1 1/2 Weeks Post Discharge and *Glup* All is well!

So, believe it or not...M was discharged a week and a half ago (Monday, June 18th) to go directly to his new school and life has been relatively copacetic!

We had a meeting with the phosp pdoc, sw, M's old school's sw, and (via teleconference) his new schools sw the Wednesday before discharge where we developed the discharge plan and made the final med change (swapped out the Strattera- finally- and swapped in Tenex). Not sure I personally feel the Tenex is either needed or helping, but it's there. I AM glad the Strattera is OUT. Life is better. The sw from M's old school was instrumental and invaluable in orchestrating our discharge and getting M on board with going to his new school. Prior to her involvement, he was adamantly opposed to going to his new school and as soon as she was on the scene, he was all for it. She pitched the "M Team" idea and it was a beautiful thing. :)

Upon discharge, the Celexa was increased to twice a day, so I'll be watching M closely for any reaction or mood changes. 10 mg, from what I hear, was a very low dose, so 20 mg a day seems a bit more substantial. We're now at 3 1/2 weeks total ON Celexa and 1 1/2 weeks on the 20 mg/day. We're at about 2 weeks now on the Tenex. M is still on the Seroquel, which seems to be a good med for him. Of the three atypical anti-psychotics we've tried, it seems to be the best fit, as long as we titrate SLOWLY in either direction. It's evident we can't go up or down abruptly or his body revolts! (remember- we doubled the dose and he couldn't pee, then he took a 24 hr Holiday to try to solve that problem and he was vomiting 'round the clock!)

So...how is M actually doing? Well, he WENT TO SCHOOL! That was HUGE! He TOOK THE BUS from day 2 on!!!! That was HUGE! He WENT TO THE PDOC without raging! That was HUGE! In fact :::knock on wood::: we've been *rage free* the entire week and a half since discharge! We've had a lot of activity the past week too....his cousins were visiting from out of town. He was very excited to see them...even said, "I can't stop smiling" when they're around. Though I was a little fearful that this was a red flag, I took it at face value as a happy moment. He also went to an amusement park over the weekend with his cousins where he bumped into an old friend/girlfriend from preschool. I wasn't there, but dh said it took him a short while to warm up to her because he didn't remember her, but after a short time they were laughing, playing, holding hands, sharing food (food M has REFUSED to try in the past...like ketchup on french fries!!!), and riding rides M has REFUSED to ride (like roller-coasters!), and was genuinely HAPPY! DH said he hasn't seen M that HAPPY in he can't remember when! It was wonderful.

I still hear "the voice." That warning voice that M makes when he's irritable, hyped up, cranky, "manic-like," whatever you want to call it. That voice that tells you, "I had better tip toe around M today or I might set him off. He still yells. He still does not accept the first answer. He still expends WAY too much energy trying to find ways to make something happen that you said NO to. He still obsesses about video games and buying things and finding ways to get someone to take him to the store to buy things. His brother still pushes his buttons. He's still impulsive. He still has trouble getting along with other kids his age (sets too many rules on play and then walks away when they don't get his rules and start mocking him).

So, life is better. I'm cautiously optimistic. I'm waiting for the other shoe to drop. I've voiced my opinion that I fear M is BiPolar...it's no secret. I'd love for that not to be the case. I'd love for his problems to purely be rooted in anxiety...maybe a hair of depression....some impulse control issues...heck, some ADD. But, the mood swings, the rages, the family history of mood disorders, the intensity of this little boy...I'm remaining cautious and my eyes are peeled. I hope that the Celexa and the Tenex are a good fit for him because they seem to be working, but I hope he doesn't go manic in the next 3 months. If he starts riding down the stairs in a laundry basket or jumping off the top of the swing set, I'm going to start to worry. Happy is great....too happy is not.

Meds & Plans so far...

So, we're on day 11 of phosp stay 3 and here's where we stand: the new pdoc think's M problems are caused by anxiety, so he started M on an SSRI (Celexa) a week ago (last Tuesday). My concern with an SSRI is that he'll go manic, but I've got my fingers crossed that it's really just anxiety like the good Dr thinks. He was supposed to come off of the Strattera, but for some reason, he's still taking it. No idea why?

We've been fighting for psych testing (specifically with a Neuropsych) since admit #1 back in March, but the problem is that the Hospital doesn't do testing because Insurance pays them under one big balloon payment and they don't have anyone on staff that does testing and we can't get M stable and out of the phosp long enough to do any testing outside of the hosp! So, after much complaining, they have asked our Insurance company if they would pay to bring in a Neuropsych while M is inpatient and they said YES! Now, the one thing we are crossing our fingers on is waiting to hear that the Neuropsych has agreed to come in and do the testing.

As far as discharge plans go, we don't have anything set yet because we don't yet have any discharge date in mind. The big battle however, is getting M to school...his new school. So, the tentative discharge plan is that M will be discharged early in the AM to leave directly for school so that staff can assist in prepping him to be physically and mentally ready to go so he's not raging at home. Then, if he loses it, he is to be immediately re-admitted. The downside to this plan is that he is currently admitted under our old insurance plan ($250 co-pay) and will be re-admitted under our new insurance which is a 10% co-pay! YIKES!

Current Meds:

Strattera: 25 mg bid

Celexa: 10 mg at 8 am

Seroquel: 100 mg at 8 am
150 mg at 8 pm

PRN's:

Benadryl: 25 mg for agitation or insomnia

MiraLax: 17 g packet for constipation

Tylenol: 325 mg for headache