Miss Diagnosis: Ritalin

Thursday, December 31, 2009

Ritalin

We heard back from the phsychologist last week; they said they will do a complete evaluation but that they have up to 60 days to complete it. Considering this I called the pediatricain who then prescribed Ritalin. She wanted Alex to start on a lose dose (5mg. twice daily) and see how it goes. On Sunday we gave it a try; I gave Alex the Ritalin with her A.M. dose of hydro. She woke up a couple hours later and said she felt less groggy than usual first thing in the morning. She also said she felt "stupid", because she could only focus on one thing at a time. She thought it might be helpful for school work but wasn't so sure she liked the feeling. By noon she was getting a headache and took the second dose. The headache lingered through the afternoon. By early evening when the Ritalin should have been wearing off the headache got really bad. By 8:00 the headache was so bad she thought we might need to go to the hospital. Along with the headache she started feeling A.I. She took 2.5 mg of hydro, waited a half hour, took another 2.5mg waited another half hour and took 5mg. With the extra hydro things started improving including the headache.

Now the questions... was Ritalin the cause of the headache? Was it the cause of the A.I.? Could the headache pain have caused her body to need more hydro? It's frustrating! The plan is to wait a few days and try the Ritalin one more time, one dose in the morning, and try and do school work while on it. If it doesn't work out we'll get a prescription for something else.

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Transphenoidal Pituitary Surgery- From the UCSF web site

What happens during surgery?
The surgical removal of the pituitary adenoma is performed by a technique called a transsphenoidal operation. The word 'transsphenoidal' describes the path the surgeon follows to reach the pituitary gland. The word comes from 'trans', meaning 'to cross or pass through', and 'sphenoid', the name of the cavity (the sphenoid sinus) that is passed through to reach the pituitary gland. Newer techniques and improvements in technology now allow removal of these tumors without the need for an incision under the lip or within the nostril. The surgeon begins the approach by entering through the nostril on one side. The surgeon uses a brilliant fiber optic light to illuminate the internal anatomy, a microscope to magnify the area of surgery to 12 times the actual size, and very tiny microsurgical instruments especially designed for this particular operation. The surgeon guides the surgical instrument into the nasal cavity and an opening is made in the sphenoid bone. The sphenoid sinus is entered, and then an opening is made in the wall of the sella turcica to expose the pituitary gland. The adenoma can be readily distinguished from the normal pituitary gland tissue and is removed without removing the normal gland. After the surgeon removes all the tumor tissue, the small cavity that is left is treated with alcohol to destroy any tumor cells that may remain. This cavity is then sealed, sometimes with a piece of fat that the surgeon removes from the patient's abdomen. The surgeon then applies a biological 'glue' that helps seal the pituitary area from the nose and promotes natural healing. No nasal packs are used with this approach.