The Joint American Homeopathic Conference. I have no financial relationships with commercial interests to disclose

Transcription

1 Ifeoma Ikenze MD

2 Name, Degree The Joint American Homeopathic Conference Academic/Professional Title Affiliation/Institution, City, State, Country I have no financial relationships with commercial interests to disclose OR I have financial relationship(s) with: List Commercial Interest(s) and Type of Financial Relationship Grant/ Research Consultant Stockholder Speakers Bureau Advisory Board Other Example: Advisory Board, Pfizer Speakers Bureau, Merck AND My presentation does/does not include discussion of off-label or investigational use. (If so, please describe)

3 Dr. Ikenze has no commercial affiliation with or financial interests in any of the products, tests, medicines or remedies mentioned in this presentation. All cases presented with the express consent of the patient and/or parent.

4 *PANDAS is an acronym for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection. *PANDAS is an autoimmune condition initially triggered by streptococcal infection, which disrupts a child s normal neurologic activity.

5 *PANS and PANDAS are infection-induced autoimmune conditions that disrupt a patient s normal neurologic functioning, resulting in sudden onset of Obsessive Compulsive Disorder and/or motor tics. *PANS and PANDAS can include a variety of other symptoms such as anorexia, eating disorder, anxiety, irritability, hyperactivity, sleep disturbances, mood swings and urinary problems.

6 *PANS is for Pediatric Acute Neuropsychiatric Syndrome, which is associated with a variety of different infections, other bacteria and viruses. *PANDAS is associated with only streptococcal infections specifically group A strep, not necessarily throat. * Although the etiology for PANS is different from PANDAS the symptom presentation is nearly identical.

7 *Children with PANS and PANDAS are often misdiagnosed as having a psychiatric illness and are treated solely with psychotropic drugs to manage their symptoms. *For PANS and PANDAS patients this does not address the fundamental disorder, just as anti-inflammatories and steroids do not address the root of rheumatic fever or nephritis following streptococcal infection.

8 *Conversely, not all children with OCD, anxiety, bed-wetting or other psychiatric symptoms have PANS or PANDAS *The practitioner must maintain a high index of suspicion when there is a sudden change in behavior following even a mild illness *The rapid strep test is often initially negative or not done at all in most cases. *If negative strep test, consider ASLO or CRP as a measurement of acute or chronic inflammation

9 *Case #1

10 *2009: 7 y/o boy has had recurrent strep throat x 1 year. *Used to be outgoing and very athletic. *Since this year, suddenly can t be left alone, clingy to mom, avoids peers. *Since 2 nd strep throat he started constant handwashing, insomnia and nightmares, fear of germs and illness. *Started urinating frequently and bedwetting.

11 *Was given multiple antibiotics for strep and treated for possible Lyme. *Now has developed sugar craving and anal itching. *Has become difficult around food, c/o nausea from eating. *Mom also has anxiety, OCD, with skin infections, possible AANS in an adult. *Cina 200c + Strep 200c + Candida 200c prescribed for the child.

12 *Feb 2016: Has been reasonably well, strep-free until now. Sick with strep since Oct Was given antibiotics. *Is a baseball pitcher. Severe fracture of elbow from a foul ball. Nerve damaged. Needs multiple additional surgeries. *Over the past month has developed OCD. Has to do rituals or something bad will happen to him or his family. *Extreme anxiety, not sleeping. Loves baseball, afraid to play and of surgery.

13 *July 2016: Falco 200c prescribed. *April 2017: Falco 200c helped anxiety for some time but now OCD really bad. Had revision surgery in Feb 2107 but not healing. *Fear he ll never heal. *Can t go for driver s license due to fear of mom dying in MVA while he is driving. *Mom says he s perfectionist, must get all As in school or something bad will happen. Can t fall asleep without Melatonin. *Kali Brom 1M prescribed.

14 *June 2017: Still cannot go for driver s license or 3 rd surgery fear if something happens to mom. *Wanting to be with mom all the time and critical of her at same time. *Puls 1M prescribed. *July 2017: Got his driver s license, decided to go for surgery and to return to baseball. Has started training with his team in spite of pain.

15 *Dec 2017: Elbow surgery in August Developed hospital acquired non-mrsa staph infection from surgery. Was following MDs Rx, still not healing. Depression OCD, anxiety increased. He feels he needs a psychiatrist. Dx: PANDAS resurgence *Strep 200c+ Staph 200c + Badiaga 200c, for 4 wks followed by Aurum Met 1M *Feb 1, 2018: In for sports PE. Elbow has healed rapidly and surgeon surprised, has given OK to return to pitching. Did not see psychiatrist and did not take antibiotic.

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18 *CRP obtained at his PE is extremely high at 20.9, normal is <0.9. I call him back in. *He denies sore throat but has chronic sinus and postnasal drip he thinks is allergies. *Tonsils are huge with exudate. No swollen glands. *Feels like he has a potato in his throat when he talks. *Depression, anxiety and OCD persist. No better at all from Aurum Met. Not sleeping, having nightmares and anxious dreams. *Case retaken.

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21 *Nasal and throat culture ordered. No antibiotics or antidepressant or anxiolytics. Feb 22, 2018: Lac Caninum 1M + Strep 1M prescribed. *Feb 26, 2018: Throat culture negative. Nasal culture grows MRSA *Has had chronic sinusitis for 2 months and recurrent nasal staph for past 2 years. *Bactrim + Rifampin are standard RX *Staph 1M + Strep 1M + Silica 1M given *Follow up in 1 month will be reported

22 *Case #2

23 *Nov 2016: 7y/o boy: high fever, vomiting, stomach ache. No strep test. Dx: virus. *Dec 2016: Mom sees strange behavior, cries if toilet is flushed. Frequent tantrums. Cries from missing friends and toys long gone. Saves photos of his food, won t eat because it will be gone. *Nat Mur 1M: No better, intense tantrums, nausea, motor tics. Constantly wiping his hands. Extreme hoarding behavior, won t flush. *Ars Alb 1M: Still no better. *Developed rash on back of hands. Won t bathe or change clothes, no school for 3 months. Refuses strep test. Dx: PANDAS

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25 *Mar 2017: Puls 10M + Strep 1M *April 2017: Mom reports remarkable improvement the day after first dose of Puls 10M. Agreed to wash and change his clothes. Had been in same PJs for 3 months! *Is now going to school fulltime. OK with flushing toilet and less photographs of food. *No more tantrums, sleeping well.

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27 *Jan 2018: Has fever, sore throat. Mom reports subtle reappearance of tics. *Strep test positive. No better on Belladonna

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29 *Option of abx + remedy or only remedies *Chose only: Puls10M + Strep1M + Bapt1M *7 days later strep test NEG, feeling fine.

30 *Feb 2018: Is completely well.

31 *Case #3

32 *Oct 2017: 10 y/o boy started in Mar 2017 with high fever, HA and stomach ache. Strep test from clinic NEG. Dx: Virus. No antibiotic. *Soon after started strange behavior. Went from confident happy boy to fearful, clingy to mom, refusing to go to school. Won t leave the house. *Chronic stomachaches and nausea. Alternating diarrhea and constipation. *Extremely volatile alternating with infantile behavior. *Extensive labs by MD showed sky high ASLO titer. Given a lot of antibiotics + supplements.

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34 *Oct 2017: Puls 1M + Strep 1M *Nov 2017: Stomach aches better, but still attached to mom, rages, is verbally and physically abusive. Now also bedwetting. *Refuses to go on a plane to visit family on East Coast but misses grandparents. *Wants to go but can t separate from mom. *Paranoia about people videoing him and laughing. Takes offence at everything.

35 *Nov 2017:Puls 10M: 2 days later he decides to fly alone without mom to East Coast. *Dear Dr. Ikenze, Thank you for seeing B. and pinpointing his symptoms so clearly. I am afraid to say that things have been much, much better! I'm afraid that I will jinx it! He had refused to take the remedy because he heard you say that he "may experience some or all symptoms". He is smart. We got them down though and he had nightmares and a lot of crying that night.

36 *He hasn't had the terrible stomach aches nor the extreme emotional outbursts and oppositional behavior. It's not perfect, but for the first time in months there's a calmness and reasonableness that is his baseline personality. *B. said you were the best doctor in Marin. I agree! Thank you so much for a moment to regain some sanity. *

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38 *Jan 2018: Back from East, sick with low grade fever x 2 wks and now bedwetting. *Rage attacks again but not as bad as before remedies. Screaming, throwing things. He constantly wants to hang upside down. *Is very fidgety, unable to settle down. *Hallucinations at night in bed. Grinding teeth. Cheeks flushed. *He agrees to Strep Test: Positive *Belladonna 1M given PRN acute symptoms

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41 *Jan 2018: Aranea Ixabola 1M + Strep 1M *Feb: 2018: from mom: *I was thinking about giving you an update on B. this week after strep. He has made a very confident step into being independent this week, walking downtown by himself and talking about walking home from school tomorrow and going to taekwando camp this summer (he couldn t do it last year). *His attitude is generally upbeat and positive.

42 *He isn t as obsessive about being right and compulsively having to have things his way. He even did homework on his own volition without breaking pencils and screaming. He s helped with setting the table without refusal. *The air around him has calmed down considerably. He s reaching out to friends to make plans again. He spends a lot of time upside down and is much more physically active.

43 *Our young cat disappeared last week and he didn t fall apart talking about suicide or go into a deep funk. *He apologized for speaking out inappropriately a few times. *I could go on and on!... *Feb : Recheck, strep test negative. *He is feeling fine. Still likes to be upside down. Still has moments of opposition which is probably age appropriate. *Aranea 10M weekly, Belladonna 1M prn..

44 *Case #4

45 *2015: 11y/o Dx: PANDAS. Started with anorexia and OCD in 2013, lost 25lb. Stopped playing sports and stopped interacting with peers. Obsessed about germs. Now has started bedwetting. *Won t bathe or change his clothes, sleeps with shoes and socks on. Wouldn t leave the house for 6 months. Eats alone at school. *Developed vocal tics using falsetto voice. *Rage attacks, kicks the dog and family * Veratrum Album 1M + Strep 1M

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47 *Has become very censorious, formal and stilted in his language. Reads books and pontificates on what he reads. Thinks he is superior to peers, and they are all stupid. *Given SSRI by psychiatrist. Developed hallucinations. Switched to Lorazepam and more abx. Seen at Stanford and given IVIG, DDAVP and biofeedback. Still bedwetting. *Early Aug 2017: Puls 1M : Still rage attacks. *Late Aug 2017: Lyssin 1M..less wetting *Feb 2018: Still acts superior, Plat Met 1M