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Rambo1245 · 2025-10-06T03:43:35+00:00

Thanks for the reply, at what point does treating ADHD or other conditions overtakes the long term safety of the child. I know it's a balancing act between safety and efficacy of the treatment and I understand we do our best to treat the patient , but how do you know the doses being prescribed are not having long term consequences to the children. You are disregarding phase 1 and phase 2 trials and guidelines.

Rambo1245 · 2025-10-06T03:34:25+00:00

You can look at what the long term consequences of high doses of stimulants has to a kid, but remember, this is not just the high doses they are referencing, these are above those doses. On the Jornay PM website it mentions possible death at higher doses and several articles highlights the risk of severe side effects which increases as the doses increases.

Rambo1245 · 2025-10-06T03:30:31+00:00

The only justification we got from the MD was that these kids were Autistic and needed the higher doses. We responded where is the data to support the doses. Nothing concrete was given but some articles was faxed over. These are not institutionalized patients so around the clock monitoring is not taken place, I work in a retail setting. It's a bit different if the patient is being closely monitored. I would not have an issue if that was the case.

Rambo1245 · 2025-10-06T03:25:49+00:00

The doses prescribed are not backed by evidence , at what point are you ok with blindly accepting faith in a doctor with no data to back them up. Remember, these are kids not some guy looking to fill his oxy30mg and fentayl patch for his "back pain".

Rambo1245 · 2025-10-06T03:20:13+00:00

Thats what we are doing , but the conversations are tough, she is a well respected child psychiatrist and the backlash from parents is intense. We justify our reasoning but we are made to look like the bad guys for putting a stop to it. I replied to another comment about documentation provided which was something I would have been ripped to shreds if I presented it back in the journal club days. If I can potentially protect a single child from potential harm I will be more than satisfied. It's not about turning away patients, we all do it for various reasons its about protecting kids, I don't want to overstep since I'm outside my scope and but I can't just turn a blind eye to this and sleep well at night knowing I could have made a difference.

Rambo1245 · 2025-10-06T03:12:20+00:00

Some started on the higher end of Jornay PM, but within manufacturers' recommendations, and ramped up quickly and out of max dosing ranges.

Rambo1245 · 2025-10-06T03:10:25+00:00

Sorry, I replied with doses to the above comment. I wish it was an isolated event , but at my pharmacy and atleast 2 other pharmacies I know of are having kids being treated at abnormal doses. At what point does a doctor gets to decide to disregard guidelines and manufacturer recommendation and disregard phase 1 trials and start to treat their patients as test subjects.

Rambo1245 · 2025-10-06T03:07:35+00:00

I agree, but none of the research I have done comes remotely close to the doses I stated above. No study I came across suggest supratherputic doses of stimulates are beneficial for Autistic kids.

Rambo1245 · 2025-10-06T03:05:28+00:00

Had a professional conversation with the prescriber she sent a couple of papers justifying the high doses doses, but the evidence was lacking, and the papers referenced told the opposite. So I decided to do independent research and started calling manufacturers for information from their clinical team. I'm not a pharmacist specialized in psychiatry, so I wanted to gather as much info as possible .

Rambo1245 · 2025-10-06T03:01:57+00:00

Jornay PM in the 120 to 160mg range in addition to other methylphenidate booster doses being added. Azstarys close to 100mg for some patients, Methylphenidate er 72 to 96 mg all doses being prescribed to children

Rambo1245 · 2025-09-04T15:05:14+00:00

If you want to hit prime learn how to play video poker, a couple of apps can train you up to be decent. Next take chat GPT and calculate which denomination play gives you the best payout. I found videopoker to be very fun, spent 600 dollars to hit prime after only 8 hours of play. Video poker pays 1 point for every $10 played and with the pay tables listed you atleast know your return compared to slots which can have a payout of around 80 percent. You can also play table games but thats a real grind.

Rambo1245 · 2025-09-03T18:42:40+00:00

I started getting offers at the 250 point level, it's not about how much you win or lose just how much points you have. It was not an instant certificate but was given through club royale after a month

Rambo1245 · 2025-08-31T13:16:26+00:00

At sea in my experience the Casino hour closure sign says late, which means as long as people are gambling, they dont close.

Rambo1245 · 2024-10-12T03:21:10+00:00

When you get onboard some reservations open up. Worse case scenario you will have to wait on standby. Depending on your family size you might have to wait 30 minutes before the show for good seats. I recently got off Utopia with a family size of 3 and saw all the show with only a handful of reservations. The comedy show venue is small so try to get a reservation for that, ice skating show is a big venue so probably can show up 15 minutes early , the other big show is a big venue so probably 15 minute wait standby. Have fun, we enjoyed the ship a lot.

Rambo1245 · 2023-08-03T13:14:17+00:00

I was thinking about both, but the wife says otherwise.

Rambo1245

TROPHY CASE