Dr James Schaller
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Texas Child and Adolescent Psychiatry:
The Cost of Waiting

Michael was on Dr Fine's appointment list to be seen in 4 months. His mother did not like to wait so long, but what could she do when many subspecialty child psychiatry experts were entirely filled? He was having significant trouble focusing in school and was getting moodier.

He had been given some stimulants by her pediatrician and also some Strattera, and while both seemed to work initially; they had stopped working even with dose increases.

What does it mean when a medication works, and then stops working? It is often a sign something is being missed!

This common experience of a medication stopping effectiveness has about 100 possible meanings, depending on the illness and the medication class. Stimulant dosage based on weight is out of the middle ages, and avoid anyone who talks this way. Children weighing 60 or 600 pounds are dosed super low, and raised as fast as can be carefully watched. Period.

Some doctors write or teach that attention problems are based on about 15-25 causes. Lets try about 200-300 causes.

So lets get real, ok?

You think someone is going to process all these 300 options in 15 minutes? Or will someone with no advanced biochemical and medical training be able to sift these? Never. I would have missed 50 last year.

I have another option for you. One I do every week.

Call me for 30 minutes and lets talk over your child's problems, and listen and see if I seem like I have a clue. Do you sense chemistry with me? Do you feel I am bringing an "A-game?" If the answer is "yes," consider grabbing a cheap flight to Ft. Myers, Florida and come see me with your child in Naples -- a lovely drive down the edge of SW Florida's coast.

I have worked through much illness in dozens of relatives and friends, and I have always operated on one principle: my loved ones are going to see the best in the USA. These doctors are always very creative and excellent clinicians, not necessarily the residents in training at Ivy Medical Centers, or their busy attending doctors who are too often grossly uncreative drug grant workers.

If I have seen your child visually, I can treat them.

Do you fly for work? Do you fly for vacations? Do you fly for weddings, funerals or sick relatives? Consider that your child might be ill enough to be treated seriously.

Michael had a serious car accident while he was on Dr. Fine's waiting list, but thankfully the car was 10x worse than his injuries. He is fine. His parents flew in to see me and we found 5-6 causes of his problems, and 3 would not have been found easily with routine child psychiatry or basic organ failure labs.

We spoke a couple weeks ago, and his mother said she was so glad they came to Naples for care. As I joked with a happier Michael, I thought about what an honor it was to serve them and to know such good people.

What a great thrill to know parents, grandparents, aunts or uncles or siblings who really love their kids or their relatives. It is great working with hurting and challenging kids from such goodness. I have long since lost my hero's. But if forced to pick, these types of parents and relatives are the best people I know, and folks I respect deeply. They are not perfect, but neither am I, and I love when Michael kids me about my absent-minded professor "act."

He is a happy kid. What a great thing to be part of that restoration.

My Sincere Best,

Dr. J

Bank Towers, Tamiami Trail, Naples, FL
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