Medication Revisit of 2008

[Hawthorne]

So... inevitably, actually, not inevitably because I thought that we were moving towards a different kind of diagnosis, but not surprisingly, Lily's psychologist has some medications he would like us to consider using.

Get this:

Ditropan
DDAVP
Imipramine

What kind of drugs are these, you ask? Drugs used for over-active bladder and nocturnal enuresis.
Neither of which Lily has. At least one of which causes constipation. :smack:

:hmmm: :dunno:


Are we forgetting that Lily has more going on than wetting?
So next week we discuss, Tony and I and the doc.

I'm listening to what you guys tell me, but I'm not sure how much discussion this even needs! LOL I mean, do tell experiences and whatnot, please, but unless one of you tells me these are miracle drugs, we aren't even considering them.

[skyra]

I am confused. She is wetting AND having BM's correct? Do they think that perhaps by calming the overactive bladder and adding a constipating effect that will help? I know that there is a lot more to the situation than this, but this is obviously the direction he wants to go for now? I thought the bm's were the larger problem here? I don't get their logic on this one.

So... inevitably, actually, not inevitably because I thought that we were moving towards a different kind of diagnosis, but not surprisingly, Lily's psychologist has some medications he would like us to consider using.

Get this:

Ditropan
DDAVP
Imipramine

What kind of drugs are these, you ask? Drugs used for over-active bladder and nocturnal enuresis.
Neither of which Lily has. At least one of which causes constipation. :smack:

:hmmm: :dunno:


Are we forgetting that Lily has more going on than wetting?
So next week we discuss, Tony and I and the doc.

I'm listening to what you guys tell me, but I'm not sure how much discussion this even needs! LOL I mean, do tell experiences and whatnot, please, but unless one of you tells me these are miracle drugs, we aren't even considering them.

[Sue]

(((Rebecca and Lily)))) I don't even know what to say. :-( ~nt

[Hawthorne]

I am confused. She is wetting AND having BM's correct? Do they think that perhaps by calming the overactive bladder and adding a constipating effect that will help? I know that there is a lot more to the situation than this, but this is obviously the direction he wants to go for now? I thought the bm's were the larger problem here? I don't get their logic on this one.

I don't get it either and I would have told him that at the last appointment if I had known anything about them. He knows I do a lot of online research, so he wrote them down and told me to look them up and think about it.
He's not pushy at all, thank goodness, but I could have told him upfront that I thought he was on the wrong track. Making Lily "go" less frequently will only mean that she "goes" on the "floor" less frequently. LOL And constipating her would be a BAD BAD course of action.
This is just the thing... say the average person pees four times a day, and poops once. So Lily might pee in her underwear 2-3x, and either poop once or if she's naked, make it to the toilet. So if we make her pee less frequently and now, she goes 2x a day in her underwear and is too constipated to poop, or starts going in small amounts in her underwear because of leakage?
I mean, this is just setting us up for a bad scenario it seems. I'm totally stumped.
Let's not forget that Lily's favorite books are the Childcraft encyclopedias that she reads for hours each day, that she has a splinter collection (complete with names pertaining to their size and shape), that her favorite toys are her hair accessories (which she organizes by color), that she can't follow simple directions without forgetting what she's supposed to do, that she is frequently so involved in her own play that she doesn't hear us speaking to her (and her hearing is normal), and that she CRAVES sensory input (i.e. deep massage, therapy brush, head scratching, squeezing etc.). Off the top of my head.

Again :hmmm:

[skyra]

I don't get it either and I would have told him that at the last appointment if I had known anything about them. He knows I do a lot of online research, so he wrote them down and told me to look them up and think about it.
He's not pushy at all, thank goodness, but I could have told him upfront that I thought he was on the wrong track. Making Lily "go" less frequently will only mean that she "goes" on the "floor" less frequently. LOL And constipating her would be a BAD BAD course of action.
This is just the thing... say the average person pees four times a day, and poops once. So Lily might pee in her underwear 2-3x, and either poop once or if she's naked, make it to the toilet. So if we make her pee less frequently and now, she goes 2x a day in her underwear and is too constipated to poop, or starts going in small amounts in her underwear because of leakage?
I mean, this is just setting us up for a bad scenario it seems. I'm totally stumped.
Let's not forget that Lily's favorite books are the Childcraft encyclopedias that she reads for hours each day, that she has a splinter collection (complete with names pertaining to their size and shape), that her favorite toys are her hair accessories (which she organizes by color), that she can't follow simple directions without forgetting what she's supposed to do, that she is frequently so involved in her own play that she doesn't hear us speaking to her (and her hearing is normal), and that she CRAVES sensory input (i.e. deep massage, therapy brush, head scratching, squeezing etc.). Off the top of my head.

Again :hmmm:

Seriously, if you feel that you are not being heard, or if you think that he is WAYYYYYY in left field, it is time to find a new psych. I can't believe that he is missing the larger picture here. Can you just lay it out in black and white? This is what I am feeling it is, can we explore that further please? I am sorry that he seems to be missing the mark ENTIRELY. :( that is so incredibly frustrating.

[Artemis]

(((((hugs)))))

That's sounds WAY off! I really think no matter how non-pushy and nice your psychiatrist sounds, it's time to find a new psych. I'm sorry. OH wait...you said psychologist?????? Nooooooooo!!!! He should not even be talking about meds...this is out of his scope of practice unless he's also an MD. He is acting unethically here unless of course he is a psychiatrist. He must refer for med consult. Most psychologists have had NO training in psychotropics..at most some have had one course. Good for you for doing your own research here.

Does he actually talk about meds with you? And then get them from a Dr he works with? This again, is not ethical and i'd fire him based on that and report him as well. ONly the states of LA and NM allow Psychologists to do this, and I don't think you are in that state.

http://wiki.answers.com/Q/Do_psychologist_prescribe_pills

[anna v]

He's a farging idiot. IDIOT!

Does he have medical qualifications? He's obviously ::snort:: not in touch with the current thinking to put it mildly.

We use amityrtipline here (akin to imipramine, they're both tricyclics). It is the only psychotropic which has helped M and we all decided (dev paed, gastro and me) that it is better to manage the resulting constipation. Which is not easy. K went on it and we saw no change but his bowel management is so aggressive it's not surprising.

In the absence of eneurisis, no way would I trial those meds ahead of ones with fewer side effects. Oh just FYI zoloft is associated with loss of bladder sensitivity in some kids so they don't pee. Not a particularly good outcome IMO.

I'd do meds with a good pdoc and a gastro working together.

[Hawthorne]

(((((hugs)))))

That's sounds WAY off! I really think no matter how non-pushy and nice your psychiatrist sounds, it's time to find a new psych. I'm sorry. OH wait...you said psychologist?????? Nooooooooo!!!! He should not even be talking about meds...this is out of his scope of practice unless he's also an MD. He is acting unethically here unless of course he is a psychiatrist. He must refer for med consult. Most psychologists have had NO training in psychotropics..at most some have had one course. Good for you for doing your own research here.

Does he actually talk about meds with you? And then get them from a Dr he works with? This again, is not ethical and i'd fire him based on that and report him as well. ONly the states of LA and NM allow Psychologists to do this, and I don't think you are in that state.

http://wiki.answers.com/Q/Do_psychologist_prescribe_pills

What he was telling me was that in his experience he has seen these medications help with daytime wetters, and that if we are interested in trying that to consult with our family doctor, who obviously would give us more direction. I don't think that's out of line.

And I just want to be clear that he and I are both grasping at straws to figure out what's going on, he knows that I want any information he can provide me with, and vice versa. He knows me well enough to know that I will thoroughly research it before deciding anything.
He is one of the best psychologists in the area and is recommended far and wide.

Rereading my initial post I can see why you got a different impression. We are actually meeting next week, not to discuss medication (though I'm sure it will come up), but to discuss his final conclusion on her evaluation.

[Hawthorne]

He's a farging idiot. IDIOT!

Does he have medical qualifications? He's obviously ::snort:: not in touch with the current thinking to put it mildly.

We use amityrtipline here (akin to imipramine, they're both tricyclics). It is the only psychotropic which has helped M and we all decided (dev paed, gastro and me) that it is better to manage the resulting constipation. Which is not easy. K went on it and we saw no change but his bowel management is so aggressive it's not surprising.

In the absence of eneurisis, no way would I trial those meds ahead of ones with fewer side effects. Oh just FYI zoloft is associated with loss of bladder sensitivity in some kids so they don't pee. Not a particularly good outcome IMO.

I'd do meds with a good pdoc and a gastro working together.

She does have daytime enuresis, but not nocturnal. However, and maybe I'm misunderstanding the term here, she doesn't go more frequently than normal. So if she goes less times during the day, I don't see how that's going to help her go :idea: I need to go on the potty!
Does that make sense?

We use amityrtipline here (akin to imipramine, they're both tricyclics). It is the only psychotropic which has helped M and we all decided (dev paed, gastro and me) that it is better to manage the resulting constipation.
Just for clarification, are you saying that it helped with enuresis?

[Artemis]

OK, it did sound much different way up there, lol.

I'm glad you like him and I hope he is helpful with the developmental stuff.

I don't really know about meds for eneuresis, but they sound really off to m and I think your brain and gut are really telling you something with that.

[anna v]

Sorry for calling him an idiot then :-). I've just come across too many practitioners who just don't get it with bowel conditions.

No, we have never dealt with day or night eneurisis. I don't agree with his line of thinking at all. Either it's behavioural and she needs to practise the skill of listening to her bladder or it is physical and making her more constipated can just add to the stress on her bladder. Sometimes constipation can lead being unable to control voiding or unable to void.

[Hawthorne]

Sorry for calling him an idiot then :-). I've just come across too many practitioners who just don't get it with bowel conditions.

No, we have never dealt with day or night eneurisis. I don't agree with his line of thinking at all. Either it's behavioural and she needs to practise the skill of listening to her bladder or it is physical and making her more constipated can just add to the stress on her bladder. Sometimes constipation can lead being unable to control voiding or unable to void.

Thanks, I didn't know that and I will pass that info on to him as well. I can't wait to find out what he's thinking on this one.

And I understand about the name calling. :P I didn't have the desire to call him an idiot, because I know him enough to know he's not, but I was frustrated and would have if I didn't know him! lol One of my best friends also saw him and described him as strange. I couldn't figure out what on earth she was talking about, because he's the most "normal" psychologist or psychiatrist I had ever met with. I talked to her yesterday and told her that I have a hard time gauging "strange"... she thoughtfully said, "I mean, don't you think he's kind of like us?" :rofl: YES, strange in THAT way. (he thought it was fantastic that I've had two home births for example, he's kind of a hippy)

[Kathy]

So... inevitably, actually, not inevitably because I thought that we were moving towards a different kind of diagnosis, but not surprisingly, Lily's psychologist has some medications he would like us to consider using.

Get this:

Ditropan
DDAVP
Imipramine

What kind of drugs are these, you ask? Drugs used for over-active bladder and nocturnal enuresis.
Neither of which Lily has. At least one of which causes constipation. :smack:

:hmmm: :dunno:


Are we forgetting that Lily has more going on than wetting?
So next week we discuss, Tony and I and the doc.

I'm listening to what you guys tell me, but I'm not sure how much discussion this even needs! LOL I mean, do tell experiences and whatnot, please, but unless one of you tells me these are miracle drugs, we aren't even considering them.

Huh? First off, I agree with Artemis - there's no reason at all a Psychologist should be discussing medication, as it's completely outside his field and background. That said, I'm beginning to think professionals in general have issues of their own with any kind of elimination problem. Why on earth treat her with something that *prevents* urination and that causes constipation???

Sheesh. I'll add, just because it's just as crazy, that the urologist we took Ryan to NEVER suggested any of those medications....even though his problem IS excessive urination during the day and at night. No, he wanted Ryan to have surgery ON HIS SPINE because he *might* have tethered cord that *might* be causing the problem (and that surgery only solves urinary issues about 1/3 of the time). :banghead:

[anna v]

Kathy did you have an MRI? Did the urologist explain that tethered cord needs treatment regardless of whether or not it affects the bladder?

Nobody would do neurosurgery on the spine without establishing that tethered cord is there -- without having tethered cord, there's nothing to operate on ;).

ITA that a lot of professionals are weird about elimination stuff.

[Kathy]

Kathy did you have an MRI? Did the urologist explain that tethered cord needs treatment regardless of whether or not it affects the bladder?

Nobody would do neurosurgery on the spine without establishing that tethered cord is there -- without having tethered cord, there's nothing to operate on ;).

ITA that a lot of professionals are weird about elimination stuff.

No, we chose not to do the MRI, since we don't want the surgery on Ryan regardless of whether he has a tethered cord or not. From the research I have done and doctors I've talked to, there are many people who walk around with tethered cords with no ill effect, ever. Tethered cord is one of the new things to fix in medicine, kind of a trend, but there isn't research to back up having the surgery unless there is pain or problems with gait. And in Ryan's case, he has no issues with bowels at all and never has, plus no pain or mobility issues, so even if he *has* tethered cord, it most likely isn't causing his urinary issues.

An MRI for him requires general anesthesia, so for right now the risks outweigh any possible gains. If he shows any other symptoms as he grows older, we'll revisit the issue.