Greetings, MSers. I have been told I have cognitive deficits stemming from either two recent relapses or a cumulative effect of my fourteen years with MS. I have started having problems tuning out distracions, or tuning in so intensely at times that when I do get my concentration broken, I react like a sleeping cat getting startled by someone exploding an inflated paper bag. (Pop! OMG somebody go get a crowbar to pry me off the ceiling, please. )
I am currently a client of my state's Bureau of Vocationmal Rehabilitation, which is trying to help me devise strategies for working around these issues without divulging my diagnosis and having to ask for accommodations under the ADA, assuming I even NEED accommodations if the strategies forestall it. Today I cinched a possible job offer that pays more than my last job (if you've read my most recent posts in the Lemtrada forum, the circumstances of my separation with my last employer are all in there; I don't have the time or pateince to type all that out again.)
Below is a summary of what is going on with the BVR right now detailing my questions about medication to treat ADD/ADHD. I hope after reading this portion of my post, y'all can share what you think about treating ADD/ADHD, if that is what is going on with us cognitively; If you think it's a fatigue issue when you get "cog fog."
Email to my BVR case worker:
"Good morning, I assume, if you get this message on Friday.
I'd like to apprise you of a new development in my circumstances. With regard to my possible attention span problems/cognitive deficits...however they choose to manifest themselves...I mentioned to my Neurologist's nurse practitioner today in my MRI exam follow-up appointment that I wasn't sure if I had what anyone could technically call ADHD or fatigue issues, but that I was aware that people with ADHD issues are frequently prescribed medications to control whatever is causing them problems staying focused. Which tends to be an issue for me. No one seems able to explain satisfactorily to me the mechanism behind prescribing a stimulant to help someone with ADHD (atttention deficit HYPERACTIVITY disorder). It seems counter-intuitive to me.
My nurse practitioner said that Ritalin is prescribed for both ADD and ADHD... I have never been evaluated for either condition, if in fact they are real. People who have been diagnosed with one or the other will insist that they are real. Ever since the condition started receiving so much publicity, it seemed like every other kid (or parent of one) claims they have it. Hmmm. Seems like a bit of a fad, if you ask me. Over-prescribed, maybe.
Nevertheless, if the medication shows a correlation of effectiveness at curtailing the same symptoms, then as I believe the theory goes, ADD/ADHD medication might help people with MS showing similar issues. My nurse practioner theorized, as others in the MS medical community seem to, that some cognitive deficits are a result of cognitive fatigue, resulting in patients' inability to compensate for leftover damage from relapses...much like the physical fatigue they prescribe medications designed to treat physical fatigue for... worth a shot, I guess?
So I asked my nurse practitioner if she thought giving it a trial run to see if I noticed my attention span/ability to focus improved, and she wrote me a prescription for 10 mg. Ritalin daily for a one month trial. (For the record, I'm an otherwise healthy female, no other drugs at this time, 5'8", 163 pounds...not prone to depression, no need for birth control, as I had my tubes tied after the birth of two kids <-- Just throwing that in there to eliminate concerns of the drug possibly adversely affecting bc efficacy/it's not an issue). I'm not content to try Ritalin out on my own without some kind of credible, quantifiable evidence to support that it may in fact be shown to be effective for me. I understand that some of these drugs can be addictive, and I sure don't want that bad juju sneaking up on me. Like I don't have enough problems, right?
So here's where I'm going with this: We already have a base line measurement of my cognitive abilities and performance without Ritalin in the picture. I am proposing that you consider sending me back for the exact same neuropsych testing that Dr. (Name redacted) performed with me earlier this year, so that an apples-to-apples comparison can be made from the first test, and appropriate conclusions drawn from it.
If I'm not mistaken, the drug should take effect relatively quickly after being ingested, although perhaps more research is in order, to maybe see if you need to get it built up to a therapeutic level and then maintain that level for maximum efficacy. I will research this, but I wanted to run the idea by you to see if BVR would approve another referral and have the funds available to pay Dr. (Name redacted) for a repeat test of this nature for the reasons I am trying to outline.
I would very much appreciate hearing from you in the affirmative, so that I can get in for a follow up neurpsych exam as soon as possible before my expected work schedule takes effect. (Oh yeah, I forgot to mention the business owner was very positive with me in my second interview and expressed intentions to forward a compensation package to me for my consideration. I'm going to consider that a job offer. Yay, me! Still nervous.)
Best Regards.
So, MSers, what do you think? Thanks in advance for your replies! I look forward to reading your experiences and comments.
I am currently a client of my state's Bureau of Vocationmal Rehabilitation, which is trying to help me devise strategies for working around these issues without divulging my diagnosis and having to ask for accommodations under the ADA, assuming I even NEED accommodations if the strategies forestall it. Today I cinched a possible job offer that pays more than my last job (if you've read my most recent posts in the Lemtrada forum, the circumstances of my separation with my last employer are all in there; I don't have the time or pateince to type all that out again.)
Below is a summary of what is going on with the BVR right now detailing my questions about medication to treat ADD/ADHD. I hope after reading this portion of my post, y'all can share what you think about treating ADD/ADHD, if that is what is going on with us cognitively; If you think it's a fatigue issue when you get "cog fog."
Email to my BVR case worker:
"Good morning, I assume, if you get this message on Friday.
I'd like to apprise you of a new development in my circumstances. With regard to my possible attention span problems/cognitive deficits...however they choose to manifest themselves...I mentioned to my Neurologist's nurse practitioner today in my MRI exam follow-up appointment that I wasn't sure if I had what anyone could technically call ADHD or fatigue issues, but that I was aware that people with ADHD issues are frequently prescribed medications to control whatever is causing them problems staying focused. Which tends to be an issue for me. No one seems able to explain satisfactorily to me the mechanism behind prescribing a stimulant to help someone with ADHD (atttention deficit HYPERACTIVITY disorder). It seems counter-intuitive to me.
My nurse practitioner said that Ritalin is prescribed for both ADD and ADHD... I have never been evaluated for either condition, if in fact they are real. People who have been diagnosed with one or the other will insist that they are real. Ever since the condition started receiving so much publicity, it seemed like every other kid (or parent of one) claims they have it. Hmmm. Seems like a bit of a fad, if you ask me. Over-prescribed, maybe.
Nevertheless, if the medication shows a correlation of effectiveness at curtailing the same symptoms, then as I believe the theory goes, ADD/ADHD medication might help people with MS showing similar issues. My nurse practioner theorized, as others in the MS medical community seem to, that some cognitive deficits are a result of cognitive fatigue, resulting in patients' inability to compensate for leftover damage from relapses...much like the physical fatigue they prescribe medications designed to treat physical fatigue for... worth a shot, I guess?
So I asked my nurse practitioner if she thought giving it a trial run to see if I noticed my attention span/ability to focus improved, and she wrote me a prescription for 10 mg. Ritalin daily for a one month trial. (For the record, I'm an otherwise healthy female, no other drugs at this time, 5'8", 163 pounds...not prone to depression, no need for birth control, as I had my tubes tied after the birth of two kids <-- Just throwing that in there to eliminate concerns of the drug possibly adversely affecting bc efficacy/it's not an issue). I'm not content to try Ritalin out on my own without some kind of credible, quantifiable evidence to support that it may in fact be shown to be effective for me. I understand that some of these drugs can be addictive, and I sure don't want that bad juju sneaking up on me. Like I don't have enough problems, right?
So here's where I'm going with this: We already have a base line measurement of my cognitive abilities and performance without Ritalin in the picture. I am proposing that you consider sending me back for the exact same neuropsych testing that Dr. (Name redacted) performed with me earlier this year, so that an apples-to-apples comparison can be made from the first test, and appropriate conclusions drawn from it.
If I'm not mistaken, the drug should take effect relatively quickly after being ingested, although perhaps more research is in order, to maybe see if you need to get it built up to a therapeutic level and then maintain that level for maximum efficacy. I will research this, but I wanted to run the idea by you to see if BVR would approve another referral and have the funds available to pay Dr. (Name redacted) for a repeat test of this nature for the reasons I am trying to outline.
I would very much appreciate hearing from you in the affirmative, so that I can get in for a follow up neurpsych exam as soon as possible before my expected work schedule takes effect. (Oh yeah, I forgot to mention the business owner was very positive with me in my second interview and expressed intentions to forward a compensation package to me for my consideration. I'm going to consider that a job offer. Yay, me! Still nervous.)
Best Regards.
So, MSers, what do you think? Thanks in advance for your replies! I look forward to reading your experiences and comments.
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