Dr Hive and Adderall/vyvanse circulation issues or Covid toes.

[Toocrazy!!]

DS20 started on vyvanse last year about this time. A couple months into it after the dose had been increased, he was diagnosed with Covid toe by telehealth visit and also in person express clinic. 
They gave him a steroid cream and it cleared up. He ended up switching to adderall for other reasons and after ramping up, the toe issue returned. The dr refused his adderall renewal and referred him to another NP who dealt more with these meds. 
The new NP switched him to a non stimulant one I can’t ever remember the name of but after a few months, they agreed to let him try the lowest dose of adderall again. Which he was on for about 6 months, same dose, no increase.  
Last week when the weather turned cold again, his toe issue returned. 
Does anyone know if this could be a circulation issue caused by adderall and the cold? Would Covid toe return only in the cold repeatedly? 
We don’t know if he had Covid. He was sick last December, but tested negative. Express clinic said that was most likely Covid, and thus Covid toes. They do look exactly like every Covid toe picture on the internet. 
What kind of dr/test would determine if he’s having a bad side effect like this? He’s always had extremely cold hands and feet but no diagnosed issue- same as his dad and grandmother really. 
He does pretty well on the adderall but decided at his last appointment to take himself off again given this toe issue in case it’s a side effect. 
Any thoughts? 

[ktgrok]

I know that Raynauds is aggravated by adderall/vyvanse, as they can cause vasoconstriction. But from what I remember what you described was not Raynauds?

[Toocrazy!!]

He’s not been diagnosed with that, but it seems likely he has a mild case possibly? His fingers or toes do not get white, just super cold and somewhat numb. 
Can you stay on adderall if diagnosed with Raynauld’s? 

[pinball]

I thought “Covid toes” turned out to be chilblains but were not related to even having Covid?

[Toocrazy!!]

7 minutes ago, pinball said:

I thought “Covid toes” turned out to be chilblains but were not related to even having Covid?

I don’t know? I’ll go look that up. Thanks. 

[Toocrazy!!]

14 minutes ago, ktgrok said:

I know that Raynauds is aggravated by adderall/vyvanse, as they can cause vasoconstriction. But from what I remember what you described was not Raynauds?

Thanks for reminding me of this. I see all sorts of info out there connecting these two. I guess I just don’t know about permanent damage. Lots of people seem to put up with it because the benefits of the meds outweigh the discomfort. 

[ktgrok]

9 minutes ago, Toocrazy!! said:

He’s not been diagnosed with that, but it seems likely he has a mild case possibly? His fingers or toes do not get white, just super cold and somewhat numb. 
Can you stay on adderall if diagnosed with Raynauld’s? 

I imagine it depends on severity? Mine only flares up rarely - but I live in Florida, lol. So I actually never bothered to get formally diagnosed with raynauds because it just isn't a consistent problem for me. But if I lived elsewhere and had it happen more than every very so often, I'd look into it I guess. 

[TechWife]

He may want to consider making an appointment with a psychiatrist. They know more about side effects to these types of meds than a general practitioner will. He may have to wait several months for a new pt appointment, but making the appointment is the first step. Once established, it’s easier to get on the schedule. 

[ktgrok]

3 minutes ago, TechWife said:

He may want to consider making an appointment with a psychiatrist. They know more about side effects to these types of meds than a general practitioner will. He may have to wait several months for a new pt appointment, but making the appointment is the first step. Once established, it’s easier to get on the schedule. 

I'm obviously too tired, because at first I couldn't figure out why you thought his toes turning colors was a mental health issue. Oops. 

[kbutton]

Chilblains/pernio? You can get it with or without Raynaud’s.
https://www.mayoclinic.org/diseases-conditions/chilblains/symptoms-causes/syc-20351097

I know someone with Raynaud’s that takes ADHD meds. I am not sure which one. I think she just works to keep fingers and toes warm. 

[Kassia]

I get chilblains on my fingers about 9 months a year (summer I'm fine).  It's much worse when I'm thinner.  I've gained weight this year and the chilblains are milder than usual but one of my fingers turns blue constantly.  I have no idea why.  I saw a vascular doctor a few years ago and she didn't have any suggestions other than some testing that wouldn't really solve anything (submerge fingers in ice?) so I decided not to do it.  

I wear two layers of socks most of the year and one in the summer and have no issues with my toes getting cold.

 

[Toocrazy!!]

Yes, it appears to be chilblains. I remember that now.  He is underweight. And goes barefoot a lot. Now, he pays more attention 🙂 
Thanks for all the info. This gives me a lot to go on. 

[Grace Hopper]

3 hours ago, ktgrok said:

I know that Raynauds is aggravated by adderall/vyvanse, as they can cause vasoconstriction. But from what I remember what you described was not Raynauds?

Raynauds (eta lol autocorrect!) is what first came to mind for me, too, but it doesn’t look like covid toes. FWIW my vyvanse kid had raynaud symptoms prior to the adhd diagnosis/ treatment ( and way before covid). 

Edited December 26, 2022 by Grace Hopper

[Storygirl]

I don't know about the connection to toes and circulation. But if the doctor wants him off of Adderall, there are other stimulant meds that he can try. Nonstimulants didn't work for DS. Adderall was a bad fit for DS. Ritalin, Focalin, Concerta all work for him -- they are a different type of stimulant based medication.

I agree with working with a psychiatrist. If it is several months' wait (which I agree that it can be), perhaps ask his current doctor if they would try Focalin or Concerta for him.