Slightly outside the parking lot medicine

When a child has deficient attention

This is my diagnostic contention:

     The least sufficiency

     Would be to test for deficiency

Of iron and vitamins that I’ll mention

This evening I went to another town outside my thirty-mile non-compete limit with a friend who teaches Tae Kwon Do. 

I could write a great deal about martial arts, and in fact I made Tae Kwon Do the subject of a novel (not in print, I am hoping to get an agent).  In brief, martial arts communities have an important place in our cities and towns.

I sat next to the mother of two of the students, a male age eight and a female age ten.  She gave me permission to write about the following information.

The eight year old had a medically complicated first two weeks, and since then he’s been a behavioral problem at home, but not in school.

I asked if he were on medication; the mother told me no.  I told her that a medication list with nothing on it is a good start.

Then I said that I never give the diagnosis of ADD or ADHD until I have the following normal lab work:  complete blood count, erythrocyte sedimentation rate, thyroid stimulating hormone, 25 hydroxy vitamin D, lead level, chemistry 14 panel, ferritin, vitamin B12, and folic acid.

I have never once seen lead poisoning, and I’ve been looking hard for thirty years.  But I’ve seen a lot of behavioral problems from iron deficiency, which has much biochemistry in common with lead poisoning, hangovers, and porphyria (a very rare blood disease).

I’ve also seen ADHD get a lot better with vitamin B12 replacement; my youngest B12 deficient patient was eleven years old.  Some of my ADHD patients improved when the vitamin D deficiency resolved.

The few children I’ve seen with underactive thyroids all had behavioral problems, which either improved greatly or disappeared when they had adequate thyroid supplementation.

I’m not a big fan of medication for ADHD.  The disease runs a spectrum from not so bad to disabling, and at every level treatment involves varying combinations of coping strategies or medications.  Pills alone won’t help nearly as much as pills and skills.  A combination of an alarm watch that goes off every fifteen minutes, a continuously updated list, and a Palm or other PDA can go a long way to obviating a pharmacologic strategy.

If easy distractibility makes the diagnosis of ADD, then I have the disease.  I suppose in comparison to other people my age I’m hyperactive.  I have made a lifelong habit of avoiding cross talk and multiple conversations, and I will be the first to admit that I don’t multitask well.

I’m a Family Practitioner from Sioux City, Iowa.  In the year that my 30-mile non-compete clause ticks out I’m having a lot of adventures.  If you want to comment on a post, click on the title.


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One Response to “Slightly outside the parking lot medicine”

  1. Tweets that mention Slightly outside the parking lot medicine « Walkaboutdoc's Blog -- Says:

    […] This post was mentioned on Twitter by Joanna Cerazy, Low Iron. Low Iron said: 20 Slightly outside the parking lot medicine « Walkaboutdoc's Blog: But I've seen a lot of behavioral problems f… 20 […]

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