not being able to concentrate on anything, complete tasks, and so on. I was in constant state of panic over what was't getting done, sliding away, and not working out. With ritalin, I am completing tasks, able to read books, etc. This has been an enourmous morale boost. While I am still not exactly the picture of model mental health, the ADD treatment has been very important to get me on my way. I do understand that many doctors are reluctant to prescribe for ADD because many of those drugs have a high addiction and abuse potential- perhaps that is part of the problem? They can also make an anxious person feel much more "wired". (I've experienced that, too.)
As for provigel- I even tried that. It did keep me awake and helped me focus- with absolutely no "wiredness"! Ultimately, in my case, ritalin worked out best. But, provigel, if you can get it, might be a good one.
I wish you good luck.
> I took an ADD test at T's and show results of ADD, but pdoc won't treat it because she thinks my mood disorder needs to be addressed first. In the meantime, I can't concentrate at work (or anywhere for that matter) and she keeps giving me stuff to "quiet my brain" like Zyprexa or Seroquel. Those have done nothing but tranquilize me for at least a dozen hours at a time. Can't get much done that way now can I? Not sure what I should do next. Should I fire her and find a new doc or go through all the AP's that she keeps bringing up as options. I know they will all do the same thing (knock me out.) I am not very happy right now about this situation. Grrrr
Posted by laima on July 19, 2006, at 10:51:29
In reply to re provigil » llrrrpp, posted by saturn on July 7, 2006, at 12:58:48
I took provigel for awhile because I have ADD as well as a sleep disorder and an anxiety problem. It indeed kept me awake and modestly helped me with concentration. I didn't notice any side effects, though my doctor did say it interacts with many diffferent drugs. What- I still don't know. I didn't have any trouble falling asleep at night while using it, either.My doctor said no one knows exactly how it works, but that it is very, very specific as to where it acts in the brain. I also heard it was originally developed to be used by pilots and military personell who need to be alert but not "wired".
Ritalin works well for me now- but a tiny amount dexedrine once made me feel that I was about to completely freak out. I think we might not all react the same to these drugs.
>
> > I am doing well on seroquel 25 mg at night and provigil 200 mg in the daytime.
>
> Hi ll,
>
> Do you mind if I jump in here and ask if you'retaking the provigil for ADHD, and if so how it works and/or side effects? Thanks. Peace. Saturn.
>
Posted by cloudydaze on July 19, 2006, at 17:52:03
In reply to Doc won't treat ADD, posted by curtm on July 6, 2006, at 9:19:55
Do you have bipolar? You said "mood disorder" - so i wasnt sure.
I have bipolar, and for years i was medicated for ADD. I really am not sure if i ever had ADD. The problem is, symptoms of bipolar (and sometimes depression & other disorders) cross over with the symptoms of ADD.
I always thought that my trouble concentrating was ADD, but then I learned about the "racing thoughts/disorganized thoughts" symptom of bipolar...and i think that's my problem. It even affects my sleep (can't turn off my mind...)
Maybe your doc thinks you really don't have ADD, but you have similar symptoms caused by your mood disorder?
I wasn't aware there was a test for ADD. Unless it's a new thing...the research I did on ADD always said that there is no actual test, just evaluation of symptoms combined with family history of the illness (several people in my family have ADD, but i seem to be the only one with bipolar..).
If there is a test, it would be interesting to know if i actually ever had ADD...or if i was just taking ritalin for nothing!
I've taken both Zyprexa and serequel...felt like a zombie. I didnt like it.
> I took an ADD test at T's and show results of ADD, but pdoc won't treat it because she thinks my mood disorder needs to be addressed first. In the meantime, I can't concentrate at work (or anywhere for that matter) and she keeps giving me stuff to "quiet my brain" like Zyprexa or Seroquel. Those have done nothing but tranquilize me for at least a dozen hours at a time. Can't get much done that way now can I? Not sure what I should do next. Should I fire her and find a new doc or go through all the AP's that she keeps bringing up as options. I know they will all do the same thing (knock me out.) I am not very happy right now about this situation. Grrrr
Posted by curtm on July 20, 2006, at 8:34:26
In reply to Re: Doc won't treat ADD, posted by cloudydaze on July 19, 2006, at 17:52:03
The ADD test was simple. I took it on a computer
The screen was black with a 2" x 3" square in the middle. The computer would either display the number 1 or 2 in the box. The computer will sound a number 1 or 2 also. Each time you hear or see the number 1, you click the left mouse button. Somehow base on your reaction and accuracy it evaluates your "symptoms." My psychologist ran this test for me.
Posted by pseudoname on July 20, 2006, at 8:58:12
In reply to Re: Doc won't treat ADD » cloudydaze, posted by curtm on July 20, 2006, at 8:34:26
> I took it on a computer
> My psychologist ran this test for me.If you don't mind my asking, how much did he/she charge for it?
Thanks.
Posted by laima on July 20, 2006, at 9:54:04
In reply to Re: Doc won't treat ADD » cloudydaze, posted by curtm on July 20, 2006, at 8:34:26
I was going to say, I've seen questionaires about ADD just as I've seen questionaires about anxiety disorders, depression scales, psychosis evaluations, etc. But the test you took sounds even more "official" or "unbiased" somehow than those. I do agree with the person who said that questionaires and tests alone are perhaps not the best way to make a definitive diagnosis, and also agree that it is important to consider factors such as how the disorder affects daily life functioning, etc.
A lot of "healthy" people might score high on the tests when in a poor mood, for example. (I imagine you know, as likely we all do, "feeling blue" or "disracted" once in awhile, doesn't make a clinical mood disorder. I get so irritated when happy, well-adjusted people say stuff like "I'm so depressed that there is nothing good on tv tonight", "I can't pay attention to this boring lecture- must be my add". etc., but I digress...) And then there is a lot of potential for overlap, as in the very unfortunate story shared by cloudydaze.But, is it true that adult add usually lacks "hyperactive or "racing" elements? Or am I wrong in thinking this? My own add is more spaciness, inability to concentrate, pay attention, or stick to tasks, easy distraction, etc.
I was thinking about your predicament, and it occurred to me that every psychiatrist I've ever met seemed to have a philosophy of "one thing at a time so we know what is affecting what".
Perhaps, plausabley, your doctor is understandabley reluctant to prescribe a stimulant to a person who expresses troubeling agitation, racing thoughts, and the like? A stimulant might make such symptoms much worse by increasing anxiety and agitation. Also, in my own experience as a patient, I noticed that there is often a mood lull or slight fall as they (stimulants) wear off. (Provigel the exception-but while not sure again, I think it is better for sleep and wakefulness troubles rather than ADD. (At least in my case.) And again, my doctor claims it can interact with many other substances, limiting overall treatment options.) Maybe that's why this talk of first "quieting" your mind came up?I'm still sorry your doctor seems so insistent on anti-psychotics.
What if you proposed that you wished to try something like klonopin or even one of those "mood stabilizers" like lamictal?
I myself found lamictal didn't agree with me, but it sure was a massive improvement over zyprexa. (And again, I know zyprexa works great for many people- and I envy those who can tolerate it- for it sure does seem to help with mood and anxiety!)I hope I didn't step on any slippery slope here with my thoughts or words in this post-I know we are all different and went through different trials and have had different experiences.
I'm no medical expert, I'm just speculating based upon my own experiences as a patient who over the years tried many different drugs, and and am sincerely wishing to be helpful and supportive. (diagnosed and being treated for mood disorder- resistant unipolar depression and anxiety-and add)> The ADD test was simple. I took it on a computer
> The screen was black with a 2" x 3" square in the middle. The computer would either display the number 1 or 2 in the box. The computer will sound a number 1 or 2 also. Each time you hear or see the number 1, you click the left mouse button. Somehow base on your reaction and accuracy it evaluates your "symptoms." My psychologist ran this test for me.
Posted by curtm on July 20, 2006, at 10:33:13
In reply to cost of test? » curtm, posted by pseudoname on July 20, 2006, at 8:58:12
> > I took it on a computer
> > My psychologist ran this test for me.
>
> If you don't mind my asking, how much did he/she charge for it?
>
> Thanks.
Hmmmm. I hope it didn't cost anything. I never asked. I assumed that it was just part of my therapy at his hourly rate. Oh well. I do have insurance anyway. I will ask next Monday when I go. (If I remember)
Posted by pseudoname on July 20, 2006, at 11:28:56
In reply to Re: cost of test? » pseudoname, posted by curtm on July 20, 2006, at 10:33:13
> I hope it didn't cost anything.
Hey, Curt.
I was only curious because computer-based ADHD tests were one the things marketed at the APA convention. The salesguy told me I could use it to increase my billing (he thought I was a pdoc) by about $200 per patient intake with virtually no clock time by the doc. The suggested bill for the test itself (if given once) was $45, I think.
Posted by curtm on July 20, 2006, at 12:06:08
In reply to Re: cost of test? » curtm, posted by pseudoname on July 20, 2006, at 11:28:56
>> he thought I was a pdoc
You should be. You would be very good I'm sure.
Thanks for the info. I would think they should disclose additional costs beforehand. Watch me get pissed if he didn't. Funny.
Posted by laima on July 20, 2006, at 12:11:46
In reply to Re: cost of test? » pseudoname, posted by curtm on July 20, 2006, at 12:06:08
Seems odd that they would want to charge extra for a diagnostic test on a computer...
> >> he thought I was a pdoc
>
> You should be. You would be very good I'm sure.
>
> Thanks for the info. I would think they should disclose additional costs beforehand. Watch me get pissed if he didn't. Funny.
Posted by curtm on July 20, 2006, at 12:19:49
In reply to Re: cost of test?, posted by laima on July 20, 2006, at 12:11:46
>> Seems odd that they would want to charge extra for a diagnostic test on a computer...
Yeah. All he did was sit and read other stuff while he waited for me to finish.
Posted by pseudoname on July 20, 2006, at 12:29:34
In reply to Re: cost of test?, posted by laima on July 20, 2006, at 12:11:46
> Seems odd that they would want to charge extra for a diagnostic test on a computer...
The docs have to pay for the equipment and the licensing, sometimes a per-test royalty. But I've heard of offices charging for administering non-licensed pencil-&-paper checklists!
The way this particular computer test arrangement was supposed to work – as explained to me by the salesperson – was that the patient would take the test to establish her baseline ($45). Then she'd get one dose of, say, Ritalin ($15). Then she'd wait around the office for two hours (which was also, somehow, billed). Then she'd take the test again (another $45). If she did better the second time, supposedly that would show that Ritalin is the drug for her! All with almost no time on the part of the pdoc, just nonprofessional staff.
Posted by pseudoname on July 20, 2006, at 12:37:59
In reply to Re: cost of test? » pseudoname, posted by curtm on July 20, 2006, at 12:06:08
> You would be very good I'm sure.
Thanks for saying so, Curt.
Now that I seem to be coming out of my 24-year depression, I'm looking for a direction to go in for what remains of my natural life. I don't think I'll try to be a pdoc, but I really appreciate you saying such an encouraging thing.
Posted by laima on July 20, 2006, at 12:41:09
In reply to charging for tests » laima, posted by pseudoname on July 20, 2006, at 12:29:34
Sure, they pay for the equipment. But can a machine do a better job than an experienced doctor who asks detailed questions? And who liscenses it? Is it more than a patent? I don't know, I'd rather interact with a very good doctor. But whatever works...> > Seems odd that they would want to charge extra for a diagnostic test on a computer...
>
> The docs have to pay for the equipment and the licensing, sometimes a per-test royalty. But I've heard of offices charging for administering non-licensed pencil-&-paper checklists!
>
> The way this particular computer test arrangement was supposed to work – as explained to me by the salesperson – was that the patient would take the test to establish her baseline ($45). Then she'd get one dose of, say, Ritalin ($15). Then she'd wait around the office for two hours (which was also, somehow, billed). Then she'd take the test again (another $45). If she did better the second time, supposedly that would show that Ritalin is the drug for her! All with almost no time on the part of the pdoc, just nonprofessional staff.
Posted by pseudoname on July 20, 2006, at 13:23:52
In reply to Re: charging for tests, posted by laima on July 20, 2006, at 12:41:09
> But can a machine do a better job than an experienced doctor who asks detailed questions?
Well, I'm not selling these, but I think the argument is that there's no way a doctor can test someone's responses in these areas with as much accuracy or detail as the computer can. Machines are used in testing and diagnosis throughout all branches of medicine. And especially in areas like ADHD, the vague diagnostic criteria, personal bias, subjectivity, and unreliability (i.e., differences among testers) are prominent criticisms. So a reliable test from a machine may be a good ADDITION to the other information a good doctor would consider, including personal interviews. It would be really sad if the computer test were the only thing the doc looked at.
> And who liscenses it? Is it more than a patent?
The company that developed it or is marketing it licenses it, just like the accounting software in the doc's office is licensed (essentially, rented with restrictions on its use).
> I'd rather interact with a very good doctor.
What if a very good doctor gave you an EEG? Or a blood test done by a machine?
Don't get me wrong, these marketing practices (as I thought I was making clear) may be quite off-putting. But the fact that a doctor or psychologist might use a machine to help guide treatment shouldn't lead us to assume that she's not a very good or experienced practitioner.
That may not be very romantic, but it could be helpful.
Posted by curtm on July 20, 2006, at 13:49:02
In reply to Re: charging for tests » laima, posted by pseudoname on July 20, 2006, at 13:23:52
>> But can a machine do a better job than an experienced doctor who asks detailed questions?
> Well, I'm not selling these, but I think the argument is that there's no way a doctor can test someone's responses in these areas with as much accuracy or detail as the computer can. Machines are used in testing and diagnosis throughout all branches of medicine. And especially in areas like ADHD, the vague diagnostic criteria, personal bias, subjectivity, and unreliability (i.e., differences among testers) are prominent criticisms. So a reliable test from a machine may be a good ADDITION to the other information a good doctor would consider, including personal interviews. It would be really sad if the computer test were the only thing the doc looked at.
********
But remember, the software was created by humans, which would unfortunately add the issues of "vague diagnostic criteria, personal bias, subjectivity, and unreliability" to it.
At least it would have more consistency.
Posted by laima on July 20, 2006, at 14:34:51
In reply to Re: charging for tests » laima, posted by pseudoname on July 20, 2006, at 13:23:52
Well, I admit that while I'm a flakey skeptic about it, the machine test actually makes real sense when you explain it this way. Thank you for taking the time to discuss. Maybe it will prove to be helpful to people, especially to those who are having trouble getting treatment. The part I'm still a tad suspicious about is regarding the specific drugs it recommends. Is the machine non-biased, or is it affiliated with a particular pharmaceutical company? Oh by the way- I agree-good medicine not always so romantic.
> > But can a machine do a better job than an experienced doctor who asks detailed questions?
>
> Well, I'm not selling these, but I think the argument is that there's no way a doctor can test someone's responses in these areas with as much accuracy or detail as the computer can. Machines are used in testing and diagnosis throughout all branches of medicine. And especially in areas like ADHD, the vague diagnostic criteria, personal bias, subjectivity, and unreliability (i.e., differences among testers) are prominent criticisms. So a reliable test from a machine may be a good ADDITION to the other information a good doctor would consider, including personal interviews. It would be really sad if the computer test were the only thing the doc looked at.
>
> > And who liscenses it? Is it more than a patent?
>
> The company that developed it or is marketing it licenses it, just like the accounting software in the doc's office is licensed (essentially, rented with restrictions on its use).
>
> > I'd rather interact with a very good doctor.
>
> What if a very good doctor gave you an EEG? Or a blood test done by a machine?
>
> Don't get me wrong, these marketing practices (as I thought I was making clear) may be quite off-putting. But the fact that a doctor or psychologist might use a machine to help guide treatment shouldn't lead us to assume that she's not a very good or experienced practitioner.
>
> That may not be very romantic, but it could be helpful.
Posted by laima on July 20, 2006, at 14:37:35
In reply to Re: charging for tests » pseudoname, posted by curtm on July 20, 2006, at 13:49:02
Yes, yes! Consistency is a good thing, especially when many of us struggle with vague symptoms that could be classified under various diagnoseses. I keep thinking of the person who was misdiagnosed with add when bipolar was the real problem...
> >> But can a machine do a better job than an experienced doctor who asks detailed questions?
>
> > Well, I'm not selling these, but I think the argument is that there's no way a doctor can test someone's responses in these areas with as much accuracy or detail as the computer can. Machines are used in testing and diagnosis throughout all branches of medicine. And especially in areas like ADHD, the vague diagnostic criteria, personal bias, subjectivity, and unreliability (i.e., differences among testers) are prominent criticisms. So a reliable test from a machine may be a good ADDITION to the other information a good doctor would consider, including personal interviews. It would be really sad if the computer test were the only thing the doc looked at.
>
> ********
>
> But remember, the software was created by humans, which would unfortunately add the issues of "vague diagnostic criteria, personal bias, subjectivity, and unreliability" to it.
>
> At least it would have more consistency.
>
Posted by pseudoname on July 20, 2006, at 15:01:50
In reply to Re: charging for tests, posted by laima on July 20, 2006, at 14:34:51
> Thank you for taking the time to discuss.
Gosh, thanks for telling me.
> The part I'm still a tad suspicious about is regarding the specific drugs it recommends.
At least as far as this computer program goes, it doesn't recommend any drugs. It's pretty limited in what it tells, which is just how "alert" or "focused" (in specific ways) a person was when he took the test.
One doctor might look at the results and say, "Well, you need Ritalin." Another might look at the same results and the same patient and say, "You need Wellbutrin" or whatever. Another might say the guy needs no medicine.
But, at least with the computer test, when the patient comes back a month or two later and he says, "I don't know if I'm really doing any better at focusing" or whatever, the doc could give him the test again and compare scores and say, "Nope, it doesn't look like we're helping you focus. We should try something else."
Well, that's an ideal use, I suppose. It might be very easy to start relying too much on the scores and forget to talk to the patient.
I have very bad insurance ($4,000 deductible), so if a doc charged for this test, knowing what I know from the salesman, I don't know if I would pay to take it. I might just tell him my scores from computer chess.
Posted by laima on July 20, 2006, at 15:23:59
In reply to computer recommended drugs » laima, posted by pseudoname on July 20, 2006, at 15:01:50
That machine sounds like a pretty good tool, I now have to admit. Especially since it is about add, a disorder which some doubt even exists. (What human can claim to never have been distractable at times?) I like the sounds of it! Hope it helps people.
> > Thank you for taking the time to discuss.
>
> Gosh, thanks for telling me.
>
> > The part I'm still a tad suspicious about is regarding the specific drugs it recommends.
>
> At least as far as this computer program goes, it doesn't recommend any drugs. It's pretty limited in what it tells, which is just how "alert" or "focused" (in specific ways) a person was when he took the test.
>
> One doctor might look at the results and say, "Well, you need Ritalin." Another might look at the same results and the same patient and say, "You need Wellbutrin" or whatever. Another might say the guy needs no medicine.
>
> But, at least with the computer test, when the patient comes back a month or two later and he says, "I don't know if I'm really doing any better at focusing" or whatever, the doc could give him the test again and compare scores and say, "Nope, it doesn't look like we're helping you focus. We should try something else."
>
> Well, that's an ideal use, I suppose. It might be very easy to start relying too much on the scores and forget to talk to the patient.
>
> I have very bad insurance ($4,000 deductible), so if a doc charged for this test, knowing what I know from the salesman, I don't know if I would pay to take it. I might just tell him my scores from computer chess.
Posted by curtm on July 20, 2006, at 15:26:25
In reply to computer recommended drugs » laima, posted by pseudoname on July 20, 2006, at 15:01:50
>> I might just tell him my scores from computer chess.
lol
Yes, thanks for chatting. And liama, too.
:) ((((PN)))) ((((liama))))
Posted by cloudydaze on July 22, 2006, at 14:41:04
In reply to Re: charging for tests, posted by laima on July 20, 2006, at 14:37:35
> Yes, yes! Consistency is a good thing, especially when many of us struggle with vague symptoms that could be classified under various diagnoseses. I keep thinking of the person who was misdiagnosed with add when bipolar was the real problem...
>I'm still not sure if I have ADD or not. I definately don't get hyperactive, except in my mind. The problem was that while ritalin seemed to help me on some days, it didn't always, and eventually the bad outweighed the good (it would agitate my anxiety more than it helped me concentrate). I think maybe the stimulant helped me have energy...and that's why i took it for so long.
Btw...i could be wrong, but i think there are 2 types of Attention Deficit Disorder - ADD and ADHD - depending on whether or not you have hyperactivity.
As for the computer testing - either it's a new develpment since I was diagnosed, OR they just don't offer it in my small town :)
I remember taking a whole bunch of tests, but none were on a computer...I still don't know EXACTLY what my full diagnosis is, outside the bipolar disorder. But i know i have taken meds for ADD and anxiety (klonopin?)
Sorry for the long post...kinda manic lately...
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