Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2026-02-28 Encounter: Spruce text message CC: Excessive fatigue, insomnia, and bradycardia possibly related to guanfacine; request to decrease or discontinue medication. HPI: Parents reported that over the last few months Eamon had been extraordinarily fatigued — worsening significantly over the last two weeks of swimming. He was reporting difficulty falling asleep at night, falling asleep in class, and feeling tired all the time. Parents measured his heart rate at 39 bpm. Parents were concerned these symptoms were guanfacine side effects and requested stopping the medication immediately. They also noted the fatigue concern had been present since early in guanfacine treatment but had seemed to worsen. A separate concern about sleep was also raised on 2026-03-01, with parents reporting Eamon was wearing an Oura ring to track sleep data, and requesting bloodwork to evaluate underlying causes. Assessment: Dr. Hobbs acknowledged guanfacine's likely contribution to fatigue and bradycardia. However, expressed concern that guanfacine may have been helping reduce behavioral outbursts and cautioned against abrupt discontinuation. Gradual dose reduction recommended. Sleep quality to be monitored with wearable data; bloodwork consideration raised. Plan: Guanfacine dose reduced from 3mg to approximately 1.5mg daily (by splitting the 2mg tablet, as no lower-dose tablets were available). Parents to reassess symptoms at reduced dose. Sleep monitoring with Oura ring to be continued for more data. Bloodwork discussed as future consideration. No immediate medication discontinuation. Medications: - Guanfacine ER Reduced from 3mg daily to approximately 1.5mg daily (split tablet) (adjust) Key clinical quotes: "I will share I'm concerned that it was helping decrease his outbursts based on your feedback and that decreasing the medications will cause more" "No, don't skip, decrease it by 1mg and reassess" "Ok. Then the 1.5mg plan is a good one" Source: Spruce conversation t_27GA7V0S3U800