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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Neurology
Satisfied Customers: 11309
Experience:  20+ years as a doctor. Internal Medicine Internship in NYC
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I am currently in the process of seeing a neurologist for

Customer Question

Hi. I am currently in the process of seeing a neurologist for diagnostic assessment. For the last few years I have been having episodes of daytime sleepiness that are so strong I physically cannot fight the urge to sleep. I was on Modafinil (Provigil) back in 2012 which worked really well and helped me stay alert. I have a diagnosis of Asperger's Syndrome and ADHD with anxiety and depression. The psychiatrist I started with when we moved started me on dexamphetamine which helped me with the alert and attention difficulties. Soon, however, I was still getting episodes of sleepiness again. Recently I have been experiencing sudden onset sleepiness to the point where I go into a sort of microsleep. I physically can't keep my eyes open and I have gone to sleep while driving for what must have been milliseconds or seconds and come to only to find I'm veering off the road! I have had to swerve to save myself. I had to call my parents to come and get me and drive the car home. These episodes are happening more regularly and my psych is not prescribing dexamphetamine for me anymore as he feels I'm misusing it. I have regularly said to him that my body is very tolerant to any medication meaning that I need more of it to get the same result as others. I have told him about the sleep episodes an asked him repeatedly to put up my dosage from 6 tablets per day to 8 or 9 (which I known is legal as I researched the guidelines) to help me stay alert. He refused to do this and I got into trouble for taking the extra myself even though I felt much better. I am therefore ,as of tomorrow, not on any ADHD medication. I asked him if he could prescribe Provigil for me and he wouldn't as neurology isn't his area. I had a sleepiness episode last night where I fell asleep while eating yoghurt and woke up this morning covered in yoghurt. I had slept in the yoghurt all night. I was supposed to drive to Brisbane today but the sleepiness is so overwhelming I couldn't safely drive. I went to a friends house for coffee and ended up falling asleep and slept all day till she had to wake me up. I am worried about what is going to happen with no dexamphetamine if I am like this with it! I want to start on Provigil again but need to get a script from a doctor asap to start on it. How can I download this and who will prescibe the medication for me at short notice? I really don't know who to turn to but these episodes are affecting my work, driving and study as well as my duties to my children. My son with Autism is being investigated for narcolepsy as his symptoms mirror a number of diagnoses. He has tested positive for some g type tissue that predisposes people to the disorder. It will take months for me to see a neurologist, have a sleep study done and gets treatment but I have to cope information the meantime!
Submitted: 2 years ago.
Category: Neurology
Expert:  Dr. Rick, MD replied 2 years ago.

Hi. My name is***** and I am online and available to help you today. Thank you for your patience.

Question and answer is just one of the services I offer. I can also provide you with additional services, such as live telephone or skype consultation, at a small additional cost. Let me know if you are interested.

Do you have any other medical problems or take any medications?

This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.

Expert:  Dr. Rick, MD replied 2 years ago.

It sounds like you have spent quite some time trying to get to the bottom of what is going on. I am sure that your previous doctors have thought of, and ruled out, all of the common and easily treatable conditions that could be causing your issues. Would you say this is a correct statement?

Well I think it might be time for you to take a very difficult, and bold, step to see if you can get some relief.

At this point I think the best thing for you to do would be to gather up copies of all your medical records and travel to a large University Teaching hospital. At an institution like that you could be evaluated and treated by a team of sub-specialists who are at the cutting edge of their respective fields. The best thing about these large teaching hospitals is that consultations are available with Professors and leaders in their field by just walking a few steps down the hall.

The Mayo Clinic in Rochester, Minnesota is an excellent example of just such a place as this. That being said there are many excellent teaching hospitals all across the country and I am sure that there is one near you.

I know that it is going to take significant effort on your part, but I believe that going to one of the "Medical Mecca's" is your best chance to – finally -- get to the bottom of what is going on.

Does this make sense to you?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned the top rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS