New prescriber doesn't think my husband has ADD!

As I've posted before, my husband lost his job and therefore, his insurance. I finally set him up to go to a county-run treatment center, which won't prescribe for ADD, because he was out of his anti-depressants. He's sleeping 12 hours a day, not looking for a new job, not doing anything in the house, etc. He had a bottle of ADD meds, but lost them!

The person they had him see is a Physician's Assistant, not a doctor. She thinks he doesn't have ADD at all, just depression. He seems like a textbook inattentive ADD case to me: distracted, loses things, wouldn't do the work in school, etc. How can people with the same training come to different conclusions? How can he get a good answer without insurance to have another evaluation? We don't have any place to get the SPECT studies, and have no money to travel.

If you can go back to the

If you can go back to the clinic and see another doctor or other professional, could you bring any old school reports?  Where I live in the UK, the system of diagnosis is different, you need the testimony of someone who knew the patient from childhood.  A written argument from someone who's known him his whole life might help to convince them, even they are the same age as your husband.  I hope you're taken seriously soon, and given the help and support you need.

A PA get's to make This Call?!? WTH???

I've run into a Similar situation to your DH's. My DD#1, who I did not suspect had ADD until a few months ago, had been seeing a psychologist off and on for a year or so. Diagnosed with depression and had been trying different meds. THEY WERE NOT WORKING... I began parsing through all the data as to when she started to spiral down, then it hit me like a Ton of Bricks. DD#1 is inattentive ADD, just like me. She had everything under control until this year when the started high school and was taking all advanced classes, marching band, symphonic band AND Choir. This Extreme change in Load sent her ADD into Over-Drive. I could see all of my classic reactions. The psychologist recommended a new psychiatrist (She raved about this guy) and told my DW and DD#1 that there was "NO Way" she had ADD and that she wanted to be Skinny like her dad. (I'm not skinny BTW, 5-11 @ 185)

The psychiatrist put her on Vyvannse and it made an IMMEDIATE difference. I watched the "Light-bulb Moment" right before my eyes. DD#1 still has quite a bit of work to do, but Thank Goodness I did not let the one psychologist make this call.

Sue... Don't let the PA make this call ;) 

Hang in there :)

Sueann, I'm on board

Sueann,

I'm on board with YYZ.  The PA should not be making the call.  Furthermore, if you already had a diagnosis and a prescription, I don't see why the former MD couldn't forward records and notes they take (my psychiatrist constantly takes notes, and I basically see him for med appts. to refill my prescription). If she has his previous records and still won't budge, you might want to write up what you see.  You could probably copy and paste a lot from your posts here into a Word document.  Then, if you're afraid that might not be enough, talk to family members or friends who would be willing to put something in writing; maybe answer some questions you e-mail to them...  I don't know anyone who has done a SPECT.  Family history is what it's all about!  Remember, this lady has seen him in a controlled setting where even people like us can focus for a short period of time.  It is about the big picture.  Plus, who knows if she sees that many adults with ADHD.  If she sees mostly teenagers or young kids, she might have a totally different idea of what she should be looking for.  I am ADHD, but do not fall out a chair like some of my students have.  

He may well have depression, but as we know, co-morbidity is common with ADHD.  Plus, underachieving is depressing, and contributes to a vicious cycle.  

As a side note, I giggled to myself when I read his lost his prescription. NOT because I think it's funny, but it reminded me of my first trip to my first psychiatrist for ADHD.  I tried to plan ahead of time, but got lost and was 40 minutes late.  I apologized profusely, and he calmly looked at me and basically told me most of his ADHD patients are late to their first appointment.  He added (somewhat tongue-in-cheek) that he considers it part of the diagnostic criteria...

I'm sorry I don't have a guaranteed solution, but my heart goes out to you. 

Good luck!

I always agree with YYZ!

The problem is knowing what to do about it. This PA is quite aware that 3 psychiatrists have diagnosed my husband with ADD, but in 15 minutes a month, and not even seeing him personally (it's all done by Skype), she won't prescribe for him. She's ordered some blood tests. I think she thinks ADD meds are unsafe for a guy over 50. I can't figure out how to get around this.

Meanwhile, the same agency canceled his therapy appointment and won't call back to reschedule, so I have to make the decision about the job in another city without even talking to her.

I know the answer is "don't be poor and you can get good health care" but it's a vicious cycle-his ADD and depression prevent him from working, he loses his insurance, he gets crappy health care so he can't recover. Any ideas???

 

 

My daughter is a PA and would

My daughter is a PA and would be appalled by the behavior of the one your husband saw. You have the right to see a doctor if you think an MD is necessary. You may have a hard time getting an appointment right away; he/she may be backed up for months. PA's are highly qualified and can handle almost anything required for general medicine, but if you want an MD, call and ask to make an appointment with an MD.!

PAs, etc.

That's what I feel too, but I can't figure out how to make it happen. Our county has a mental health clinic for people with severe mental illness who don't have insurance. When he first ended up there 4 or 5 years ago, they told him flat-out they were prevented by law from prescribing ADHD meds, because they have a potential for abuse. I worked for months to find a place that would do it for an uninsured poor person. Eventually, in hopes he would go back to work if treated, I paid for a private doctor. I got us marriage counseling there, with an intern who dropped us like a hot rock when she got a "real" job. My husband got a job and insurance and saw a doctor for nearly a year who prescribed for both the ADD and depression. Certainly they are not mutually exclusive.

This time they referred him to this dog-and-pony show where they don't even really see him. But she is permitted to prescribe ADD meds, and I have a letter from the manufacturer allowing him to get them free for a year. She just thinks that if she gets him not to be depressed, he will not lose things any more (that's what he got fired for), or refuse to do anything but watch TV or any of the other ADD behaviors that make me crazy. I disagree because even when he was adequately treating his depression alone, the ADD symptoms prevented him from working or trying to work. 

I am so unhappy. I am 58 years old, he's younger. I think of the idea of a person with a physical disability being expected to be the total means of his existence for the rest of his life and I feel sick with fear. He wants me to support him and totally maintain our home. I bought a broom and asked him to clean up the litter the cats throw around outside the litterbox and he picked up one piece of it and said he was done, he doesn't see any more. That means I have to get down on my hands and (surgically repaired with screws) knees and clean the rest of it.

I have to know by next week this is going to get better ! (not get better right away, but to know it will get get better sometime) I have a chance at a job 90 miles away and  I will take it and let him try to live and pay rent on $239 a week in unemployment if I can't figure out how to get him adequately treated.

We don't get another 15 minutes with her for another 4 weeks. I have to make this decision before that. 

 

 

 

 

All PA's work under an MD.

All PA's work under an MD. Ask for an appointment with that person. If they refuse, report them to the AMA. That 's bad medicine.

I think YYZ has the

I think YYZ has the beginnings of a cult following:)

If it's not ADD what is it???

As I've posted before, my husband's current prescriber doesn't think he has ADHD and won't prescribe for it. 4 other MDs have said he does have it. I want to tell you about my experiences yesterday.

I went to the grocery store because I wanted something he doesn't eat, so he made me go. I asked him to put the food away; he said he would. This was in the afternoon. When I went to cook breakfast this morning, I found the frozen fish on the counter (not frozen any more) and the ice cream in the refrigerator (not the freezer). The ice cream wasn't bought on this trip. He actually took it out to make our nightly snack and put it back wrong at a different time than he put the groceries away wrong. This brings up 2 issues: 1. I PAID FOR that food; he isn't working. How do I not be angry about the waste of money I earned? 2. Would someone who doesn't have ADD do those things?

I think I am looking for some way to use this to prove to this clueless PA that he really does have ADD. Thoughts, anyone?

 

 

I would start documenting

I would start documenting EVERYTHING he does which constitutes ADHD behavior:  interrupting, forgetting, short-term memory issues, repetitive mistakes, forgetting what you guys fight about, etc... You might not want to tell your husband; he might think you're just documenting his mistakes (even though, technically, you are).  I don't think the ice cream/fish incident (alone) will convince her, though everyone on this site "gets it," no doubt.   

I would document it for a month.  She could dismiss a week or two...but not a month.  And if she does, keep documenting; don't give up.  The more proof, the less she stands a chance at refuting it.  At that point, you could go to the Director of mental health services...

He would have to be the one

They have told him he can see a different person but he'd have to request it, not me. When I ask him to do so, he says "Perhaps". Good Lord, who even says perhaps in normal conversation? He's so freaking PASSIVE it makes me nuts! (In case you haven't noticed, I'm not the passive type.)

I do like the idea of documenting, though.