Monday, March 25, 2013

Medication Musical Chairs

It's been a week since Korbin went back into the behavior hospital's acute stay program. Stays can be as short as 3 days, but are typically 5-10. The psychiatrists know him (and me) well enough that they were completely open to my request to get Korbin off the Thorazine. His body has been physically reacting with EPS (Extra pyramidal Symptoms) and it definitely wasn't taking care of his symptoms. He does still need an anti psychotic. He's had Zyprexa in the past as a PRN medication. For those who don't know PRN means "as needed". Occasionally folks need a medication to get through a moment. Sometimes when he has a psychotic break he'll become aggressive and can't be kept physically safe from hurting himself or others. Having a PRN medicine can help him through that moment for safety and to avoid more of these acute stays.

Knowing that he's handled Zyprexa well and it's a viable option for his symptoms, we chose it as our main tool to control his psychosis. The Thorazine was already causing him to shake, twitch, and even jerk like he's having seizures. Side effects like this are unfortunately common in high dose and long term anti psychotic use. Changing medication can help, but there's another option. Cogentin can help counter the side effects, similar to the way Benadryl counters allergies. We've added Cogentin to help now and to keep the ugliness away for the long term. Oh and we're going to do a little Hokey Poky and turn the Thorazine around into his PRN med.

Even though I don't care for the Depakote and have been tolerating the idea of the Topamax, the docs say it stays. Yes, he's a roller coaster of moods, but I haven't really seen much difference with the mood stabilizers on board. This is where I have to trust the professionals. They say that taking him off the mood stabilizers can make getting him balanced again much more difficult. Not that he's all that balanced, but can get fare more ugly. I've read the studies and seen it in person. Coming off medication can reveal symptoms that are far worse than before and more difficult to control. It's just one of the many reasons we need to make sure our friends and family stay on their medication.

The one medication we won't go without is Clonidine. Korbin has huge, HUGE issues with attention and impulse control. Using stimulant medications for kids who also have an autism spectrum disorder or a risk of mood disorders usually doesn't turn out well. When my oldest son was tried on one at the age of 3 it sent him into his first manic phase. Clonidine and Tenex are both blood pressure meds that are used for ADHD symptoms in place of stimulants. Tenex was enough for Aidan, but Korbin required the slightly more sedating Clonidine. It's been the one constant in his little pharmacy. It's also been like a magic pill for his Tourette's Syndrome. We had him on a much lower dose years ago when his tics were more mild, but then came the earthquake. His little body wouldn't let him be still. He had to do a full body dance to speak in sentences. Little man's eyes blinked so fast it was difficult for him to see. The neurologist just increased the dose. Almost instantly the tics were under control. Yes, he's still a twitchy, fidgety little dude, but he can physically function again. This week we went from 0.1mg 4 times a day to 0.15 mg 3 times a day. It's not a big increase, but it's a little tweak that seems to be helping with his impulse control.

At least his asthma and allergy medicines are staying the same. I keep them sorted in one of those fancy pill boxes that holds a week's worth of meds separated into 4 times a day. Our pharmacists are amazed by my OCD organizational skills. With Korbin on a total of 9 medications daily, Aidan on 4, and me on 11, it takes neurotic dedication.

Although I strongly dislike taking and giving my sons man made, chemical medications, I do realize that some things are necessary. Insulin, cortisone, and so many others save lives. Psychiatric medications do the same, just not so directly. I am very thankful for these nasty chemicals. Without them my Korbin would be in an institution for life. We'll have many more medication changes over the years. We'll dance around the side effects while working toward the best symptom control. Now will someone stop the music so we can sit down and rest?

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