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ADHD in adult - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Mental Health
Answered by

General & Family Physician
Practicing since : 2009
Answered : 681 Questions
User :   Yes I have questions about my ADHD an other possible medical disorders                                                                 
Doctor :   hi
Doctor :   Dr. XXXXXXXX here.
Doctor :   please describe your problem in detail.
User :   Hello sir
User :   I was recently diagnosed in the ... Marines with ADHD predominatly inattentive type an prescribed 20 mg adderall once daily. However I have other conditions that my family thinks I may have an I have questions about the medication I take
Doctor :   ok. please proceed with your questions one by one
User :   Ok first. The adderall xr 20 mg is what I take I was on 15 but it did not last all day (I take at 5 am an don't get off work till about 4 pm) so they bumped me to 20 but the xr still seems to wear off too early an I don't want a higher milligram because I experimented with my mess an anything more than 20 is too much of I take more I feel too anxious towards the end of the day. The military doctors are hard too talk too so what should I do about this problem
Doctor :   let me read what you have typed. please give me a moment
User :   Ok
Doctor :   ok. the medication dose that you take is fine. was any behavioral therapy or counseling prescribed for you along with medications?
Doctor :   usually counseling and behavioral therapy should be prescribed to help the individual come out of the problems
User :   No I was just told by the doctor too keep a log book of daily activities too track what I need to do
Doctor :   ok
Doctor :   if the medication dose is not feeling sufficient then I would recommend you to get started on counseling and behavioral therapy
Doctor :   meet a psychologist for this
User :   Since I need to stay focused for longer than the xr lasts should I ask if I can have the instant release an take 10mg before work am the other dose after lunch because the second set of beeds in the xr releases 4 hours after the first which is at around 9 am an medication will be wore off by 1 pm?
Doctor :   no, usually the XR is better since you need to be alert for longer time
Doctor :   you will be fine with the counseling and the therapy I suggested. do not worry about the medication.
Doctor :   are you there?
Doctor :   did you follow what I said?
User :   Ok I will inquire about that. Also I have question about exercise that the military doctor cannot give me good answers on. As you know the marines run an exercise a lot, with thy dosage when is it best to exercise? Before taking? An if I want to exercise after taking the medicine how many hours after taking should I wait
User :   Sorry I am typing from a iPhone so messages do take some time to type
Doctor :   you can do the exercises anytime, the medication should not affect it
Doctor :   ok. it is fine. i understand, I just wanted to make sure that I have not lost you from the conversation
User :   Ok it was just I notice that after taking my BPM an BP does increase. My normal HR is 50-60 BPM an they increase too around 90 when the onset of the medication occurs
Doctor :   yes it can lead to that. as long as it does not cross 100 BPM it should be fine
Doctor :   since th emedication is tp keep you alert
Doctor :   it will accelerate the heart rate
Doctor :   and brain functions to try to keep you alert and awake
Doctor :   BPM=beats per minute
User :   I am 24. While running on a treadmill what is the max I should allow my heart rate too reach before slowing the treadmill down
Doctor :   your heart rate should be such that you should be able to breath and speak clearly at the same time.
Doctor :   it should not make you breathless while speaking
Doctor :   when working on treadmill, your heart should not increase more than double of your resting heart rate
Doctor :   if your resting heart rate is about 50-60, then it should not increase more than 100-120
Doctor :   while exercising
User :   Ok because my resting HR is 60 BPM but while extreme running I have let it get to 170 because the chart on the machine says for my age that is about 85% max rate for cardio work out
Doctor :   that is for the normal people, since you are on medication, do not let it cross the double of it
Doctor :   or you can allow a maximum upto 140 BPM, not more than that
User :   Ok that is very informative
Doctor :   do you have any other query to ask me?
User :   What about BP how much of a BP rise while on the medication is exceptable
Doctor :   what is your normal BP while at rest?
User :   And I have questions about anger before the mess my bp is usually 115-125/70
Doctor :   ok. acceptable rise is +10 systotic (that is the higher reading) and +5 diastolic (that is the lower reading)
User :   Ok that's about what mine does
Doctor :   which will make it not more than 125-135/80
Doctor :   it should not go beyond 140/90 for your age and with medications.
Doctor :   even when doing workouts
User :   If it does can the doctors give me something for that without taking me off the meds because they work way too well for me. I don't monitor BP too much but will start
Doctor :   you can monitor your BP, if it goes more than 140/90 then they will give you medication to lower it down, even with rest for about 10 minutes, BP will get lowered
Doctor :   you do not need to take off your medications
User :   Ok thank you. Also I have always had anger problems an have taken anger management before this is all before the meds but I will get so angry sometimes that I will throw an break things an omost a panic attack. The mess help control this but is there something else they can do to assist with this
Doctor :   again here the counsellings and the behavior modification therapy will help you to control the anger.
Doctor :   try and avoid the situations taht make yu angry
Doctor :   make a note of all the situations where you got angry
Doctor :   read over them and try to avoid them
User :   I will start making notes is that part of some of the ADHD?
Doctor :   or distract yourself with things that you like to do, like playing your favorite game etc.
Doctor :   yes, it could be a part of ADHD.
Doctor :   are you there?
User :   Yes
Doctor :   is there anything else you would like to ask me?
User :   One more question
Doctor :   yes. please proceed
User :   The medication has never caused me sleep problems in the entire year I have been taking it but lately due to family problems but now I have trouble on occassions sleeping at night. What are some fixes for this? I have tried meditation but it does not work at all
Doctor :   try having a glass of warm milk 1/2 hour before going for sleep
Doctor :   it helps in getting sound sleep due to amino acid tryptophan in it
Doctor :   do not self medicate yourself
Doctor :   have you followed what I have said?
Doctor :   is there anything else I can help you with?
User :   Yes I have sir
User :   An I have read about drug holidays for the medication when should this be done an how often an how long cause the military doctors have no good input
Doctor :   as of now go ahead with all the multidirectional approach
Doctor :   with the counselling and medications and the behavioral modification therapy
Doctor :   we will see how you respond to these
Doctor :   and based on your response it can be decided if you need drug holiday or not and how often you need them
User :   Ok this has been very informative. So take notes for anger am get counseling for ADHD. What exactly should I ask the military doctor when I go in for this. It seems like they should have already put me on this stuff
Doctor :   yes they should have put you already on this
Doctor :   you can discuss with them about
Doctor :   the inefficacy of the medication, but request them for the counsekling and teh behavior modification therapy
Doctor :   to manage the ADHD well along with anger management
User :   For the inefficiamcy with the medication you think is just the counseling
Doctor :   the medication does work for you as you said earlier
Doctor :   so the counseling and the therapy will help
Doctor :   to give you the extra support
Doctor :   such that the same medication dose can be continued
Doctor :   but with greater efficacy
Doctor :   did you follow what I said?
User :   Ok sir I thank you very much for your input these military doctors are stuborn on there techniques am the one I am seeing now is only a physician assistant for family practice
Doctor :   you can take second opinion for the condition from an outside medical practitioner
Doctor :   or you will have to persuade your doctors to help you
User :   The only other question I might have is a friend non military that has ADHD was on adderall for years an recently his doctor moved him to a medication called vyvanse. He told me that it lasted longer than adderall as he took two doses of XR a day am only one dose of vyvanse is this a possible medication I should ask my doctor to consider for treatment do to my long work hours for focus?
Doctor :   yes you could ask your doctor and see if that could be given to you for better control
Doctor :   any medication would work well with supportive therapy
Doctor :   make sure you ask for that too
User :   Ok sir I will. For extended need for ADHD treatment for long hours of the day what do you think would be best, the adderall xr or vyvanse?
User :   Because one PA recommend me for ritilan but I took this when I was younger fe ADD but stopped due to too many side effects like diareha an headaches
Doctor :   the medication use and response varies from individual to individual
Doctor :   it can be treid for you
Doctor :   if you get better response with Vyvanse, it will be continued for you
User :   Very well sir I appriciate all your information an will follow through with it. That is all I have for you
Doctor :   is there anything else you would like to ask me?
User :   That is all sir
Doctor :   thanks for consulting me. bye for now.
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