Insurance Nonsense

After a month of taking Concerta (this first month of which was free, and therefore no insurance involved), my psychiatrist and I agreed that the dose I was at seemed to work better than other treatments (Straterra and Adderall).

My doctor wrote me a prescription and I dropped it off, hoping to pick it up later in the day.

Easy enough, right?

I guess not, because about an hour later the pharmacy called me, indicating that Concerta was denied by my insurance, needing "prior authorization" in order to be filled.

Okay... No problem. I'll just contact the doctor and have him phone in this authorization, right?

Wrong.

I called and left a message for the doctor. Also, the pharmacy faxed a form that he needed to fill out. Later in the day the doctor contacted my insurance company and the proceeded to ask him a number of questions.

Now, let's me clear: I side with the doctor on this. He has explained to me what insurance companies often do. A company doesn't want to fill a prescription because it costs money, so they put restrictions on it, trying to make it difficult to get. Then, when the doctor calls to authorize the prescription (the fact that HE wrote the prescription is not enough), they ask him harassing questions, assuming that he, a psychiatrist, is making a poor diagnosis.

That said, I'm not surprised by what happened: My doctor, feeling harassed, lost his temper. At question 8 of 10 he yelled, "This questions are outrageous. I'm going to report your to the board."

I don't know what the questions are and I don't know anything about this "board." All I know is this:

1. I pay high insurance premiums to Caremark.
2. I paid for the visits to my psychiatrist.
3. Neither my psychiatrist nor my insurance company seem to be acting in a manner that is beneficial to me, the patient.

So with my insurance company making unreasonable demands and my doctor angry with my insruance company, I am in an odd position, and uncertain of how to proceed. It's no wonder so many Americans are cynical about the state of health care in America. This is downright absurd.

What would you do?

impulse control

My mind still races
and I talk a hundred miles and hour
but I am noticing I do not have to DO everything I think about.
I still get nervous around my X wife ( you would too)
and that can shake me for a bit.
BUT
( its a big but)
I am so much more aware of what I need to do and how to
( to quote a friend in Michigan) "Get er done!"

Cleaning is one of the hardest things.
On Saturday I spent 'I don't now how long' cleaning out a garage where I have been working.
I kept moving things all week but never making the whole space available or securing the contents. It was drywall work and VERY dusty. Finally at the end of the day I moved everything piece by piece so I could sweep the floor under it. All of my considerable scrap and trash was in one pile, and their garage contents were in a much more orderly condition.
It felt good! It was good. I can do this.

Some of david's story.

I am not sure if it was / is Attention Deficit
I lack focus and get sidetracked easily, I like doing many things but rarely take the time to master something before moving on to another FUN thing to do.
Tha seemed to be the key to my growing up: Find fun.
Fortunately I found a lot of it through the Boy Scouts of America ( before they changed their name to"the boy, girl and transgender Scouts of The whole wide world"

See I got lost, I am back.

I do not think there was a year when a teacher did not write in my report card,
"David is so bright, he would get better grades if he just applied himself".
I went to Catholic school and was an altar boy, but I did not get molested by any priests.
I was very active in Scouting; the outdoor activity was my thing ( still is ).
I became very good with the Axe, a knife, and FIRE. Oh dear Lord, how I loved fire.
Troop 123 of Panorama City was full of lunatics. I was just one of them and by no means stood out. I was kind of small, very skinny and got teased a fair amount during the first summer camp. I can remember wanting to go home. Some of the guys were just jerks, but I met my best friend there and we had many excellent adventures over the next many years.

All of that has little to do with my story except to say that in a WIDE OPEN environment I did fine. It was inside of a classroom that I failed to fit in, go by the rules, or "GET IT' about studying. I could pass based on my test scores and did little homework or serious studying.
I was the guy who got such a thrill out of putting a thumbtack on the seat of the desk of the girl in front of me, that I just HAD to see if it worked as well on the teachers chair. Surprise! she had the same reaction.... woohoo !
I was late in discovering girls and had some serious setbacks because of the way I approached them. At first I seemed to go for the flashy types, who already had lots of attention from boys and had little use for my teasing, annoying games. I handled rejection well for a thirteen year old, I guess, and two years later, at the age of fifteen I was ready to try again.
High school was a mess of social clusters and seeming barriers that mostly kept me out. No way I could keep up with the academic types, and was by no means a jock. I can only think of a couple classes I liked, one was an English class taught by the youngest, prettiest woman in the whole school. She somehow managed to ignore the dress codes and wore her skirts high and her blouses cut low. Now I was really distracted!
The second person who got my attention was another English teacher who also coached Drama. My building skills were already pretty well developed, so I built and painted sets for the plays we would put on twice a year. She was a fabulous person, and a bit of a renegade who did not really uphold all the teachings or the Holy Mother Church, but gave us a quality education, nonetheless. I loved drama, though it was populated by brains and nerds. I sometimes got a part when there were more roles than actors, and I tried my best. We worked hard and made much with almost a zero budget. I summoned up great courage one time and stole enough lumber from a housing project to build an entire set. This was a huge load in the back of the parents full sized station wagon! I do not remember anyone asking WHERE it came from. I was so proud to contribute to the cause. truth is, I liked to steal back then, for the thrill, the risk. Same reason we blew up stuff with firecrackers and M-80's. Same reason we burned every Navy ship model we ever built in the fish pond out back. Nothing like recreating the battle of Midway to get your blood pumping. My brother liked burning them too, but I think he might have had a conscience, way back then, and might have known he was destined to be a prosecutor and did not need a criminal record. I just liked the flames and the stinky smoke of plastic burning, and KNOWING that I was outside of what was normal acceptable behavior.
I better post this its getting too long.

Breakfast with the boss.

( that's me )

I’m very much enjoying my toasted bagel .
It’s a little bit cold in my room, but the kettle is on the stove downstairs, and the fire is burning hot on a beautiful clear Saturday while I plan my day.

Having breakfast at my house is not as easy as it would seem.
After I put the bagel in the toaster and put the water on to a boil I almost immediately began to go upstairs to my computer.
The toaster and the boiling water were out of my mind. I couldn’t believe it myself. That is the way it is for me with ADD, and I am sure that it is the same for many others.
The tea kettle boiled for more than five minutes!
Funny, yes, unless I burn the kitchen down….

I am so glad to have this to read and share:

This is from Matt, a reader and now contributor, its long but has strong merit:
AS A CHILD

When I was a kid I was loved by my teachers. I was a 'good kid.' Really good. I sat in class and never acted up, never spoke up and never caused any problems. So, of course, teachers loved me. Why wouldn't they?

What was I doing? Was I learning? Was I taking it all in? Was I so focused that I never acted out?

Nope. I was daydreaming, as I recall. My thoughts were a million miles away, and nowhere near anything being written on the chalkboard. Not being engaged in any way whatsoever, I wasn't learning and I wasn't bothering anyone. I was just there, so my teachers were content to leave me be. They had hyper kids to deal with.

There is a story my step mother likes to tell. It was time for dinner, so she came to get me. Standing about 10 feet behind me as I sat on the edge of the patio, staring at the sky, she called my name. "Matt," she said, trying to get my attention, "It's time for dinner."

There was no response.

"Matt?"

Nothing.

"Matt, can you hear me? Matt? Matt!"

I didn't hear her, and yet my hearing was fine. My mind was somewhere else, hyper-focused on some sort of daydream. I entered into such states often, and because of this I was very often accused of being shy (and I was) or 'quirky' (and I still am).

ADHD was never thought of. We don't think of it this way. It's what the bad kids have… It's something that those really hyper kids are diagnosed with. It's not for the shy and inattentive kid at the back of the room who isn't causing any problems.

That's the myth. (At this point, I'd encourage you to read about 'Inattentive ADHD.')

People thought of me as artistic (and I was this as well). It was easy to see this, as one could easily observe by looking at my school notes. Such an observation would demonstrate where my mind was: Doodling.

I doodled on everything, all day long. My notes were filled with drawings interspersed with occasional notes. It's not just that my hands were doodling: My mind was doodling as well. My mind was somewhere else. It's always felt this way. I've always felt a little 'disconnected,' as if viewing life through a TV screen rather than being there. And despite the fact that such feelings have always been present, I never attributed such things to any kind of psychological concern. After all, if indeed I have a problem, it's minor enough to deal with it in a number of ways.

The question this raises is a big one: Am I describing something called 'Inattentive ADHD' or am I simply describing laziness? That's the million dollar question.

the family may or may not be helpful at first

QUIRKY



I'm not dumb and I'm not lazy, but I am 'quirky.' I'm not sure exactly how to put this, but it's particularly observable in me that my mind is often engaged in something outside of where everyone else's mind is.



This has always been a little 'cute,' I suppose. Quirkiness, I think, is a good attribute, and, as the cliché goes, normal is boring. I agree.



Here's when quirkiness isn't cute:



* When you seem unable to maintain your home.
* When you get angry and agitated with friends and family because they are interrupting your daydream.
* When you blow up at people because you have a desperately low frustration tolerance.
* When you blow up at your in-laws for minor infractions, forcing your loving and loyal wife to take sides with bad behavior.
* When you scream and yell and kick things because you are frustrated by assembling something, like a Christmas tree, and you remain unwilling to read the manual. (If I had a nickel for every hole I've punched in drywall…)
* When your wife asks you to do something, and although you look at her and nod, you didn't hear a word she said. You love her dearly, and you really do want to listen, but your mind has some strange difficulty following through with your desires.
* When your kids are begging for your attention but you can only seem to give it in short bursts. You want desperately to give your attention, you really do, but some kind of driving force seems to pit your attention against itself.
* When you don't work. You go to work and stare at the monitor for many minutes, entirely zoned out.
* When you surf the web all day at work, rushing to get tasks done, and doing them sloppily, so that you can return to your mindlessness. Never mind the fact that you actually do hold a job that can be enjoyable.
* When you change hobbies every month or so, spending a significant amount of time hyper-focused on your new love, and ignoring those who need you. Money, large amounts of it, may be wasted on such endeavors.
* When one day you decide you're going to move, so you give your two-weeks notice, sell your home, quit your job and move, only to realize that you made a life-changing decision on a whim. Talk about hurting your family! (Thank God for His grace on this one, which put our family back where it was and saved us from what would have been a very bad situation).



The question remains: Is all the stuff above quirkiness or is it ADHD? It's a good question, and one that I don't think even psychiatry can completely answer. ADHD, like anything, shows up in varying levels, and in the mild-to-moderate side, diagnosis may be difficult.





I WANT TO LISTEN



One day my wife scolded me (and rightfully so). She told me how conversationally I sometimes drift off and it ends up being rude. I'll be talking to a friend, a friend who I like and want to talk to, when I suddenly disengage from the conversation. I'm standing there, pretending to listen, but I'm not. I may be looking the person in the eye or I may be looking somewhere over his shoulder. Either way, I'm gone.



It's obvious when I do this, and it's not me. I want to be there, present in the conversation. I like people, and I like my friends. I value what they have to say. So why don't I listen?



And you're reading this saying, "We all do that."



Yes, I agree, but this is probably more powerful than what you are thinking. It's not that I do this from time to time. The problem is the fact that I'm characterized by it. I've done this for as long as I can remember, in any conversation that lasts very long.



When this type of disengagement happens it's not because I lost track or interest. Rather, it's like some force just pulled me away, and no matter how much I want to return to the conversation, I cannot. It's powerful, and I can't describe it, I can only say it goes beyond a "pull yourself up by the bootstraps" kind of thing. It can't be handled that way.





ADHD, REALLY?



There's more to this story than I care to write down. It goes into a number of ways that I have failed as a father and husband. I woke up to the fact that this may be an issue worth discussing only recently, and not because of the impact it had on me. Rather, it was because of the impact it had on those around me who I love: My wife and children.



As the psychiatrist said, and I was startled by this: You definitely have ADHD. It's not the worst case I've ever seen, but it's there.



This was a Christian psychiatrist, and a guy who I trust. It's a guy who, based on much of our dialog, doesn't think of drugs as the only line of treatment in such cases. I found comfort in talking to a Christian psychiatrist and two Christian counselors because of how I perceived the mere consideration of medical treatment of this issue. I perceived it as a distrust of God and a lack of faith. I won't go into all the details, because I still wrestle, but the advice they gave was great.

one man's story

DRUGS? WHAT? REALLY?



One day I left the psychiatrist's office with a prescription for ADHD medication in hand. I felt dirty. I felt like I was doing something bad. I felt like there was something messed up with me.



But I also felt a sense of wonder. I wondered what would happen, and how, if at all, these drugs would impact me. So there were a number of thoughts, good and bad, positive and negative.



The first treatment I tried was Adderall.



I picked up the plastic container full of blue pills around 2:00 in the afternoon. I took two (20 mg) right away.



Something happened, and it hit me like a ton of bricks. I noticed a number of things, and they were mostly focus related. I was at work, engaged in a task that required complete attention. In a way that I cannot describe, I was able to focus completely on the task at hand. There was no urge to walk around, call home, buy a drink, check email or surf the web. None. I was just working.



Another thing happened that I didn't expect, and it had to do with frustration tolerance, which I will go into later.



That was the good about Adderall. Here's the bad: I think I reacted too strongly to it. I entered a state of hyper-focus, and this isn't what I'm after. Oh sure, it's good to be hyper focused at things, I suppose, but going through life in drug-induced states of hyper focus is basically drug abuse. I'm not going for that.



Another problem: It made my heart race. As a runner I'm a fit person. My resting heart rate is typically 47-53 beats per minute. While on Adderall my resting heart rate jumped to over 60 beats per minute. I didn't like this feeling one bit.



(As a side note, I've always been a heavy caffeine drinker, which is probably related to my focus problems. That said, I didn't curb my caffeine intake on Adderall, and this likely exacerbated by reaction to it.)



Another thing about Adderall was it's impact on my appetite. I had none… I could skip breakfast and lunch and still not be hungry at dinner time. Okay, so some think this is an advantage, but let's face it, it really isn't a good thing to be without any sense of food craving. God gave us this sense so we would know when our bodies needed nutrition.



Adderall also interfered with my sleep… Big time. I was wired.



So yes, Adderall worked. It worked too well. It was too blunt, and I didn't appreciate that feeling. I mean, it was good to enter into some kind of state where I became hyper-focused on cleaning the entire house (this really did happen), but I don't consider this to be the point of taking ADHD medication. The psychiatrist discussed this before I even took it, acknowledging that it is abused for a number of reasons, and wanting to follow up on the reaction.



I'm glad he gave warning.



So I told my psychiatrist of the experience, good and bad. We both agreed that the bad outweighed the good.



He had my try Strattera. While I don't doubt that Strattera is probably a drug that works for many, I found it to be horrible. There were a number of strange side affects, most of which, physical in nature, I really don't feel like sharing. The side affects were bad and the intended usage was non existent. No impact on this thing called ADHD whatsoever.



After being concerned about the abuse potential and negative health impact of Adderall and disgusted by Strattera, I thought I would at least try the last recommendation: Concerta.



Could this be the perfect treatment?



Concerta seems to help me come around with my focus issues. The impact isn't blunt like Adderall, but it is present. I don't enter into any strange states of hyper-focus, my heart doesn't race and, as far as I can tell, there are no physical side affects. None.



My frustration tolerance is better, as is my ability to focus on tasks. Adderall had a strange affect, where it made me seem to want to work. While that seems good at first, it doesn't seem healthy. With Concerta I'm not converted into some kind of work-a-holic, rather, I'm just able to focus a little on my work.



It still takes my own effort and my own motivation, but I'm just not as easily distracted. I can focus on a conversation from beginning to end, staying in it the entire time. I don't doodle during meetings. I don't zone out at work. I don't check my email ever 5 minutes. I don't surf the web all day.



Let me be clear: I'd like to do these things. The desire is there, sure, but the distractions seem to be less of a driving force. It feels right. I feel a little more like I am present at work and in meetings and with my family rather than simply "viewing it through a TV," ready to change the channel at any moment. Does that make sense?



Now I realize, I'm not explaining any of this very well. It's so hard to explain something that is really only experience is subtle ways.





AM I POPPING 'NICE' PILLS?



It all leads to some inevitable questions, doesn't it?



Last week we put up our Christmas tree. I always hate doing this. We have a 12 foot artificial tree, and it's always a pain in the neck to find all the branches and match up all the letters. Every year I get frustrated as I attempt to quickly throw the tree together.



Without fail, there always seems to be a few branches I can't find. As I go looking for the branches I grow more and more frustrated. Agitated, I become less likely to organize in any productive way, so I just simply get mad… And it spirals, until I yell at my wife.



Putting the Christmas tree together should be fun. I want it to be fun. Why is it never fun?



This year was different.



I got the huge box up from the basement and dumped out the contents. My daughter, the 3-year-old, loved it, as she "helped" daddy by scattering the branches everywhere. As the tree grew my daughter decided to "help" even more, by tucking the branches she found inside the parts of the tree I had already constructed. This led to many, many missing branches as I neared the top of the tree.



Normally this would have frustrated me to no end, and I would have yelled and ruined the day for everyone. Not so this year.