The Doctor's Reply

Thank you for your very thoughtful email this afternoon. Ewen's condition is certainly challenging, as you suggest. I agree with you that we should look at an adjustment to our current strategy. This will require a discussion in person. Ewen should be present.

Here are two quick heads up. First, Buspar is not going to be my first option. The best data in the literature do not support what we are trying to do for Ewen with Buspar. Second, transcranial magnetic stimulation has no place in the treatment of anxiety, OCD, or tics. There are no compelling studies whatsoever in the child/adolescent literature.

Clearly, Prozac has been extraordinarily helpful. Thus, our initial approach is going to see what we can do to augment Prozac at the 4 ml dose, while addressing tics.

Finally, do not forget the power of cognitive behavioral psychotherapy in treating anxiety and depression. Do not forget that remission of anxiety results in remission of tics.

Thanks, and I'll get back to you with possible rapid appointment times.

Comments

The Chair of the Pediatric ER Wrote Back!!!!!

Ms. ....... Thank you very much for bringing your son’s case and experience to our attention. First of all, I hope that Owen is still doing much better. I absolutely understand how devastating this could be in terms of a missed opportunity to appropriately diagnose. I have to say that in reading your email and updating my knowledge about the condition, I could see how it may be quite difficult to make a diagnosis accurately in an Emergency Department setting and I could see why things occurred in the manner in which they did. That said, I am very sorry that we let you and your family and your son down in this way. Our Pediatric Emergency Department are staffed by a group of very expert pediatric emergency medicine specialists trained in some of our nation’s leading teaching institutions who I was able to recruit here to ........... to take care of our community. I know that the fact that we were not able to expeditiously diagnose your son’s condition caused a great deal o...

Spring Break 2017 Update

4ml Prozac, 500mg Zithromax 3x a week, 1.5 mg melatonin, less than a quarter of Clonidine Ewen is doing well. Right now he is vacuuming and mopping the whole house (all 850 square fee lol) To earn an hour of screen time playing Overwatch. We have had a few hiccups. He got in major trouble in school for hacking into the computer and writing silly things on a class web page. He said he didn't realize he would get a referral and get in so much trouble since he wasn't hurting anyone and would never bully. He also dropped his grades because he was too busy having fun with his friends. So Mike and I had a meeting with his teachers. He now has a 504 plan since he has had lots of absences. We are paying close attention so that we can make sure he completes his assignments. Last month he was having trouble with tics (mostly huffing) and anxiety and so his pediatrician put his Zithromax up to 500 mg every day for a full week. That completely helped and was amazing to get him back...

Titrating Prozac (Really Low and Slow)

Ewen is in his bedroom editing an Agario video. Since he is doing video editing I'm calling it a part of homeschool. I also have some work for him to do on the dining room table this afternoon. We have his first acupuncture appointment this afternoon. It is going to cost $90. I'm not sure if it will do anything to help since today was our 2nd day of Prozac and I am sure that meds interfere with natural and holistic treatment. But we will try. Maybe it will help? I'm giving Ewen barely any Prozac this week to start off with. It comes in a liquid and we are supposed to be giving him 1 ML...which apparently is very low. But yesterday I gave him .1 ML, to get his body used to it. And today I gave him a smidge under .2 ML's. There is no reason not to titrate it so low. He is so ultra sensitive that I want to give his body time to get to know the drug before we put it up enough to make a difference. He did so badly on the Lexapro that I think this is the right way t...

10-Year-Old with Panic (PANS)

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