Archive for October, 2008

The Punchline

I forgot to include the punchline in last night's post.

My head spinning with visions of CPT codes, diagnosis codes, claim forms, and murder plots, I told Seth he would have to take these claims to EAP which is a whole different process including a whole different set of information.  I would do it myself, except that the EAP office is an hour away from MY office and only feet from his office.

Yesterday, my beloved husband went over to the EAP office for me, armed with copies of all our invoices and claim forms.  He had a lovely conversation with the EAP representative, who was extremely helpful but could not process the claims for him.  Why? 

Oh, see, according to the lovely woman at EAP, the CPT code on these invoices is a – wait for it – medical procedure code.  Since it's not a mental health procedure code, it doesn't need preapproval from EAP, so there's nothing to be done on the EAP side.  This is, apparently, something the medical side gets wrong.  Often.

She called over to the medical claims department and explained that she was sending back these claims and that they needed to be processed and approved.  Needless to say, I'm not holding my breath.

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There's a lot "they" don't tell you about life.  Especially life with children.  And when you throw in triplets and an ADHD five year old?  Well, there's a whole lot that "they" edit out for fear of you running screaming from the room.  Today's topic?  Insurance companies. Today's blog subtitle?  Don't let the bastards get you down. 

Item the first?  I am *still* getting bills and EOBs for the triplets NICU hospitalization.  Note:  They were discharged from the NICU 1 year, 14 days ago.  I am still getting bills from the company that we rented Ellie's heart monitor for.  I'm getting these bills because the insurance company won't pay for them.  The insurance company won't pay for them because the bills are in Abby's name.  Abby never had a heart monitor.

But that's not what this post is about.  That's just an illustration of how stupid the insurance companies can be. 

Today's post is about ADHD and insurance companies.  You see, when you have a child with special needs, you're bound to run into all sorts of fun with insurance companies.  Insurance companies prefer you to have children who never get sick and who have no special needs.  They make money off of members who pay their premiums and never go to the doctor.  But when you have a child who starts going to a developmental pediatrician, a speech pathologist, a neuropsychologist, and heaven knows who else, well, the insurance company doesn't love you QUITE so much anymore.  

Here's the other fun part about ADHD:  ADHD is considered a mental health diagnosis, not a medical diagnosis.  Insurance companies don't really feel the need to cover mental health diagnoses without a lot of hoop jumping.  I guess they think you might abuse the system or something.  Because my favorite thing to do on a Tuesday morning is go see a therapist, or, say, a developmental pediatrician, just for kicks. 

Oh, and did I mention that most developmental pediatricians don't accept insurance?  At least not the ones in this area.  The ones that do are the ones that are affiliated with large hospital systems, but they have long waiting lists and aren't as good with personal followup.  My doctor is phenomenal about personally following up with everything and I get a call back within hours every time I call him for ANYTHING no matter how trivial.  He coordinates personally with every member of the J-man's team.  I wouldn't get that from any of the major medical centers – plus if I went to them, I'd STILL be waiting to get in for the initial intake appointment because their waiting lists are so long.  So no insurance.  We pay out of pocket, submit the claims to our insurance company ourselves and hope that they will reimburse us. 

For medical claims that are out of network, the insurance covers 60% of the allowable fee.  For mental health claims, the claims must be preapproved by the Employee Assistance Program (EAP), and are covered at 40%.  Mental health claims are also limited to 10 visits per year.  Each invoice includes a diagnosis code (J's is DSM IV's 314.01) and a CPT code (this is a procedure code).  The diagnosis code translates to ADHD, combined type.  The CPT code usually translates to "50 minute office consult", but has occasionally been "school assessment" or other things.

After our first several appointments with the developmental pediatrician, we submitted several claims to the insurance company, not knowing whether it would be covered as medical or mental health claims.  Astoundingly, the claims were covered as medical claims, at 60%.  It was easier than we thought!  Hooray!  After several more visits, and about $1500 in bills, I submitted another pile of receipts and waited.  And waited.  And waited.  And waited.  And waited.  No check.  No explanation of benefits (EOB).  Nothing.  Seth called the insurance company (it only seemed fair, since it's HIS insurance) and they said, "Oh, those claims SHOULD have been processed, but we accidentally denied them saying that they should have been submitted to EAP for preapproval.  We'll re-process them and you'll receive a check in 2-3 weeks."  Three weeks passed and we heard nothing.  So I called them this time, and I had the most infuriating conversation I've ever had in my life:

ME:  I'm trying to find out the status of these claims.
THEM: Oh those claims were denied.
ME:  I haven't received any EOBs.  Can you tell me why they've been denied?
THEM:  We denied them because they're mental health claims.  They need to be preapproved by EAP.
ME:  No, my husband spoke to you a few weeks ago and was told that they were mistakenly denied for that reason, but were being resubmitted for approval because they should have been approved.
THEM:  No ma'am. These are mental health claims, so they have to be submitted to EAP for preapproval.
ME:  I don't understand… in June you approved a claim with the same CPT Code.
THEM:  It doesn't matter, ma'am.  We don't use the CPT code, we use the Diagnosis code.  The diagnosis code on this claim is a Mental Health Diagnosis.  So it needs preaproval by EAP. 
ME:  But the diagnosis code last month was also a Mental Health diagnosis. 
THEM:  But last month, the CPT Code reflected a medication check, so it was a medical claim, not a mental health claim.
ME:  I thought the CPT Code was irrelevant?
THEM:  What is relevant is whether it is a medical procedure or a mental health visit.
ME:  Okay, so the CPT code drives whether it is covered or not, then?
THEM:  No, if it is a mental health diagnosis, it has to have preapproval by EAP.
ME:  You're not making any sense.  June's claims had the SAME Diagnosis code AND the SAME CPT code as this month.  The only difference is that in June you approved the claim and this time denied it.  Can you explain why? 
THEM:  Yes, it was denied because it's a mental health claim.
ME: No, it's a medical procedure, per the CPT Code.
THEM: No, it's a mental health claim, per the diagnosis code.
ME:  You're not understanding me.  Three weeks ago, my husband spoke with you and you explained to him that these claims were accidentally denied, but that they shouldn't have been.  They were to be reprocessed for approval because they should have been approved in the first place.  What you don't seem to be understanding is that you literally owe me thousands of dollars at this point, which prevents me from continuing to guarantee that I can afford appropriate medical care for my child when he needs it.  Can you at least understand where my frustration is coming from?
THEM:  Ma'am, the diagnosis code is a mental health diagnosis code, so the claim needs preapproval from EAP.
ME:  Then why did you approve an IDENTICAL claim in June?
THEM:  The procedure code in June was a medical code.
ME:  The procedure code on these claims is a medical code as well.  That's what I've been trying to tell you.
THEM:  Ma'am, as I've already told you, the procedure code has nothing to do with whether the claim is approved or denied; the diagnosis code drives whether it is considered a mental health claim or a medical claim, not the procedure code. 

I swear to you, I almost threw the phone across my office.  If it hadn't been the middle of the work day, I might have been driven to drink.  Except that drinking leads to more migraines, and that's no fun at all.

Studies show that the stress levels in parents of kids with ADHD are as high as parents of kids with autism.  I believe it, but sometimes I wonder if it's because of the ADHD, or if it's because of the insurance companies.  (It's both)

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So yesterday, my husband said to me, "Ugh!  Do you have any idea how aggravating it is when you've got a really bad headache and you take medicine for it, and it STILL doesn't get any better? Um.  Wait.  Did I just sound like a total idiot?"  Um, yes dear, I DO have a tiny little bit of experience in that department.  If it weren't so hilarious watching your shoe being shoved so far down your esophagous, I might be slightly irritated at your insensitivity. 


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Abby has this adorable new behavior, she throws these cute little temper tantrums when she's not getting her way.  She throws herself flat down on the ground, screams, pounds her little fists, looks up to see if you're watching her, and then goes back to screaming.  If you're not watching her (or you don't appear to be), she sits back up, wimpers, and goes back to playing, but sulks about it.  It is the cutest thing ever, though I'm sure when she's 5 it will seem less cute.

It's official – Sam is no longer just a baby  – he's a toddler.  But don't go trying to suggest to me that he's not a baby anymore, because he's still my baby, even if he is toddling.  Yes, it's true, he's not just taking one or two steps at a time, he's not just cruising along furniture, he's actually walking 10-12 steps at a time.  And it's not just a fluke, either.  He does this several times a day, then loses his balance and falls on his butt and giggles.  Fortunately, God made little boys with hard heads and soft bottoms for a reason.  Also, diapers are conveniently padded to help in that area.

For that matter, Ellie's not far behind Sam in the toddling department.  She also can take 8-10 steps at a time if she wants to.  She just doesn't want to do it nearly as often as Sam.  More often, she'll take 3-4 steps at a time, fall down and crawl after whatever she's after. Let's face it, my babies are smart, and crawling, for the moment, is more efficient.  They are fast little crawlers, so they're going to get at whatever they have their eye on as fast as they can!  Still, it won't be long before Ellie and Sam are walking, running, and jumping.

And climbing.  Did I mention climbing?  Oh yes.  Sam is a climber.  Abby, too.  They both climb the gates, even the ones that have bars, not holes.  And yesterday, Sam climbed his highchair.  He wasn't in it at the time.  Not good.  The J-man was never a climber, you see.  He was a bundle of energy.  He never stopped moving.  You had to keep moving to keep up with him, but ne never climbed, he never opened drawers, he never pulled things off of shelves or tables, so baby-proofing was a *snap*.  But with these triplets?  They are giving us a run for our money.  Ellie is into EVERYTHING and EVERYTHING is into her mouth.  Sam is climbing EVERYTHING. And Abby will open anything she can.  And they are all super-fast and in three different directions at once.  Still, it's fun.  And cute.  And not nearly as bad as I expected it to be.  We just have a little more work ahead of us to be one step ahead of them!

We know this because yesterday we did something very brave.  We opened up "the baby pit."  We have a living room and dining room that are essentially connected and basically one room.  But we've had the living room surrounded by a baby corral (the SuperYard XT, for those in the know), which has been a great way to contain the babies so that we can turn our backs to clean up after dinner, answer the phone, or even just play with them without worrying about which direction they're all running off into.  It also contained the toys into one discreet space.  The living room/dining room in combination is obviously a much larger space and is easily closed off because the kitchen has a gate, the basement stairwell has a door, the hall leading to the bedrooms has a door, and the doorway leading to the sunroom has both a baby gate and a door that can be closed.  So it can be one big baby pit if we want it to be, which is what we tried yesterday.  And much hilarity ensued.  The babies were SO excited at their newfound freedom.  They could hardly contain their enthusiasm.  In fact, they didn't even try.  They immediately put their minds to discovering all the little things we hadn't yet thought to baby proof.  This was good for us, actually because it gave us a good lesson in what we needed to get done.  No better trial than trial by fire, I say! 

So, I think we may be done with the baby pit.  I'm a little sad to see it go, actually.  But the truth is, they're getting a little too big and a little too active to be contained in it.  They fight over their toys and their space.  My house is really too small to have them contained in there.  And if I need to contain them somewhere, I DO have the sunroom where I can contain them (it's a nice child-friendly space with a foam floor and lots of baby toys, meant for child-containment purposes). 

So, um, anyone need a SuperYard XT?  Actually, I think it was 2 of them that we had  – one of them wouldn't have been big enough.  Sigh.  We spend so much money on this stuff and it's all so temporary, isn't it?  Maybe we'll use it again if I ever get to have that singleton I'm still dreaming of?  But that seems silly.  I mean, we never contained the J-man in a baby pit.  Do people actually contain singletons in baby pits?  Or are they just things that multiples parents use?

Finally, I love Sunday mornings because we get to be a little bit lazy with the timing on breakfast so I always (usually) make pancakes or omelettes or something yummy.  This morning was omelettes, which the babies LOVE (the J-man does too, which is shocking, since he's such a picky eater).  The babies ate TWO omelettes (total of 5 eggs), plus hash browns, plus three bananas.  They are hungry little monsters! 

Afterward, we gave them a bath, because, well, they needed it.  Even though I'm letting them each eat with a fork these days, they still mostly eat with their fingers and there was egg and cheese everywhere.  Sundays are also nice because Seth is home to help me, so I can give them a bath all together instead of three individual baths.  The babies love this, but I have to ask the moms of older triplets – how on EARTH do you manage this??  Were you really able to handle giving a group bath to your one year old triplets regularly?  Could you do it by yourself?  Because my babies are toddling all over the bathtub, in an absolutely hazardous manner and it's nearly impossible to handle them.  Even if I could manage them IN the tub (which I could ALMOST do), getting them all OUT of the tub safely would terrify me.  Can it really be done?  If so, can you tell me HOW?  This is the one thing I've never really managed to figure out how to do.  Are my kids just more excitable in the bathtub than most triplets?  They get SO riled up in the bathtub and go absolutely bonkers.  Is this normal? 

Anywhozit, here endeth my Tales o' fun, because the babies are waking up from their nap.  I hope you all are well – I'm off to snuggle with my precious babies until Seth and the J-man get home from soccer.  Then we've promised to do something SPONTANEOUS today.  I don't know what it's going to be (then it wouldn't be spontaneous, now would it??), but it's going to be SOMETHING, darnit!

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How Hard Could it Be?

I know I haven't been blogging much lately.  There have been a lot of Jewish holidays in the last month that have gotten in the way of me being able to blog.  But life is back to just it's normal craziness now, so I should be back to somewhat normal blogginess again.

We recently had the pleasure of having a couple over for dinner who is expecting triplets.  We had such a good time, and we got to show off our awesome babies, which is always fun for us.  Most importantly, I hope that we were able to pass along some of the experience that we've collected over the past year and a half through my pregnancy and through parenting these three beautiful babies.   I remember how hard it was to find out I was expecting triplets – it was the last piece of news I ever wanted to hear and I didn't react to it well.  Worse, we got a lot of negative response from people about what we had in store for us on the other end – doctors, friends, strangers. I was terrified of what was coming.  This couple is finding their experience to be similar (though thankfully they aren't hearing the same negativity from their doctors that I heard in the beginning).  Their friends are telling them how hard life will be – that they'll never sleep again, that the husband won't ever be able to travel for work again, that life as they know it is OVER. 

While I acknowledge that life after triplets will never be the same again, I would argue that life after any kids is never the same.  Your priorities shift, your lifestyle shifts, your dreams and desires shift. 

That being said, our lives are not OVER.  We still have fun.  We do sleep.  Frankly?  Life with triplets is an awful lot easier than I ever thought it could be.  Yes, it's a lot of work.  But it's not nearly as much work as I'd imagined it would be.  Even in the beginning when life was all about feed-a-baby, change-a-baby, feed-a-baby, change-a-baby, feed-a-baby, change-a-baby, pump, lather-rinse-repeat, it didn't feel as overwhelming as I expected it to.  Sure, we had moments when we were so tired we would have done just about anything for an extra hour of sleep, but I'd be willing to bet that most parents of singletons feel the same way. 

Seriously, I'm not trying to say that parenting triplets is easy, but the fact of the matter it's all we really know.  We didn't get to know what parenting the J-man was like until he was a year old, so the only babies we've ever had are the triplets, and so they are our only baseline.  Since it's all we know, it's really not that hard.  Seth and I both work full time.  We've got a five year old in kindergarten who has his own activities and appointments.  Seth's gone on business trips, I've survived and done just fine.  We watch movies together (mostly at home, but it's together time).  We've even managed to go out together a couple of times.  We have babies that go to bed at 6:30 like clockwork every night.  We do the things we want to do, we prioritize the things we have to.  But we haven't given up everything.  I'm on my synagogue board, the board of the local parents of multiples club, and I am working with the nurse educator at my local NICU to develop a parent volunteer program.   Seth helps me find time for all of these things and I do my best to help him find time for the things he wants to do.  Our lives are most decidedly NOT over.  I do more now than I did before I got pregnant.  I am more involved in the community than I ever was before.  No, my life is not over – it's just beginning.

The thing is, I was terrified to have triplets.  I thought my life would be over.  I thought it would be too hard.  I thought I would never get out of my house again.  I thought I wouldn't be able to breastfeed.  I thought I wouldn't be able to bond with my babies.  I thought I wouldn't be able to spend time with my children as individuals. I thought I wouldn't be able to go back to work.  I thought I wouldn't be able to sleep ever again.  I thought I wouldn't be able to see anyone ever again. I thought I wouldn't have any fun or enjoy my children at all.

I was wrong about all of these things.  The last year has been so much easier than I ever thought possible.  (I'm sure I'll feel differently when they're teenagers, but that would have been hard even if they'd been different ages.)

Best of all, I've met some of the most incredible women and families in the world because of being a triplet mom – and I feel so lucky for that.  And tonight I got to see some of them, so I'll blog more about that next time! 

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Calendars are funny things.  The most widely used calendar in the world today is the Gregorian Calendar, which is a solar-based calendar.  The Jewish calendar is based on an adjusted lunar calendar, which sometimes makes it difficult to explain to people why it is that certain dates have significance to me, or why the dates that have significance to me may seem inconsistent at least as they relate to the Gregorian calendar. 

Last Thursday was Yom Kippur, the Jewish Day of Atonement.  The holiest day on the Jewish calendar.  This year, Yom Kippur fell on October 9th on the Gregorian Calendar.  That meant that the date marked two dichotomous anniversaries for me, showing just how far my world has turned around: 

October 9th marked 2 years since I had a miscarriage from my first pregnancy.  I wondered then if I would ever carry a pregnancy to term.  Truthfully, I suppose I should still be wondering that, because technically I haven't yet managed to do that.  But, last year on Yom Kippur, my two daughters were officially given their names.

You see, in Jewish families, girls are given their names in the synagogue after they are born.  The father is called up for an aliyah (an opportunity to bless the reading of the Torah),  a blessing is recited for the health of the mother and the child (in this case, children), and then if the child(ren) is a girl(s), they are formally named at that time.  Boys are named at their bris (usually 8 days after birth, unless their health prohibits it – Sam had his bris when he was about 5 1/2 weeks old)  This can be done on any day that the Torah is read:  Mondays, Thursdays, Saturdays, and holidays.  My babies were born on a Wednesday, so Seth had intended to name the girls the next morning, but I had such a horrific night at the hospital that I'd called him in hysterical tears and he was with me at the hospital instead of naming the girls that morning.  Instead, he named them on Saturday, which was also Yom Kippur, the holiest day of the year – indeed, an auspicious day to name our miracle babies. 

This week is the holiday of Sukkot.  Sukkot is a beautiful holiday – a festival commemorating the 40 years of wandering in the desert and the final harvest.   It is such a joyful holiday that it is referred to as the Season of our Rejoicing.  Sukkot used to be my very favorite holiday.  Everything about it was beautiful to me (well, everything except the esrog, which I'm allergic to).  But two years ago, October 9th fell on the third day of Sukkot, and for that, I'm not quite ready to forgive Sukkot.  This is the funny thing about the way that the Gregorian calendar and the Jewish calendar cross paths.  Which day do I remember?  Both are significant to me.  October 9th also happened to be Columbus Day that year.  Last year, Columbus Day was the day I had my 2 week post-partum check up with my perinatologist.  Somehow, I don't hold Columbus Day in contempt, but I never said I was logical.

Next week are the last of the Fall holidays on the Jewish calendar:  Shemini Atzeres and Simchas Torah.  Two years ago, on Shemini Atzeres, I was back in the emergency room with complications from the D&C from my miscarriage.  On Simchas Torah, I was back in my synagogue, pretending to care about anything there, but hating every second of it.  The singing and dancing with the Torah around me – I hated everyone for being so happy.  I hated the merriment.  I hated the oblivion.  I left that night, angry, sad.  Mostly sad.  Horrified, even.  Last Simchas Torah, my three babies were in the NICU.  Seth was at the synagogue with J, dancing with the Torah, while I sat in the NICU listening to a doctor explain to me that my tachycardic daughter needed a blood transfusion.  Though we'd known it might be coming, we'd had no idea it was coming so soon – if we had, we'd have asked permission from our Rabbi for Seth to carry a pager that day, but as it was, I had no way of reaching him.  So it was up to me to decide that despite the myriad of risks listed on the consent form, none of which would have bothered me in the least bit had I been signing the consent for myself – but all of which terrified me while standing next to my two and a half pound baby – she was to have a transfusion that day.  

Honestly, I'm not sure that I'll ever quite feel the same about Sukkos, Shemini Atzeres and Simchas Torah.  I still love them.  I still rejoice in them.  And there's a great deal of healing to be had in the birth of my three beautiful babies.  I'm very lucky.  But I admit, there's still a taste of bitterness in my heart.  I think it will be bittersweet for a while, but my hope is that the rejoicing of my children in the years to come will ultimately override any remaining bitterness.  Maybe someday I won't feel like my favorite holidays were taken away from me.  Maybe I won't even feel like October 9th is significant in any way.  It's funny how these calendars play tricks on us, you see.   

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Prehensile Toes

Sam climbing gate 12 October 2008 We have, at various points, called both J and Sam "Monkey Boy."  J because he's constantly jumping around from one piece of furniture to another, much the same way that a monkey jumps from tree to tree.  Sam, because he screeches in much the same way that monkeys screech to get attention and communicate.  But Sam is starting to give us new reasons to call him Monkey Boy and I'm not entirely sure that I like it… he's becoming quite the climber AND he appears to have prehensile toes. 

Please pardon the quality of this picture – I didn't have a real camera handy, so Seth snapped a picture with his cell phone, but this morning, Sam was so very, very clingy and desperate to be held.  I put him down for just a second so that I could get something, and he couldn't handle the stress.  So distressed was he by the abandonment, that he immediately began climbing the gate in an effort to escape his temporary prison.  Can you see his little toes wrapped through the holes of the baby gate?   We are in big, big trouble.  Earlier, he had nearly pushed the entire gate over – that gate is actually one big baby corral around the entire living room and he is so strong and determined that he nearly toppled the entire structure over in an effort to get out and get into Mommy's arms.  You can see that he is quite a determined little beast and will not take no or "just a minute, sweetie" for an answer. 

I was once told that the trick to being a parent is to be able to see all of our children's attributes as positive qualities, even those that on the surface appear to be negative ones.  Stubbornness isn't a negative trait, for example; rather, it will mean that the child will grow up to be a determined individual who will succeed through their ability to stick to their goals even in the face of great obstacles.  This will be my Sam.  He will be an innovator.  He will not be pushed around.  He will get the things he needs and wants in life, no matter what obstacles stand in his way. 

In the meantime, Mommy needs to be an innovator and find a new way to contain him.  But for today, I guess I'll just be holding him a lot. 

(For the record, it turned out he was just very, very tired.  Once I held him for a while, he let me put clothes on him and put him into his crib.  He didn't make a peep and fifteen minutes later when I checked on him, he was snoring gently.)

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Here We Go Again

I haven't written about all the ups and downs, backs and forths, various changes we've made in the J-man's medications, because, really? What's the point? I'd just be writing the same post again and again. He'll take a new medication for 5, 6, 8, maybe even 10 or 12 days. And then, he'll start refusing to take it. And he'll lose privileges. His beloved Bionicles will go into the attic. His legos will be put away. His rights to use the computer will be taken away. And those threats will work for a day or two. Until they don't work anymore.

But this latest medicaton? Oh my gosh! It's been working so unbelievably well! I didn't realize how incredible life could be until we switched to it! Life was beautiful. But it was an extended release capsule that we had to open up and break into J's food… and, well, THAT didn't go over well. Because the capsule contained these little teeney tiny beads. And the beads… well, J's super-sensitive to food textures. And whenever he decides he doesn't like a food texture, he starts freaking out. So we were putting the beads in yogurt, or ice cream, or pudding, or applesauce. And that worked. For a while. And then we had to start disguising it by putting sprinkles in with the beads. And that really worked. For a while. And that stopped working. And nothing, and I mean NOTHING, was working.

Today he simply wouldn't swallow any bite he put into his mouth. He spat it out. Today was not the day for him to refuse to take his medicine – he had an appointment scheduled with a neuropsychologist to have some testing done. He didn't know about the appointment, so I know his refusal to take the medication today wasn't just acting out to get at me. Plus, he'd told his teacher yesterday that he doesn't like his morning medicine and he's not going to take it anymore. So it's been coming.

I called the developmental pediatrician in desperation at 8am and left him a message. "What do I do? Do I cancel the appointment with the neuropsychologist that I'm paying thousands of dollars to? Or do I put a patch on him and hope that does enough to get him through the appointment? Help!" He called back at 8:30 and told me to put a patch on him. He sounded defeated. I hope he was just tired and rushed. I put a patch on J and tried to get him to calm down. The appointment was at 10am. Plenty of time for the patch to work… Turns out, the new medication works a LOT better than the patch. In comparison, the patch made it seem like he was nearly unmedicated. Sigh.

Sometimes these unmedicated (or in this case, undermedicated) days are a good thing. They give me a sanity check and remind me that the medication (the one he was SUPPOSED to take, but didn't) DOES work. It reminds me that I AM right to be medicating my child, despite how unpopular a choice it is. When I see how out of control my child is, how incapable he is of controlling even his most destructive impulses… it reminds me how desperately he needs the aid of this medication. When I see how crazed and wild he becomes without medication, I am reminded that his behavior was NOT all in my head, that I was NOT making it all up or exaggerating. I was not crazy, or just completely incapable of handling it. It was not normal behavior that I was simply intolerant of. Sometimes the unmedicated days are vindicating.

Today, however, is not one of those good days to be unmedicated. Today, J needed to be focused. Today, J needed to be optimally medicated. Today, J was not. Nevertheless, the neuropsychologist did the best that she could do, and said she'd do the rest at the next appointment in a couple of weeks. She's very flexible and she'll work within whatever limitations she can. And I got to read a good deal of a terrific book: ADHD & Me: What I Learned From Lighting Fires at the Dinner Table. Maybe I'll finish it at the next appointment.

I took the J-man to school and had a long talk with his teacher on the playground. His teacher has the advantage of having an ADHD son of her own, so she can give me a lot of her own perspective on this stuff. And we decided that if the developmental pediatrician is okay with it, we can try moving him to the short acting version of the medication. He already takes the short acting version of the medication on Mondays and Tuesdays at school in the afternoons so that he's focused for speech therapy. He doesn't mind the short acting medication because it's not little beads, it's a pill crushed into powder, so the texture doesn't bother him (…yet). The disadvantage to the short acting version is that it wears off in as little as 3 hours (versus 8 hours), so it has to be given pretty frequently, which means having the teacher give it to him at least twice a day, but she doesn't mind. And so prompted my SECOND phone call to the pediatrician for the day, making my fifth phone call to him in two days. I wish I could have frequent flyer miles with him or something. Sheesh.

And so… That's what we're doing. Switching to the short acting medication, which he'll be taking at 7:30, 11:30, and 2:30 (he'll get the 2:30 dose only on Mondays and Tuesdays… the other days I'll give him a dose when he gets home ONLY if I feel he needs it – otherwise his appetite gets suppressed too much. SIGH.). And really? If anyone thinks this is all too much for a little kid? They should take him for a day. UNmedicated. Because it may be too much for a little kid, but it's DEFINITELY too much for his mommy.

Did I mention I have a full time job in addition to being a full time mommy? Did I mention I'll be working on that full time job into the wee hours of tonight to make up for the time lost this morning trying to take care of him? Did I mention that I DESPISE that people try to suggest that mothers either work full time or they parent full time? I DO BOTH. I am home for all of my triplets' therapy appointments. I take J to ALL of his therapy appointments. I coordinate with all of the teachers, doctors, therapists, psychologists, and caregivers that function as part of J-man's team. I feed them, I shop for them, I love them, I hold them, I parent them. I do all of the things that a full time parent does. And I still have to fit a full time job in between all of that. For that matter, my wondermous husband also is a full time parent and works full time, so don't go thinking he's a slacker either, because he's not. So there.

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Some days I feel absolutely ill-equipped to be a parent of an ADHD child. 

I would elaborate, but really?  Is there anything more to say than that?  I don't know that I was cut out to do this, but then again, I wouldn't trust anyone else to do it better.

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Here are some posts I’ve been meaning to write. Maybe I’ll get around to them someday…

– The Birthday Party (yeah, probably not; the short story: it was in a park, it was a good party, the sad part of the story was that Abby’s cake got destroyed on the way to the park, so she didn’t have one of the individual building block cakes like Sam and Ellie had, even though I stayed up late and made her one. I was sad. Otherwise, the party was a smashing success)

– State of ADHD / LD Treatment (I definitely need to write this one; Reader’s Digest Version: We switched medicines again, this is going well, but J’s still not eating much, which is not great. He’s otherwise doing well, and we had a great team meeting with the Dev. Pediatrician, his teacher and the school director. He’s also doing well with speech therapy and making some good progress. I’ll give more info in an actual post)

– State of Future Fertility Treatment (Also a definite future post – short story, Maryland mandatory insurance coverage is only sort of mandatory, which sucks. Postponing future fertility treatment until the start of next year. Yes, I’m still crazy enough to want another baby.)

– When are you going to Wean Already? (Never! Okay, not never, but it seems that way. I thought they were ready to wean, but then as soon as I said the word out loud, Sam and Ellie started nursing with a vengeance. Not surprisingly, this coincided with the day I took away the bottles. Well, I guess I just pretty much told you what I needed to tell you, so I guess I don’t need to write a post. Anywhozit, I guess I’ll be weaning between now and January. But I’m still going to stop pumping soon, even if Sam and Ellie aren’t weaned yet, even though that DOES seem a bit unfair to Abby.)

– On the SuperMom Phenomenon (not me, everyone else)

– An UnPrecedented Political Post (may never happen, but it might. I’ve never done this before, but for once in my life I actually CARE about politics)

– FAQ’s and also an opportunity for you to ask your burning questions. Actually, go ahead and do that. Do you have any questions for me? Anything you’ve been wondering about triplet mamahood? Or about me in general or about ADHD or about life as a kooky supermom with a cape (remember Edna’s words of advice, “No Capes!” Capes are the downfall of every superhero!)? People have asked me all sorts of things from what the sleep deprivation (you just do) is like to how I deal with three babies crying at once (mine rarely do that) to where I find my baby food recipes (who needs a recipe?) to what my favorite part of being a mom is (I have to pick one favorite part? Crazy talk!). So go ahead and ask away!

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