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Klonopin or prednisone? intense anxiety before tomorrow's school start?


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Hi all,

 

My DS16 has symptoms that are much worse in crowds, and he has definite cognitive deficits due to PANS, so he has been absolutely panicking about tomorrow's start of school. Last year he missed most of the school year, dropped down to one class and still did most on-line. Now that school is about to start, he's been out of it for so long he is catastrophizing....

 

Ativan and Klonopin -- not sure if they help at all:
I gave him 1.0 mg Ativan today and it helped very little. Tried Klonopin yesterday and it *maybe* helped a bit. Not much though. So I'm rather worried about getting him out of the car and onto campus tomorrow.

 

In addition to worrying about school itself, Kiddo is now also having intrusive thoughts that this stress itself will trigger a PANS flare. Which it has in the past -- possibly along with an illness -- but intense school-related stress has definitely been associated with flares last year.

 

We just finished a prednisone burst last week, after an illness-triggered PANS flare, so I know that prednisone helps him.

 

What do you think -- should I give a few days of 30-?? mg prednisone preventively, to forestall the release of cytokines or whatever happens when he spends a few days in fight-or-flight?

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I don't know how to help you or your son. But wanted to say my thoughts are with you as you navigate this horrendous journey. Surely there is a lesson for us all somewhere on this path. I'm still looking and learning after all these years.

 

I just cant imagine how difficult it must be for a teenager (my son is 15) to face these misunderstood debilitating symptoms. As if being a teenager were not difficult enough.

 

Good luck to your son tomorrow. That first step is indeed a giant leap!

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We went through this exact same thing a few years ago. I know how stressful this can be!!

 

What ultimately helped us was Lexapro (I know a lot of Pandas/Pans kids are not helped by this, but it was miraculous for us.) Sounds like he could use a CBT therapist (exposure therapy). It involves exposing oneself to the scary situation in manageable steps. Panic can come from feeling trapped. Ask the school to provide a safe room, like the nurse's office if he needs to regroup. I haven't had any experience with prednisone, but we use Advil and it helps somewhat.

 

You want him to feel the success of being able to go to school (even for an hour-even for a few minutes!). Praise him for the small steps. Then try for more the next day or every few days-the key is small steps. I am not a therapist, but this is what helped us. Get some professional help if you can. If you can't, look online for CBT/exposure therapy. Even though the root cause is not psychological, the CBT can help. I am sending you good thoughts. Let us know how it goes.

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Thank you both for the good thoughts. He made it into school, and participated for 2 hours. But it took his mentor teacher coming out to chat with him and thus get him out of the car. I hate to ask for that, but he had been curled up into a ball on the front seat, and wasn't going to get out on his own.

 

This morning I used the Klonpin and ... then also adding 30 mg prednisone as he felt he was getting a flare. He made it into school, is exhausted, and I hope proud of himself. I'll cross my fingers that he'll make it tomorrow, first day of academic classes, and the goal is 2-4 days / week.

 

As far as the other suggestions, I agree with all. And we are trying all that seem sensible, even if we don't have clear evidence that they're helping.

 

We already use:

  • NSAIDs
  • Neurontin
  • Mirtazapine (Remeron), a quadricyclic antidepressant
  • Trazodone 25mg every night (a very low dose, helps with onset insomnia)
  • antibiotics
  • Omega3s
  • colostrum / NK support

But yesterday as I added

  • melatonin - used when needed. Last night I gave 0.5 mg
  • Klonopin - to try to get him to take a shower. No go.

Any other suggestions?

 

I do agree with ERP, but last year I definitely pushed too hard and he was overwhelmed. The trouble is the "manageable steps" part. There's very little between (a) sitting in the car, cringing, outside the school and (B) going in with a teacher's support.... except © chatting with teacher for 5-15 min, but not going in. Which we have done sometimes when his anxiety was just too high. The school is amazing.

 

Our CBT therapist was away last week, visiting an ill parent. What I think I need to find is someone in the SF Bay Area who would get him over his anxiety about meditation and build his skills there. He gets intrusive thoughts when his brain is not focussed on distractions, but I think it would hep him to learn to focus.

 

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Good luck with your efforts. My 10 year old son has PANDAS with severe separation anxiety that interferes with his ability to go to school, among other things. Have you found a good CBT therapist in the Bay Area? We live in the East Bay.

 

All the best and good luck!
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I found these videos and articles to be really helpful in changing my perspective on fear

 

http://ct.counseling.org/2016/06/polyvagal-theory-practice/

 

plus youtube videos of Stephen Porges discussing polyvagal theory

 

and Paul Levine's Somatic Experience interview on how he uses the polyvagal theory to treat PTSD

 

https://www.youtube.com/watch?v=wDK09A49tRU

 

It's a way to understand the physical reactions the body has to stress and how to help it get "unstuck" . I'm also looking into using vagal transcutaneous electronic nerve stimulation (v-tens) to treat anxiety and depression triggered by vagus nerve hyperactivity.

http://www.psychcongress.com/article/transcutaneous-vns-shows-promise-depression-26548

https://www.sciencedaily.com/releases/2014/08/140819200211.htm

 

http://www.healthrising.org/blog/2014/08/29/system-reset-reduce-fight-flight-response/

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