Day 1 on Strattera for Adult ADHD & Why I Have Decided To Change my Family Physician

Yesterday afternoon I went to my family doctor who works about an hour or so away from where I live - in my old hometown. I left a little early in order to make it on time, and dropped by my folks' house to say hello first.

Off I went shortly afterward to my appointment, and after waiting for 30 minutes, he walked into the little room where I was sitting with my notebook and pen.

He asked me how I was doing, and took a seat. I told him that I was feeling pretty good. I had been taking the Clonazepam (an anxiolytic in the same class as Valium and Ativan) instead of the Ativan, and that it was far milder, and that I preferred the longer, gentler effects. I told him that I was planning on seeing a psychologist for counseling and that I was glad to be there to find out the results of the tests I took a couple of weeks back (blood tests and ECG).

He looked a bit flustered, and then slowly went through the blood tests and ECG. He went over each item of the blood tests (and on a few I had to ask him 'so what does that mean?')... the bottom line is that my blood tests seemed to impress him considerably. It was as though I had given him a nice watch for his birthday. He kept grinning and saying how good the results were. My blood pressure was 120/70, better than my last one of 120/80.

He seemed so excited to have a healthy person in his office, I guess. I said that I figured losing over 30 pounds might be contributing to my good results. He didn't say anything, but just closed the folder.

He then said that he would then give me a longer prescription for the Clonazapam as it seems to be working for my anxiety, and 5 minutes after he arrived, he got up to leave.

I fretted my brow and reached down for my notebook and asked him "Uhm, so I imagine you will be giving me a prescription for Strattera as per the recommendations of the assessment and evaluation report - the reason I'm here today - right?"

He frowned and absentmindedly flipped through the folder again. He stopped on a page and squinted at it. Then he asked me in a sort of quiet, doubting sort of way, "So you want a prescription for it?"

At that point my inner voice replied "Yes, you genius. That's why I spent nearly a grand on the evaluation, and spent the last fucking three months going to appointments, and ultimately received an authoritative and bona fide psychiatric diagnosis of ADHD Combined Type after attending long sessions with two eminent and very experienced psychiatrists, one who died right after I initially met with him, and with a clinical psychologist and a psychometrist - each of whom specialize in both child and adult attention deficit hyperactivity disorder. And your obvious due diligence as reflected in your unusually thorough understanding and expression of understanding of the report you hold in your hands only serves to strengthen my opinion that you are only being facetious and that indeed you are completely in control and are exceedingly competent and commanding control of this session with your patient whom you have known for nearly 30 years. No actually I'm just kidding. I'm here because I am fond of the smell of this doctor's office. And I especially like the decor. It was nice to see you, I'll now go on my way and not bother you anymore."

Shortly after my inner voice settled down, I took a deep breath and I actually (in real life) responded, using my managerial tone that I use at work to get stuff done.

I locked my eyes on his and said that my understanding was that the assessment he was holding recommends that I am to be put on Strattera, at an initial dose of 10 mg, once daily, and that I was to be titrated up while he monitored me periodically for side-effects, and until I reached an effective dosage. I said that it was indeed my expectation that this is why I had attended the appointment today, so as to review the test results that he had ordered I take, with the express purpose of ensuring I was healthy enough to be put on Atomoxetine (Strattera). And that Strattera was the recommendation contained within the consultation notes, because my comorbid anxiety precluded or at least weighed against my taking any of the stimulant medications for ADHD. I said that my understanding was that The Canadian Attention Deficit Hyperactivity Disorder Resource Alliance also specifically recommends this regime, and that I might potentially eventually end up - once titration ends - on 40, 60 or more milligrams daily, depending on my ability to tolerate the medication, but more importantly depending on when it began to effectively help me manage my ADHD symptoms. And that I expected that I would be meeting with him periodically until the dosage is working.

He looked puzzled and shuffled the papers around a bit, and then wrote out a prescription for both the Clonazepam and the Strattera and told me that I should come back in two weeks and that we would continue from there.

I thanked him for his time, and wished him a good weekend.

On my drive home I decided that once I have gotten through the titration and initial monitoring, that I will change my family doctor of 30 years to someone more local - in Toronto. I'm done. I used to put up with his chit-chat because I believed that he might be using it as a therapeutic mechanism to monitor my behaviour and interactions. Now I think he just likes to talk about himself. I've always been forgiving of his apparent passiveness, assuming his experience was somehow reflected in his few words, and defended his behaviour with family members who also used his services.

It isn't often that I get pissed off like that but boy oh boy.

So - next steps:

I took my capsule last night before bed. There were no general overall bodily side effects. Certainly I won't see any improvement (if this works) for a few weeks. But this morning a strange thing happened as I was getting ready for work having my morning - well - 'tinkle'.

I will use an analogy so that you will not blush and so that I will not blush. Imagine that you were watering the garden - perhaps the geraniums - with a rubbber water hose. And instead of simply turning the water off at the spigot once you were done, you instead - just prior to when you were ready to finish - suddenly squeezed the hose at the base. And now imagine that the hose itself for some odd reason has sensory nerves that can register pain due to unintended premature constriction before the water had fully run out.

Well, that happened. And not in the analogous world. In the bathroom. Nothing to worry too much about, but it was a weird experience. It has happened a couple of times this morning at work too, as I decided to 'water the geraniums'.

I am going to blog daily (if I can) about my observations. I will try not to dwell on the rubber hose analogy. Really. I will try to observe my behaviours, and will endeavor to be quite dispassionate and scientific about my observations.

Cheers,

Mungo

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