It is cold (but not like NYC with 6 inches of snow.  What’s up with that?). The garden has been put away. I am not forgetting to put on a hat and grab gloves when I go outside. Julia is wearing a coat (Why do teenagers think that underdressing is cool?). There is a thin coat of ice on our little bay.  There were large patches of gray, still water yesterday with just a few ripple-ly circles. 

Winter is coming.

And we are on Day 2 of an adventure.  Julia’s head scratching/picking has gotten worse.  The scratching causes hair to fall out. Julia has a quarter sized bald spot now that is visible to anyone taller than she is and a number of places of thinning hair that will soon join the bald spot. She is none to happy about this but can’t stop. It has been going on for awhile now but the lice attack was a particularly hard blow.  The scratching from itching becomes habitual and part of her stimming and the scratching from stimming makes for more itching.  Impossible for her to stop. When she is not scratching, she is appalled by the result of her behavior, although when she is in the scratching zone, it is hard to rouse her attention.

During the week, in an ever intensifying effort to reign in the problem, we visited her doctors.  The nurse practitioner at the family practice prescribed an itch reducer that Julia could take up to 3 times a day.  After a few days, it is not clear it does any good.  It makes her sleepier at night which reduces the amount of time available to scratch, so we are using it at night.  

She and I went back to some physical blocks that have worked to some degree in the past.  She wears a hat all the time and gloves when she goes to bed.  Julia has fidgets and thinking putty for school and when her hands are not busy.  All of these deterrents only work when she is highly motivated which because of the state of the top of her head is her current mood.

We had an appointment with her meds doc midweek, and I had the feeling that he was going to change her Concerta prescription.  We had run out of her current prescription on Monday and instead of getting a refill, I gave her a lower dose from an old prescription.  So, she had two days of half doses before her doc visit.

On Wednesday, her meds doc opined that the lice experience triggered and intensified the Concerta itchy head side effect.  A similar side effect happened years ago when Julia was on another ADHD medication and bites from bedbugs were responsible for an allergic reaction.  Julia developed incredibly itchy rashes on all her extremities and it was about 18 months before we got it under control.  One of the things that seems to help was changing her ADHD medication to Concerta.  A med change is not available to us and so, her doc suggested that Julia stop taking Concerta all together until her head heals and her hair begins to grow back.  Let’s say until the end of the year.

FYI: Concerta balances out norepinephrine and dopamine in the brain and acts as a stimulant on the central nervous system. Norepinephrine is a stimulant and dopamine influences one’s attention span, movement and pleasure feelings.” A single dose of Concerta lasts up to 12 hours although after 6 or 7 hours, its effects are pretty muted.  Concerta is generally eliminated from the body within 32 hours of last dose.

So after two days of half doses, yesterday Julia was Concerta free.  The immediate effect on Julia is a hearty increase in her appetite and by that standard there is not much Concerta left in her body.  She ate like the proverbial horse.  I am waiting for the loss of attention and of focus and the impulsive behavior to appear.  So far, there are no reports from school about inappropriate behavior and she did fine in OT and social skills group during yesterday’s evening.  

Every so often, Julia has been on a meds vacation for a few days but never for a long stretch of time.  She has been on an ADHD stimulate since second grade.  Eight years.  I have no idea of what my girls is like in this somewhat naked state. She takes two other medications which will stay in place.  

I haven’t seen much yet.  She did not have enough focus on her math last night but she was much more tired than she usually is, so I can’t count that as a focus change.  At least, not yet.  After her regular teenage morning grumpiness, she was extremely bright-eyed this morning which is very unusual for her.  

How long do we keep this up? And then what?  Length of time is rather vague.  Until her head heals and hairs starts growing back or until her teachers and I can’t possibly stand it.  I am hoping for at least two weeks.  There would be a lot of healing if we can stretch it until the end of the semester.  This weekend is pretty low key with no major school work due and next week is only two days at school.  So, unless she is impossible at home, we should get close to the end of the month at any rate.

It is a brave new world, or a brave old world.  And of course, I am wondering if it will make for any changes in her art and her perfectionist tendencies.  How much is the Concerta responsible for her OCD leanings? Right now, I am just hoping for another school day without any report about unfavorable behavior.  Crossing fingers, lighting candles and chanting just a bit.