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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Phillipa on March 8, 2012, at 15:31:14
I just saw my pdoc who does Charge $120.00 for 20 minute sessions. He Said "If a person doesn't have add or adhd as a child they can't have it with depression as an adult". Those words are his not mine for clarification. True or not? Also He feels that Ad's SSRI's etc do work and multi-pharmacy isn't called for other than with lets say Bipolar, Or Schizohrenia. Again his words and not mine. Curious as I feel others on here have had both as adult and not as a child? Phillipa
Posted by 10derheart on March 8, 2012, at 16:27:57
In reply to Pdoc Said Unless Add As Child Not As An Adult + De, posted by Phillipa on March 8, 2012, at 15:31:14
I would say he is both wrong and right, but *more* wrong than right.
I have been dealing with ADD since about 2000....meaning a cluster of symptoms I recognized as ADD...so about 12 years now. I have read most of the books on the market by professionals who have studied this condition, up until the last 2-3 years when I have not have the time or inclination any more since other things were more pressing than my particular symptoms. Over the years I have also belonged to several of the big organizations out there (CHADD, ADDA) and participated in message boards and so forth.
This PDOCs POV is not uncommon and is based in science...sorta. ADD/ADHD is pretty universally accepted (well,except by those who yet refuse to recognize its existence **at all**) as an organic, biological brain disorder...or difference as I prefer to see it. This shows up on PET scans. This has been confirmed in post mortem exams of brains, I believe. My brain, particularly the pre-frontal cortex, is not the same as the brains of those who do not suffer from the commonly known symptoms of attention deficit of hyperactivity.
So, due to the concrete physiological differences, the pdoc's assertion makes sense. If my brain differs, I was born with this brain. So, then does it follow that I *had* this condition from childhood? Well, I say yes and no. Do you *have* a condition when the potential is there but you either have no symptoms or they are so minor you easily adapt and others notice little? Hmmm...I guess it depends. Technically, I had ADD all my life, not just over the past 12 years from when I read books and it hit be like a bombshell that I was being precisely described, over and over and over again in books about adult ADD. But in a way, I didn't have it until it interfered with my life.
What I am trying to say is that there are two things that make your pdoc quite mistaken, IMO. First, years ago before science recognized a cluster as appearing in the same ways, repeatedly, and then beginning to study the brain to figure it out, ADD was not diagnosed. How can medicine diagnose something they are unaware of? Henry VIII, when king of England in the 6th century, most certainly had diabetes, gout, and other disorders any average doc could recognize and treat today. But he died of those since *doctors* in that time just knew next to nothing. Does that mean he didn't have the conditions, just the same as someone today has them? I think not.
The second thing that so many people, doctors and others, fail to grasp in that sometimes the way ADD manifests itself just does not become a problem until certain things happen. This is a complex situation where personality, support systems, other medical conditions, access to healthcare, type of work/school - all these come into play. For me, I had lived with disorganization, unusual anxiety, inability to prioritize like other adults, lack of sustained concentration, etc., all my adult (and child) life....and this is key...*** without having a clue that everyone wasn't like this**** And also, until my career reached a certain point and my daughter grew up and wasn't around to sort of parent me, the symptoms were manageable enough to have a relatively decent life where I wasn't a total mess - maybe just a little mess, which seemed funny and *just the way 10der is.*
But once just the right things changed, I began to lose it completely. From not being able to find the right items to dress myself for work each day, to losing my car keys constantly, to having a disaster for a home as I couldn't sort out *how* to clean (what order do you do the steps? what if you get distracted? what if it's boring?....) to getting in trouble for being late to work all the time and being unable to be a supervisor because I was utterly overwhelmed by new responsibilities, my ADD reared it's *different* head and just about destroyed everything.
So, the short version would have been he's wrong because it went undiagnosed in kids until the last couple of decades, particularly very bright, resourceful kids with supportive families who found their own coping mechanisms. And that just because it doesn't come out into the open and cause havoc until you're grown, does NOT mean an adult "doesn't have it."
So there!! Gee...this isn't something I feel strongly about, is it? (sorry...)
Posted by papillon2 on March 8, 2012, at 17:04:13
In reply to Re: Unless Add As Child Not As Adult (long answer) » Phillipa, posted by 10derheart on March 8, 2012, at 16:27:57
> So, the short version would have been he's wrong because it went undiagnosed in kids until the last couple of decades, particularly very bright, resourceful kids with supportive families who found their own coping mechanisms. And that just because it doesn't come out into the open and cause havoc until you're grown, does NOT mean an adult "doesn't have it."
You said it for me. It just wasn't diagnosed back then.
What particularly disturbs me is the refusal to try polypharmacy. Goodness help those with treatment-resistant depression requiring the addition of augmenting agents. I suppose this means ECT before the simple addition of, say, low dose Lithium. And since the anti-depressant wasn't effective enough to begin with you get to relapse afterwards and do it all again. Fun for the whole family.
Posted by linkadge on March 8, 2012, at 17:15:30
In reply to Re: Unless Add As Child Not As Adult (long answer), posted by papillon2 on March 8, 2012, at 17:04:13
>I just saw my pdoc who does Charge $120.00 for >20 minute sessions. He Said "If a person doesn't >have add or adhd as a child they can't have it >with depression as an adult".
I tend to agree that adult "onset" ADD is rare. Thats not to say that aduld ADD doesn't exist.
I think if an adult (with no problems as a child) were to develop ADD like symptoms it would be due to organic brain disease or possible anxiety / depression.>Also He feels that Ad's SSRI's etc do work
Of course he does, he's a psychiatrist. I disagree.
>and multi-pharmacy isn't called for other than >with lets say Bipolar, Or Schizohrenia.
I disagree. If SSRIs worked maybe one med would be fine.
Posted by Twinleaf on March 8, 2012, at 18:38:29
In reply to Pdoc Said Unless Add As Child Not As An Adult + De, posted by Phillipa on March 8, 2012, at 15:31:14
From what you are posting here, it sounds as though you didn't really tell him how distressed you have been. He can't start helping if he doesn't know. Is it hard to trust him?
Posted by Christ_empowered on March 8, 2012, at 19:45:35
In reply to Pdoc visit, posted by Twinleaf on March 8, 2012, at 18:38:29
I'm obviously not a doctor. I think that, instead of asking "Is it possible for an adult to have ADD/ADHD?" the question should be: could this patient benefit from an amphetamine or ritalin? I mean, maybe its some kind of depression that causes cognitive problems. They sometimes use stimulants in schizophrenia with lots of negative symptoms. I don't know the research on this, but I find the whole focus on "diseases" rather disturbing. It seems that the best thing to do would be to match up each patient with effective treatment(s). Hopefully, a doctor can do that without routinely resorting to 4+ drug combos, but that won't always be the case.
I'd be kind of conerned if my doc was earning almost $400 per hour and pushing SSRIs on people, given how they can cause problems and often fail to beat placebo. It sounds like he's going into this trying to make his patients squeeze into his pre-determined treatment plans. I don't know that I'd want to pay for that nonsense.
Posted by Phillipa on March 8, 2012, at 21:29:21
In reply to Re: Pdoc visit, posted by Christ_empowered on March 8, 2012, at 19:45:35
Hard to answer you all but will try in single response. 10der so true with what you said and time of centuries and what we knew then and now know, Link not only one med SSRI he said when asked that yes they do work. He knows I also take valium and xanax and luvox. Calls it rather unconventional to take two of each but since doses are low it's okay with him. Twinleaf he knows showed him the rash that looks like ecezema on arms and back asked if caused by anxiety and he said unconclusive. He keeps excellent records and keeps the focus on the conversation. I have two choices in this area of docs that take medicaire he is one the other is forensic. I'm also thinking his thinking is based on the specialty of his addictions. I almost agree with him as to me in my case since in past I didn't need meds for periods of time it's good for me to keep trying to problem solve my fears. He's my age also. He knows how upset I am also knows that problems in life with family and lots of stuff. Fear of disease and death. And that so many of the people I know in real life from high school to mammo tech are now dealing with breast cancer which is a bit fear of mine. Anyone feel free to babblemail me and will answer anymore questions. As I said to him the doc today I'm an open book. I will tell all. So many fears and demons to try and deal with. Hence the nightmares and cold sweats also. CE I know where you are coming from. I'm so used to having choices and being able to fix things for me and now knowing I have to finalize my life that in a way it's up to me. What was that book out years ago named that listed the decades and the challenges of each for each sex? Phillipa ps who wanted to take 5mg of lexapro and he said no
Posted by sigismund on March 9, 2012, at 3:51:08
In reply to Re: Pdoc visit, posted by Christ_empowered on March 8, 2012, at 19:45:35
> I think that, instead of asking "Is it possible for an adult to have ADD/ADHD?" the question should be: could this patient benefit from an amphetamine or ritalin?
Yes
Posted by SLS on March 9, 2012, at 6:46:55
In reply to Re: Unless Add As Child Not As Adult (long answer) » Phillipa, posted by 10derheart on March 8, 2012, at 16:27:57
Great post!
I hope you are doing wonderfully.
- Scott
Posted by bleauberry on March 9, 2012, at 13:48:18
In reply to Pdoc Said Unless Add As Child Not As An Adult + De, posted by Phillipa on March 8, 2012, at 15:31:14
Jan, I'm so sorry. I have a fair idea of what you have to deal with each day and you just want to feel a little better. And then someone you trust your care and money to gives you this kind of nonsensical mumbo jumbo, wow, that's just really discouraging. Unfortunately I think that happens a lot.
I don't know. I think politics, money and personal egos are involved. Actually doing something to help the patient takes a lower priority than does not rocking the boat with an insurance company, or earning rewards for prescribing certain meds from reps, or a big ego doc that is convinced he/she knows all. Sorry, I guess you can tell I'm feeling a little bad and negative myself today. No matter, it's all still probably true with certain doctors. I'm sorry you got stuck with one of them. There are some fabulous doctors, but these guys tarnish that image.
Nobody knows what ADD or ADHD actually is....all they know is that a certain cluster of symptoms can be given one of those names for purposes of categorizing or attempting to compartmentalize something that really isn't comparmentalizable. Is that a word? So anyway, let's assume the doctor is speaking a provable fact and that indeed unless you had add as a child you couldn't have it as an adult. Ok, so what? How does that help the patient, you? It doesn't. Just that simple.
If a doctor told me what that doctor told you, I'm not shy about being suspicious or curious or whatever, because after all it is my $120, right? I have a right to ask questions. Patients are expected to ask questions. In your case I would have said, "I have a hard time believing that but it sounds interesting...how did you come to believe that?" (basically trying to get a feel for whether his view is scientific or personal)Look, add in some cases can be nothing more complicated than small amounts of potent neurotoxins from a bacteria or fungus or metals or plastics or chemicals or petroleums....stuff in our fatty tissues....and it's causing some moderate level of chaos in terms of neurotransmitter-to-receptor relationships, or in the actual construction of neurotransmitters, or in turning specific genes up or down.
Most people would probably disagree with what I'm about to say and that's fine. I think the names we attach to certain clusters of symptoms are really fairly useless and do not further the effort to get a patient well. Sometimes they are not only fairly useless, but downright devastating. For example a person with a history of tick bites who was told they have fibromyalgia not lyme because the lyme test came back negative. That person is screwed. Because unless they have had the western blot by Igenex lab, they did not get the most accurate test, and even the most accurate test has about a 30% to 50% error rate. They need antibiotics, not pain relievers. They were bit by a tick and they have symptoms consistent with that, ok? End of story.
There are plenty of similar examples. One thing they all have in common....real people like you and me have years or decades of unnecessary suffering and deterioration and sometimes permanent damage because someone attached the wrong name to their cluster of symptoms.
It's too subjective. Ten doctors, ten different opinions.
So I guess what I'm saying, Jan, is screw the names....doesn't matter if it's add or whatever....what really matters is to have a doctor who is open and willing to try stuff, to work with you, and to be your partner in this mysterious journey where NONE of them and NONE of us really know what's going on. It is a discovery process and a journey, hopefully with a nice outcome, but it for sure is not going to happen with a doctor like the one you saw. In some parts of life I think things need to be rigid and structured....as in how to construct a building for example, or how to make CO2 from two other substances for example, and such. But when it comes to medical problems, especially long suffering chronic ones, rigid is a bad thing. It keeps people sick.
In my opinion.
> I just saw my pdoc who does Charge $120.00 for 20 minute sessions. He Said "If a person doesn't have add or adhd as a child they can't have it with depression as an adult". Those words are his not mine for clarification. True or not? Also He feels that Ad's SSRI's etc do work and multi-pharmacy isn't called for other than with lets say Bipolar, Or Schizohrenia. Again his words and not mine. Curious as I feel others on here have had both as adult and not as a child? Phillipa
Posted by Phillipa on March 9, 2012, at 18:21:58
In reply to Re: Pdoc Said Unless Add As Child Not As An Adult + De, posted by bleauberry on March 9, 2012, at 13:48:18
Blue I'm sorry you are not feeling well as had thought the antibiotics, herbs had made you well. I'm hoping you are not really down that it's a short term day long problem. I agree with what you said. Thankfully I don't have add it just sort of came up in the conversation when I asked him about add and depression and how if an adult adquired add if didn't have as a child. I do feel l0der made some really good points as when a lot of people were kids I took it to mean that basically add didn't exist to docs. Kids had it but were not treated? If I'm wrong please correct me. Phillipa
Posted by linkadge on March 10, 2012, at 7:27:31
In reply to Re: Pdoc visit, posted by Christ_empowered on March 8, 2012, at 19:45:35
>could this patient benefit from an amphetamine >or ritalin?
Anyone can benefit from amphetamine or ritalin.
Linkadge
Posted by torrid2 on March 11, 2012, at 13:15:52
In reply to Pdoc Said Unless Add As Child Not As An Adult + De, posted by Phillipa on March 8, 2012, at 15:31:14
I don't know about adult onset of ADHD, I'm sceptical. Doc's don't like to right Amphedimines even though they are helpful for more then ADHD.
Doesn't sound like it was a good start. I'd take it eazy and let him get to know you before you make any requests or he will tag your file with a drug seeker sticker. You can do a search on the criteria they use to make these kind of judgements. Switching docs is a big flag for drug seekers. Making spicific drug requests too can flag you as a drug seeker.
Do you want to stay with this doc?
Posted by bleauberry on March 11, 2012, at 15:03:02
In reply to Re: Pdoc Said Unless Add As Child Not As An Adult + De » bleauberry, posted by Phillipa on March 9, 2012, at 18:21:58
Don't forget, Jan, the whole lyme thing is a very long battle with ongoing cycles and waves....as dormant or hiding organisms become exposed over time....and bartonella for example is in the bone marrow, ok, so that takes a longterm approach. When there is a flareup, which means the bugs are being killed or fighting back, things are bad. They only get killed during the reporductive cycle, and thus the healing cycles. I have some random days that are just, well, nice. Others are pure hell. Hopefully the good days will outnumber the bad in more time, but at this time, not.
> Blue I'm sorry you are not feeling well as had thought the antibiotics, herbs had made you well. I'm hoping you are not really down that it's a short term day long problem. I agree with what you said. Thankfully I don't have add it just sort of came up in the conversation when I asked him about add and depression and how if an adult adquired add if didn't have as a child. I do feel l0der made some really good points as when a lot of people were kids I took it to mean that basically add didn't exist to docs. Kids had it but were not treated? If I'm wrong please correct me. Phillipa
Posted by Phillipa on March 11, 2012, at 20:18:19
In reply to Re: Pdoc Said Unless Add As Child Not As An Adult + De, posted by torrid2 on March 11, 2012, at 13:15:52
Really have no choice with medicaire. I like him. He sees things differently than younger docs. He's not swayed by the new stuff. So far have turned down any prescriptions from him for close to six months now as have enough from old doc. Phillipa
This is the end of the thread.
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