October 17, 2024 Stimulants and Cold/Flu Season
Guidelines for safe teatment of colds and flu when you are taking stimulant medications for ADHD:
When taking stimulants like Adderall (amphetamine and dextroamphetamine), it’s important to be cautious with over-the-counter (OTC) medications due to potential drug interactions. Here’s a general guide to common OTC medications:
Safe OTC Medications (with caution):
1. Pain relievers
– Acetaminophen (Tylenol): Generally safe for occasional use with Adderall, as it doesn’t interact with stimulant medications.
– Ibuprofen (Advil, Motrin) and Aspirin: Usually safe, but if you have heart issues, consult your doctor first since both Adderall and these drugs can affect blood pressure.
2. Allergy Medications:
– Antihistamines: Non-sedating antihistamines like loratadine (Claritin) and cetirizine (Zyrtec) are safe. However, diphenhydramine (Benadryl) can cause drowsiness and may have additive sedative effects when coming down from Adderall, so use it cautiously.
3. Cold and Flu Medications:
– Avoid decongestants like pseudoephedrine (found in Sudafed) and phenylephrine, as they can raise blood pressure and heart rate, amplifying Adderall’s stimulant effects.
– Cough suppressants like dextromethorphan (found in many cough syrups) can be safe but should be used cautiously due to potential interactions.
4. Gastrointestinal Medications:
– Antacids and Proton Pump Inhibitors (e.g., omeprazole) can affect how Adderall is absorbed, potentially increasing its effects. Use these sparingly, and consult your doctor if you’re using them regularly.
– Laxatives and antidiarrheal agents are typically safe.
Medications to Avoid:
1. Decongestants (e.g., pseudoephedrine, phenylephrine): These can increase heart rate and blood pressure, compounding the stimulant effects of Adderall.
2. Certain cold medications that contain decongestants and high doses of caffeine.
3. Cough syrups with dextromethorphan in high doses may have interactions with Adderall, increasing the risk of side effects like increased heart rate or nervousness.
Consult a Doctor or Pharmacist:
– If you are taking OTC medications frequently, it’s important to consult your healthcare provider to ensure no negative interactions occur.
Since specific interactions can vary depending on individual health conditions, it’s always best to check with a healthcare professional before starting any new medication.
April 29, 2024 Guided Meditations from UCLA in multiple languages!
Be sure to chekc out this link and share freely with others. Use these meditations in whatever language you are most comfortable and become a self care warrior! https://www.uclahealth.org/programs/marc/free-guided-meditations/guided-meditations#english
April 25th, 2024 Metformin Study Reviews Life Extension and Health Benefits in Aging
A cheap drug may slow down aging. A study will determine if it works
March 11, 2024 NEW Guidance for Symptoms fo COVID-19
On March 1, 2024, the Centers for Disease Control and Prevention (CDC) released new guidance about what to do if you have symptoms of COVID-19. Please note, this new guidance does not apply to hospitals, clinics, and other healthcare settings. Current policies and guidance for healthcare settings have not changed. You should continue to contact your care team before an in-person visit if you meet any of the below criteria:
- Have a fever or other flu-like symptoms
- Have a known COVID-19 infection and are within 10 days of the start of symptoms (20 days if you have a weakened immune system)
- Have a known exposure to COVID-19 within the last 10 days
The new guidance for community settings applies to any viral illness, not just COVID-19. Symptoms of a viral illness include: fever, chills, fatigue, cough, runny nose, and headache.
Even with a positive COVID-19 test, you can go back to your normal activities in the community when:
- Your symptoms are better for 24 hours AND
- You have not had a fever for 24 hours without the use of fever-reducing medications like acetaminophen (Tylenol) or ibuprofen (Motrin, Advil).
The CDC also recommends taking extra precautions for 5 days after you go back to your normal activities. These include:
- Taking steps for cleaner air
- Practicing good hygiene
- Wearing a mask
- Physical distancing
- Testing if you may be around others indoors
You may still be contagious even when you are feeling better. If you start to feel worse after returning to normal activities, you should stay home again. Stay home until your symptoms improve for 24 hours and you have not had a fever for 24 hours without the use of fever reducing medications. You can find helpful tips and examples at the CDC website here.
Dec 7, 2023 Why Drug Shortages Persist
“Patients bear the harm of drug shortages, yet they cannot choose the manufacturers of their essential drugs nor evaluate their reliability”.
NYT Opinion piece by Emily Tucker, MD (Clemson University) states 3 avenues needed:
Legislative action is the only real way to ensure the availability of essential medications. After 20 years of drug shortages, it seems clear that markets alone are not the solution. And there are a few specific ways Congress should address drug shortages.
- The first is to ensure better quality drug manufacturing. Modernizing manufacturing facilities would make them more reliable and prevent shortages.
- The second is to improve the adaptability of drug manufacturing itself. Manufacturers should be able to switch quickly to alternative facilities or to increase production when demand unexpectedly increases.
- The last is to maintain buffer inventory of essential medications within our health care system. Having inventory available to allocate to those most in need during shortages would buy time for the system to adapt to supply disruptions or surges in demand….
Aug 31, 2023 Do Masks work?
Interesting article on effectiveness of masking, social distancing and a nuanced discussion of where , what, and when each strategy worked best! (Clue: social distancing!) Read more…
August 24, 2023 Nancy Valentine Award!
I guess the word is out!
I received the Nancy Valentine Leadership in Psychiatric Nursing award!
This award is given to a nurse leader in New England who has made a significant contribution to the field of psychiatric nursing and will be bestowed on Oct 6th, 2023.
I must say I was very surprised and honored by the acknowledgment. I am so excited to let my professional community, patients and family/friends know how happy I am to be honored in this way. Leadership is something that I had not necessarily aspired throughout my career, as I am always most excited to be a “team player” but so happy to know that many of my colleagues and friends have experienced my work in such a wonderful way.
Thank you to those who supported and nominated me (Diane Grimaldi – also a recipient of the Nancy Valentine Award!) and reminding me of how wonderful it is to be thought of in such esteem by my wonderful colleagues!
Article: “Are ADHD Medications Safe During Pregnancy?
Women with ADHD who become pregnant must decide whether to remain on medication or cease taking their Adderall or Vyvanse or other prescription for at least nine months. For women hoping to breastfeed, this decision may impact life — for the mother, the child, and the rest of the family — for two years or more.
Complicating this decision is the fact that there are no clear-cut studies regarding the safety of stimulant medication use while pregnant. None of the medications used to treat ADHD — including Vyvanse, Adderall, and Ritalin — are proven to be safe to use during pregnancy, but they are also not proven to be harmful, according to the Federal Drug Administration (FDA). In short, there is no ethical way to conduct a study, giving medication or a placebo to a population of pregnant or nursing women, and then collecting data on the outcome for the babies…. (read more)
May 22, 2023 Pracice Update
I have recently made important changes to my solo practice, leading to improvements in time management, stronger boundaries around screen time and increased efficiency. There are still improvements to be made in billing/collecting copayments following the brief pause during the COVID emergency from MArch 2020 to July 2021. Although I am still working through paperwork and billing challenges, I am confident that I will resolve them in the next few months. Additionally, I am planning to simplify my non-practice responsibilities by stepping down from the Chair position at MAAPPN (Massachusetts Association for Advanced Practice Psychiatric Nurses) after December 2023.
Over the years, I have been dedicated to advocating for high-quality psychiatric care in Massachusetts and supporting the role of Advanced Practice Psychiatric nurses. I am proud to say that we have largely achieved our mission with the enactment of full independent practice legislation. However, it is important to secure these gains and continue supporting new Psych APRNs. As I transition, MAAPPN is exploring options, including partnering with similar organizations starting in 2024 or coninuing with new volunteers. This process will take most of 2023.
After that, I aim to keep a priority focus on solo practice and continue Psych APRN advocacy activities through old and new alliances formed during this year.
March 19, 2023 Practice Update
Many of you (of my current patients) will be receiving notices to about my decision to cut back in my practice starting in June, 2023. I will attemptot refer to other providers (see below) and I do so with a confident heart. As you may or may not know, the environment for care has become onerous for solo practitioners. Paperwork, medication supply shortages, insurance demands, volume of patient communications and federal law changes in prescribing controlled substance medications (such as stimulants) have placed the usual care and quality that I aspire to give in jeopardy. I have tried to adjust my practice procedures to meet these demands, but sadly, these changes do not appear to be effective in this new environment.
To this end there are new providers entering the field that you should be able to find in any internet search. I can recommend two practices that may be able to help:
Goodpath: https://www.psychologytoday.com/us/psychiatrists/good-path-health-services-norwood-ma/1079783
Lighthouse Mental Wellness: https://www.lighthousementalwellness.com/
If there are interim gaps in retaining new providers, I am asking that patients reach out to their primary care providers for prescription assistance and make an appointment soon so that we may form an adequate medication transition plan.
I regret that I am losing many long-time patients and some newer ones too for whom I care a great deal about. But I feel that there are providers that can meet the care and treatment needs now and in the future and with whom I know my patients will be in good hands with!
January, 2023 Practice Update
Co-pays/Scheduling Link: For telemedicine or in-person the co-pay policies must be followed. You may use the button below to schedule your appointment and/or pay your co-pay in advance: https://appointmentsKANDOLINA.as.me/
In-Person Office Visits Available: Thursdays at 82 Marlborough St. Although I have moved properly out of Boston, I will still commute to the office at least 2 – 4 times a month and hope to see many of you in person this coming year (weather permitting). New regulations from the Centers for Medicare Services (CMS) re: frequency required for in person office visits may be forthcoming in 2023.
Winter Weather Cancellation Policy: For in-person appointments, if the Boston City Schools are closed so will my office be closed
COVID Precautions: Please stay up dated with your boosters and self-care. Office visits will have air filtration, chair distancing and masking available as needed.
November 3, 2022 Adderall Shortages