Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2024-02-20 Encounter: Spruce text message followed by phone call (2024-03-09) CC: Follow-up on newly started ADHD medication with dose titration and emerging behavioral/emotional side effects. HPI: Eamon was started on a stimulant medication (half-capsule/10mg) prior to 2024-02-20. Parent reported no notable improvement and no significant side effects initially, though an unusual early awakening at 3:45am was noted during an out-of-town stay with possible confounding factors. Dr. Hobbs instructed doubling the dose to a full capsule (20mg) for a trial period. At full dose, parent reported no demonstrable behavioral change while Eamon self-reported improved focus and calm; teacher feedback was planned. Around 2024-03-09, Eamon experienced a physical/emotional outburst with crying (described as highly out of character), which had occurred 3-4 times since starting medication. Assessment: Dose titration in progress; at 20mg there is room to increase toward 40mg based on weight (~40kg). Emotional outbursts and uncharacteristic crying noted since starting medication raise concern for side effects at the current or higher dose. Decision made to pause medication over spring break to reassess. Plan: Dose doubled from 10mg to 20mg for trial; teacher feedback obtained. Following the 03/09 outburst, medication was stopped. Plan to observe the remainder of the school week and check in before spring break to determine next steps. Larger dose noted as likely needed for maximal effect if medication is resumed. Medications: - UNSPECIFIED (stimulant capsule) Started at 10mg (half capsule), increased to 20mg (full capsule) (adjust) Key clinical quotes: "at 87#, he's about 40kg and that would make a dose appropriate for his weight be about 40mg. we started at 10, increased to 20mg and can increase to 40mg." "How's this plan sound to you? Stop the meds, see how this week at school goes and check in before you go to create the next step in the plan?" "He likely needs a larger dose for maximal effect" Source: Spruce conversation t_27GA7V0S3U800