From IVIG to PEX to Rituximab to Helminths to treat PANS

Before

We have four kids; two have PANS. Charlie’s came on like a freight train in the summer of 2010 at age 5. Maddie’s PANDAS was a slower unfolding until she was nine when suddenly her OCD became unmanageable. We completely lost her at 11. They were normal functioning kids before their onset of PANDAS. Maddie was a sweet, loving, adorable child who would dance and sing her way through life. She was OCD-ish, but nobody seemed to be concerned, so I trusted the doctors…. something I no longer do. He wasn’t as easygoing as my other kids, but he had a sweet nature and a sense of humor that went beyond his years. 

PANDAS diagnosis for two children

In the summer of 2010, we moved from Chicago to NC. Days before we moved, I had a doctor’s appointment scheduled to have Charlie’s kindergarten physical. He received four shots, chickenpox, polio, DTap, and MMR. Shortly after, things got very dark. Rages that would last for hours and end in crying, begging us for help. Days filled with screaming, crying, kicking, spitting, biting. He lost eye contact. He would no longer let us touch him. He started to wet himself and the bed despite being potty trained for almost three years. He became obsessive. He became sensory deregulated; he stopped wearing clothes because he couldn’t stand the feeling of anything touching his body. He could once write his name and any five-year-olds, maybe better. That disappeared, and he was barely capable of creating a scribble. He started to have throat-clearing tics. He would cover his ears constantly because he couldn’t stand the noise, making him irritable and angry. He would have meltdowns every time we were in the car, screaming and kicking my chair while I was trying to drive. He stopped playing with other kids. He would stand, all alone, in his own world on the playground. He stopped telling us he loved us. Our little boy was gone. While searching for answers, professionals told us everything from this is a reaction to our move over the summer, to bipolar disorder, to oppositional defiance disorder, to finally Aspergers. I knew this wasn’t Aspergers; I would have seen signs before age 5. I fought the diagnosis but not without resistance. I was treated like a mother in denial even though I was anything but. After months of searching for answers, we finally discovered PANDAS. 

We found a PANDAS specialist’s website. When reading the criteria, it almost fit Maddie more than Charlie. We made an appointment and flew both of them back to Chicago from where we had just moved. He diagnosed both Maddie and Charlie in November of 2010. Charlie’s symptoms obviously led us to PANDAS, but the doctors said Maddie was actually more of a textbook case. Maddie had chronic strep from the age of three onwards. Several bouts of walking pneumonia, coxsackie, sinus infections, and finally post strep psoriasis led to having her tonsils out when she was 8. Unfortunately, this didn’t stop the strep; she continued to get it in other places of her body. She had increased anxiety and OCD, but no one ever put two and two together. She had irrational fears, would constantly tap things, chew her sleeve until it would disintegrate, obsess over all sorts of things, and had transient tics. Anytime we addressed her OCD/anxiety with the pediatrician, it was dismissed as a phase or a predisposition to anxiety. He told us if the OCD didn’t interfere with school, sleep, or friends, it was nothing to worry about. So I trusted him. Maddie wasn’t diagnosed with PANDAS until age 9.

IVIG heals Charlie but not Maddie

We tried IVIG for both Maddie and Charlie. IVIG was a miracle for Charlie; nearly all his symptoms disappeared. Unfortunately, IVIG never really made a difference for Maddie. At this point, her OCD was becoming unmanageable. She could no longer concentrate in school. The OCD occupied so much of her brain she became incapable of friendships. She couldn’t fall asleep and/or stay asleep because her intrusive thoughts became so intense. These are three of the benchmarks our pediatrician told us to look for. But because IVIG had no real impact on her symptoms, doctors (non-PANDAS, of course) were even more convinced her OCD was “psychiatric” (which I always put in quotes because I now know there is really no such thing). But all agreed her symptoms needed intervention. After months of CBT and Zoloft, Maddie’s OCD continued to get worse.

Maddie’s Sudden Acute Change

It was the beginning of 6th grade when Maddie drastically changed. She became psychotic. She would have severe bouts of OCD that came on like a tsunami followed by fits of rage that would last for hours. Screaming, kicking, pulling out chunks of hair, violence, self-harm, the list is endless. The sweet, loving, happy, outgoing, smart little girl we knew for 11 years was gone. Everything in our world went black. Up to this point, her OCD revolved around dying, mainly cancer. This fear soon morphed into something completely psychotic. In her mind eating would equal fat, and fat equaled unhealthy, and unhealthy equaled dying. This is the only way I could make sense of her utterly irrational thinking. She stopped eating and drinking. She stopped bathing in fear that her body would absorb the water and cause her to gain weight. She thought her hair made her look fat, so she pulled her hair back into a ponytail so tight she started to go bald every day. She would randomly cut pieces of hair off she didn’t like. It spun out of control so fast we didn’t even know what hit us. Her weight dropped so low, so quickly that we were forced to hospitalize her. She went into inpatient care at a major university hospital in the south shortly after her 12th birthday. The hospital didn’t separate children from adults, so Maddie, who was still very much a child, was mixed in with chronically ill adults who all had a myriad of lifelong problems. No judgment, just not an experience a child should ever have to face. The treatment was awful. No one would listen. If we ever even suggested this was an autoimmune issue, the doctors would literally pretend they couldn’t hear us. They told us they wouldn’t admit her unless we agreed to take her off all antibiotics. They also told us that going forward, we were not to mention the word PANDAS, to accept that this is an eating disorder and that it would be treated as such. This was all happening around the same time Elizabeth Wray was taken from her parents by Boston Children’s. Maddie’s case mirrored Elizabeth’s, so saying we were scared is a gross understatement. I was supposed to accept that my 11 year old had just “gone crazy,” and that is just the way it is. The doctors, of course, backed us into a corner with psych meds. We knew we couldn’t refuse, all the while knowing these drugs would make matters much, much worse. They put her on Luvox, which of course, made her worse, but the doctors insisted she was making progress. I always wondered if we were talking about the same child.

The hospital managed to get Maddie’s weight restored with the constant threat of tubing her, but her mental state deteriorated. When Maddie had psychotic meltdowns, the nurses locked her in a metal room alone as she banged on the door begging for help. No one notified us this happened until Maddie told us after the fact. I naturally addressed it with the head psychiatrist as soon as I found out. She lied and told me she contacted us, and I approved of the “isolation room.” As if we would ever agree to have our extremely sick child locked in a room scared to death begging for help. This was disgusting and heartbreaking, to say the least. When trying to articulate what I was going through to friends and family, I would describe it like I was in a terrifying dream trying to scream for help, but nothing would come out of my mouth; I had no voice.

I felt as if I was mourning the death of my child. As I knew her, Maddie was gone, but in return, I got this child I did not recognize. No one was listening; no one wanted to help. We were alone and scared, and not a day went by. I sobbed uncontrollably.

Next Steps – Autoimmune Encephalitis, IVIG, PEX

After we got Maddie out of the hospital, a leading Hospital with an Autoimmune Encephalitis clinic agreed to take her as a patient in their AE clinic. They believed she had Hashimoto’s encephalitis, I didn’t, but at that point, I didn’t care what they called it as long as they acknowledged this wasn’t “psychiatric.” They immediately started IV steroid treatments. We would get three days of extreme explosive crazy, three days of good, and then back to baseline. It wasn’t sustainable. We finally told the doctors we wanted to stop steroids; the good was not outweighing the bad. They refused to go further with treatment until we got a second opinion. In the midst of all this, my husband got a job in NYC, so we moved to NJ.

Onward we marched to a Neurologist specialized in Autoimmune Encephalitis at a leading hospital in New York City. He confirmed this was PANDAS. She started IVIG right away. But, again, IVIG did not help much. The anorexia was getting worse; it was so severe that this Neurologist ordered emergency Plasmapheresis (PEX). We spent eight days at the NYC hospital. The worst eight days of my life. We shared a room with three other families. Maddie didn’t eat or drink one thing for the entire eight days. Because she had a tunneled catheter surgically implanted into the central vein in her neck, there was no way they could tube Maddie to feed her. The Ng tube would involve restraint, as there was no way Maddie would agree. They could not risk it. The staff there didn’t understand PANDAS at all. She was on the pediatric floor, and the nurses were not familiar with psych patients. They treated her as psych patients are often treated with no respect and zero compassion. It was a real eye-opener. The Neurologist admitted Maddie without insurance pre-approval and sent her to the pediatric floor. Pediatrics said she was a psych patient, and they didn’t want to deal with her. Billing was coming at me, telling me the PEX wouldn’t be covered. It became a bureaucratic nightmare, and we were kicked out before Maddie’s PEX treatments were finished, one more roadblock. He said she needed Rituximab but said his hands were tied because he didn’t have the hospital’s support. And so, yet another doctor dropped us.

Rituximab

Again, onward we marched to a PANDAS specialist and Pediatric Neurologist, who also agreed that Maddie needed Rituximab right away. So we did Rituximab, and within weeks of finishing all of the treatments, the psychosis started to abate. We were slowly getting glimpses of our little girl again. Odd behaviors started to dissipate. The ponytail came out. She started to shower. Maddie was able to interact again. 

Eating Disorder Returns

After missing all of the 7th grade, she went back to school and got A’s and B’s. I never thought I would see the day she would walk through the doors of a school again, let alone make the honor roll. I felt hope for the first time in years. As time went on, we had hoped all the psychotic behaviors, rages, and the OCD around eating would disappear as well. Unfortunately, the OCD had such a tight grip that it wouldn’t budge, nor her eating. After being in school for three months, we hospitalized Maddie once again to treat the anorexia. This time we sent her to a hospital in Virginia. She was inpatient for six months. She spent Christmas, Easter, and her 14th birthday in the hospital. While they didn’t necessarily treat PANDAS, they believed in it and were willing to work with us. It wasn’t easy, but we managed to dodge psych meds and flu shots. We were relieved that this was a children’s hospital, so this time she would not be mixed in with adults. However, even though these were technically children, many had very adult problems—many kids in foster care, rape victims, and several kids from really sad, tragic backgrounds. Again, not what you hope for your child to experience, but I had to find the silver lining in all of this. Maddie saw and experienced things that have made her mature beyond her years. She has gone through more in her 14 years than most will in a lifetime. This experience has made her strong, resilient, and more insightful than most adults my age. 

Helminths & Integrative Medicine

The anticipation of Maddie coming home had us filled with mixed emotions. While we were so happy and relieved to have her home, at the same time, we were terrified of what was to come. Would the starvation start all over again? We began to see an Integrative Medicine Pediatrician as soon as we could. She started her on supplements and told us about Helminths. She told us to read about it and think it over for a while. We knew we didn’t even need 5 minutes to decide. We were willing to try anything. We had severe PTSD and were terrified the starvation would start all over again. We started Maddie on Helminths 4 months ago and started to see improvement almost right away. It is the first treatment to date that has made a dent in her OCD and anxiety. She can function again. Depending on what she is exposed to, it can be very up and down, but there is a marked improvement. 

Today

Things are certainly nowhere near perfect, but we are so grateful when we pause and compare it to where we were two years ago. After being out of school for almost two years, Maddie returned to school and made the honor roll again. She is coming to the end of 8th grade and will graduate and go to high school. Something I never thought would be possible. We don’t know that life will ever be the same, but we have accepted the new normal. The new normal includes knowing things could fall apart at any moment—the new normal means constant medical attention. The new normal is being Maddie’s only real advocate. The new normal includes living minute-to-minute. Expect the worst and hope for the best. Always on guard, but we can finally breathe again. With the combination of Rituximab and Helminths, we have gotten our daughter back. A new version of who she was, but at least, we once again have hope for the potential of what she can become. This illness has been nothing short of a nightmare but has made us better people. It has taught us patience, compassion, understanding, and the will to fight. We will never stop fighting for our kids, ever. We are parents on a mission.