Concerta vs. Daytrana: Mommy's perspective

MOMMY: If you read Daughter's post last night, you know we had a considerably better first day on Concerta. Whew ... what a relief to both of us. What a curiosity as well. Why would two drugs based on the exact same ingredient (methylphenidate) have such vastly different effects on her?

The only thing I can figure is that the Daytrana Patch is not metabolized through the stomach and is absorbed straight into the system, thus giving her a stronger bolt of the drug. The Concerta though, which is an extended-release pill, is designed to be released slowly from the stomach. I'd think the patch would release slowly as well. But there must be something about the metabilization through the stomach that changed the way it is absorbed into her system. That's just doctor/scientist mommy talking. (And by the way, she's actually taking a few more milligrams of the Concerta than the Daytrana, so it can't be that she was getting more of the methylphenidate through Daytrana...)

Anyway, all I can say is that the two drugs had the complete opposite effect on her. The Daytrana Patch zinged her up like she was literally on speed, and that rapid heart beat and breathing scared us to death. Plus she was so wired she didn't sleep all night. But with the Concerta, she was really rather subdued all day (the desired effect). And she fell asleep easily. Good. Good, but weird.

We still dealt with her tummy hurting and difficulty eating, but she did eat more yesterday than she did last Saturday. I even took her out for ice cream, and she ate the whole sundae and said it really tasted wonderful - even though she had been afraid it would be difficult to eat (she hadn't been able to get down more than two bites of ice cream the week before). The appetite-suppressant issue is going to be a big one for us. Her doctor will take her off of the drug if she loses weight for more than two months because of her current size, so I am actively working on this issue. Here is what I'm working on:

1) I have to see that this helps her and that the good outweighs the bad or I'll take it off her it myself, but anyway ...
2) We're eating a very hearty, nutritious breakfast before taking the pill so that at least breakfast is not affected by the drug.
3) I'm trying to get in really nutritious snacks -- yesterday she did a great job snacking on raw veggies and ranch throughout the day, even though she did a rather poor job with lunch and dinner. I'm even going to send some snacks to school, and I think the teacher will be cooperative about letting her have these at recess. She loves cashews, so I think they should make an easy and nutritious, calorie-dense snack for school.
4) We're having Ensure shakes before bed at night. She really enjoyed one last night. So that worked pretty well.

We'll just figure this out as we go! But I sure do feel more hopeful today

And to answer your question yesterday, Good Fountain, yes, it's one pill a day. Thank you so much for reading and caring.

Ready for Concerta

MOMMY: Daughter has done a fantastic job swallowing pills all week. We even tried something different this morning, as the Concerta pills are a good deal larger than the Zyrteks. So I gave her one ibuprofen pill. I know it's not generally wise to just randomly give ibuprofen, but one pill wasn't going to hurt her--and I needed to know if she could do it. The last thing I need tomorrow when I give her the Concerta is to have her gagging and freaking out over it. It went down fine, so we both feel good about it now. Pill swallowing officially learned! If nothing else, I'm glad we have conquered that little life milestone. (One thing we did learn, for anyone looking for advice on how to do this, is that the pills go down much easier with juice than they do with water. Juice and a dollar. That's my magic formula for pill swallowing.)

Regarding tomorrow, I'm pretty nervous (now, how to keep Daughter from reading this post for the next 48 hours or so?) If the Concerta does to her what the Daytrana did to her, we are so done with medicine. I'll be looking for non-medical options to deal with this. On the other hand, I've had a lot of time to work with her one-on-one this week with homework and studying because we've been cooped up with snow/ice days, and I've really seen how very much she needs help. I desperately want this to help, but I desperately want it to help without any ill side effects. Are those mutually exclusive desires?

The Patch

ME: As my mom told you in the last post the patch didn't work. Well lets start in the morning when mommy and daddy told me to put on the patch it was simple. Since it was a Saturday i was at home all day. It went well until lunch. I couldn't eat not at all. It hurt to eat. All I had for lunch was some applesauce and a bite of macaroni. Right about then my heart started racing I was breathing probably a mile a minute. Then at dinner my grandparents took me and my sister to the waffle house. It was the best meal ever. But I only ate 2 bites of my waffles. And eating a bit of a piece of bacon felt like I was forcefeeding my self. When I went to bed that night my heart was still racing. My mom was worried about me so she slept with me. But all night I could not sleep. My body was wide awake. My eyes didn't even feel droopy. I was still wide awake at about 2:00 a.m. I got barely 3 hours of sleep that night. So now trying the patch again is out of the question. Mommy called the doctor and we are going to try a new medicine next weekend.

The trial-and-error phase begins

MOMMY: Once daughter's psychologist diagnosed ADHD, the next stop was the pediatrician. My husband and I both agreed we would consider medication for her if it would help. If there's a medication out there that can help help straighten out those chemicals in her brain and bring her mind back into focus, why wouldn't we? After watching her anxiety for the last two years in school (headaches, stomach aches, insomnia, etc.) and seeing it spiral out of control this year -- hearing her cry about not understanding why she can't pay attention. Why would we deny her anything that would help?

I told her one day that her brain was kind of like my eyes. They just don't focus very well. And I need to wear my contacts or glasses to make things clear. And we were going to see if medication would do the same for her brain. She seemed to like that analogy. Score one for Mommy!

We talked to the doctor about all the medication options and decided to try "the patch." It's called Daytrana. There were two reasons we decided to go with this option. The first is that the doctor said of all the stimulant medications, Daytrana seemed to be the least likely to have the appetite-suppressant side effect (which is our biggest concern for her, as she is only in the 10th percentile for her weight as it is). The second is that it comes in patch form, and she hasn't yet learned to swallow a pill.

It seemed like a good plan. Several people (doctor, counselor, teacher) warned me that finding the right medication can be a trial-and-error process--what works for one child can be all wrong for the next child. I dreaded that process for her. The last thing I want my little girl to be is a medical guinea pig. So I was hoping we'd get it right the first time.

No such luck. She wants to write about what happened.