momto2pandas
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Posts posted by momto2pandas
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Actually, we are working on a big comprehensive survey - will let you all know when it's out there. It's already drafted, actually, and may be implemented using a sophisticated platform commonly in use in the pharma industry. I want to follow HIPAA in implementation and get IRB approval, so that we can publish the results, if called for. There are a bunch of people (professionals) involved. I will post more as it becomes more developed.
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We are in this boat as well. My younger child has very low total IgG, abnormally low IgG3, and poor response to prevnar (1/7), so he has CVID. My older has low-normal total IgG, abnormally low IgG3, and poor response to prevnar (2/7). The younger has basically been sick with strep and other sinus infections since he was a baby. My older was reasonably healthy until last year, at which time he became continuously sick. Both are now on monthly IVIG, so we are very interested in this question.
Their first dose was 1.5 g/kg. We had some turning back of the pages for a couple of weeks, but then bingo, sinus infections apparently totally gone, and PANDAS pretty much 100% gone. We were supposed to get 0.75 g/kg 4 weeks later, but for administrative reasons, ended up getting it 8 weeks later, by which time we were beginning to see more sinus symptoms and PANDAS symptoms again - but really just a little. After the 0.75 g/kg dose the older child sailed along 100% great again; the younger was 98% great - but just shy of where he had been after the higher dose (bit of speech dysfluencies still). They get their next 0.75 dose tomorrow, and I am anxious. Just in the last 3 days or so we have begun to see some PANDAS moodiness again (no tics or OCD, just "touchiness") - noticeable but quite minor - and today ds4 was writing in mirror image again suddenly. I am hoping that it goes away again after the 0.75. We'll see. I have a suspicion based on the last couple of rounds that they are going to do great for the first 3 weeks between treatments, but then maybe start to slide just as we get ready for the next dose - since their levels will be very low again at that point. Their immunologist wants to move them to weekly subcutaneous IG to help keep things steadier. Not sure what to think about this, as it would essentially mean more lower doses. Seems like a good idea from an immune standpoint but I'm not sure about PANDAS.
Anyway, my guess just based on what we've seen so far is that we're probably a ways from being able to go off of IVIG - if only for reasons of immunocompetence. If their immune systems had truly been "rebooted" to a functional state, I don't think we would see this deterioration right before each new dose. Their immunologist wants to treat for a year and then see how they do.
He also told me that immune deficiency with poor prevnar response tends to have a developmental component and that kids often grow out of it. That's why he feels that we need to stop each year to see if their immune systems have developed the capacity to function on their own. He did say that by the 1 year timepoint kids are generally so much better that the parents really don't want to stop, but that it's important to give their bodies a chance to try to function on their own.
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Ah, ok. I see what you're saying - yes, if you are removing immunoglobulins and not replacing them, you would want to replace them before doing Remicade for sure.
It's also possible that with the Remicade you could do without the pheresis - Remicade should tighten up the BBB. After all, Remicade is used to treat autoimmune disease all the time without phereisis. If her Ig's are good, you might even just do Remicade and neither of the others and see how that goes.
Obviously big caveat - I am not an MD so obviously go with their advice over mine!
I see your point, Momto2Pandas. Since it would be plasmapheresis and not PEX I was thinking we would need to replace the antibodies and then use the remicade to eliminate the inflammation in the gut that may be making her more susceptible to further infection. I'll see what Ds. Buie and Latimer recommend. The colonoscopy/endoscopy is next week and our telephone consult with Dr. L is August 4 (hopefully!).Nancy
Between PEX, IVIG, and Remicade, I think you have redundancy; if she no longer has an immune deficiency or problematic infections, you would mostly be looking for the antiinflammatory effect of IVIG, and getting rid of the "bad" antibodies. PEX would get rid of the bad antibodies anyway, and Remicade would be probably a better antiinflammatory than would IVIG. If IVIG has not helped her gut issues, it seems to me that PEX followed by Remicade would make sense. I don't think you'd want to do the Remicade first, because it could be removed by PEX. Depends on how long before you do the PEX, I guess. If that's quite a ways out anyway, you'd could be getting ready for your next dose of Remicade by then in any case. -
Interesting you should mention this because two of my cousins who also had what looked like PANDAS as kids have had pancreatitis.
Sorry, in a rush today but just wanted to throw the possibilty of autoimmune pancreatitis into the mix.. symptoms can easily be mistaken (IMO) for GERD. I've been wondering if we have been dealing with the pain of this in exacerbations and consequently dealing with the fallout of low digetsive enzymes at all other times. -
Hate to say this but I'm guess you'll find that frequency is also tied to average level of education achieved - bet that would correlate on the map as well.
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No, it was not a private office but part of the UCLA medical center. I believe that that immunology practice also does rheumatology but I'm not 100% sure. I think you will need a rheumatologist (or GI specialist or dermatologist if she has those issues) if you are looking for treatment with the biologics at this point.
Here is Dr. Stiehm. We didn't see him but I was told that he was the main PANDAS doc. I think you could get Dr. McGhee at the same number.
http://www.uclahealth.org/body.cfm?id=479&...il&ref=3021
If you become really pressed to find a good pediatric rheumatologist, let me know and I'll do some networking. I worked in pediatric rheumatology for a while, before I knew anything about PANDAS. I can't think of anyone I knew in SoCal but I could probably track down a recommendation for a good one, though I doubt that my contacts would know their take on PANDAS.
I will be talking to Dr. McGhee next Wed and will try to remember to ask him who he knows as well.
For those of you in Southern Cal who have struggled to find local PANDAS treatment for your kids...Lo and behold, I mentioned PANDAS to Dr. McGee and he knew exactly what I was talking about, didn't even consider it controversial. They treat PANDAS there regularly. He agreed completely with Dr. B's IVIG dosing regime and although he wants to try a trial with them off of antibiotics soon (they have been clear of infections for quite a while now), he said that if there were any problems at all, he'd put them right back on.
And of course at UCLA, they participate in just about every insurance. They do the IVIG as part of a doctor visit, so for us, the fee is only $40 per kid per treatment - insurance picks up the rest.
We personally didn't know about it because past experiences (pre-pandas) at UCLA have been so horrible that my kids refuse to go back. Your news is good, though. The more physicians we have to help the better. I couldn't find Dr. McGhee on the UCLA physician list. Is he in a private office? Since we are talking about So. Cal doctors, does anyone know of a pandas friendly rheumatologist (preferably south of LA)? Or any other (pandas friendly) doctor who will prescribe immunosuppressants/ antiTNFs/ biologics (i.e. humira, cellcept, methotrexate). We are in much bigger than just pandas (unkown autoimmune) and may need to go that route to save my daughter's vision.
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Between PEX, IVIG, and Remicade, I think you have redundancy; if she no longer has an immune deficiency or problematic infections, you would mostly be looking for the antiinflammatory effect of IVIG, and getting rid of the "bad" antibodies. PEX would get rid of the bad antibodies anyway, and Remicade would be probably a better antiinflammatory than would IVIG. If IVIG has not helped her gut issues, it seems to me that PEX followed by Remicade would make sense. I don't think you'd want to do the Remicade first, because it could be removed by PEX. Depends on how long before you do the PEX, I guess. If that's quite a ways out anyway, you'd could be getting ready for your next dose of Remicade by then in any case.
GREAT feedback, Momto2pandas...thank you. I was hoping you would respond. I've seen some of your previous posts and know you have knowledge of these types of anti-inflammatories. Although DD14 has had chronic PANDAS over the years and often reacts to any kind of viral or bacterial infection (not just strep), she has been so much better since doing IVIG (almost 2 years now). Before starting the infusions her IGG levels were low but they are now on the high side. I don't know if I would still consider her condition "chronic" since doing IVIG. Her first remission lasted one year and she is 6 weeks into her second remission (or as close to remission as she has ever come). She still has anxiety and OCD comes and goes. Tics, rages, mood dysregulation, impulsivity, hyperactivity, and sleep problems are 100% gone.We do plan to do plasmapheresis as soon as Dr. L comes back and I would like to do another infusion 28 days after that. Question is...if after she is scoped our GI specialist recommends remicade do we start right away or wait until after the pheresis and IVIG? Of course, both GI specialist and Dr. L will be involved in this decision if they think we should proceed with remicade but would love to know your thoughts.
Nancy
If you do Remicade, PLEASE let me know your results. Remicade is a TNF-alpha inhibitor. I've worked a lot on such drugs in my profession, but not on Remicade per se. My prediction is that Remicade and related drugs should cause dramatic improvements in "PANDAS" but, though there is literature on these drugs helping depression, anxiety disorders, etc. in people with inflammatory disorders, and there is that OCD case report that I posted earlier here and my interpretation of it, so far I don't know specifically of people with PANDAS getting these drugs.One caution - it must be used with great caution in people with choric/recurrent infections, and though it's not routine, I would also make sure that she is not immunodeficient before giving it, given that many kids with PANDAS do seem to have poor immunity and this could in principle increase the risks associated with treatment. But if it were my kids and all of that stuff looked good, and they were still experiencing bad inflammatory symptoms of any type, I personally would give it a try. I have seen lives changed so amazingly with these drugs; they are like miracles for the right set of patients.
Even if such drugs are effective against PANDAS, I think they would not be often used given that many and maybe even most PANDAS kids do have underlying/recurrent infections and poor immunity. But I do wonder about their use in severe cases where underlying infections cannot be detected and where the immune system seems to be healthy - especially if conditions such as Crohn's, psoriasis, etc. are also present.
DD14 started with GI problems at 4 weeks. She was diagnosed with ASD at 2 years. First PANDAS episode can be traced back to 2.9 years with overnight onset of symptoms though I suspect she had strep before that. Colonoscopy/endoscopy at age 5 showed severe colitis. Our GI specialist thinks GI problems may have led to PANDAS. No longer on autism spectrum but she has severe PANDAS (in remission this time for only 1 month). We're going to scope again next week...almost 10 years later. Although we cleared up colitis with monthly glutathione IVs (she was GFCF for years and we have done chelation, anti-fungals, and supplements over the years but I am sure it was the glutathione IVs that cleared up the colitis), I'm sure we will find serious inflammation in gut after 7 years on antibiotics! GI specialist said he is seeing good results with Remicade. Anyone have experience with this anti-inflammatory?Nancy
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This appears to be the guideline for Canadian coverage of IVIG for PANDAS:
http://www.bloodmed.com/contentimage/guidelines/2854.pdf
If I were you, I would look up the authors, and figure out which one is the neuro person, or contact Heather Hume directly (her email address is on the paper). This is the group that made the recommendation that IVIG should be covered by the Canadian Health Ministry - hopefully at least one of them contributed to that recommendation and could direct you to someone who would implement it, or at the least, they obviously communicate with the ministry and could make a recommendation that Canada cover treatment administered in the US - my understanding is that this does happen in some cases (not necc for PANDAS but for other things).
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Very interesting map. Seems to me like the clusters may be driven by population density in combination with where the doctors are who recognize PANDAS...
Technically our little dot there in Southern Cal should be moved to Northern Cal (94549), for my older son. My younger started symptoms at 92352.
PANDAS Denmark looks so lonely over there! If I were an infectious disease person, I would note that the family over there at 92352 (us) travels frequently to Denmark, and that in 2006, one of us (me) was forced by her job to go over there sick, touching doorknobs and coughing all the way... I'm sure there is no relationship there, but it reminds me of those charts that were created in the early AIDS days, linking cases all over the world.
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Dr. B told us that our kids could go back to school the day after their IVIGs, and we have not restricted them at all in average-risk situations. He said that they would be protected by the IVIG and antibiotics. Needless to say, they have been around a bunch of sick kids in school, etc., though none with confirmed strep that I know of. They have been fine. We might have seen a bit of moodiness and a couple of tics for few hours when they've been around sick kids, but to me, the balance has been fine - I (and they) are willing to react a touch rarely in order to not feel too restricted. So if it were us in your case, I probably would also opt for staying elsewhere, using a lot of purell and limiting physical contact, and gathering outside - and hopefully having a great time. I know that may be an unconventional attitude here but it honestly is what we would do.
On the other hand, my kids get IVIG monthly now, and insurance pays for almost all of it. And their PANDAS has always been pretty mild. I do agree that the situation would be different if one had to pay out of pocket or travel, or if it was hoped to be a one-shot deal, or if one's child tended to react severely. In our case, we are never too far off from the next booster, and my kids' episodes have been more a pain in the @#$ than disabling.
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If you do Remicade, PLEASE let me know your results. Remicade is a TNF-alpha inhibitor. I've worked a lot on such drugs in my profession, but not on Remicade per se. My prediction is that Remicade and related drugs should cause dramatic improvements in "PANDAS" but, though there is literature on these drugs helping depression, anxiety disorders, etc. in people with inflammatory disorders, and there is that OCD case report that I posted earlier here and my interpretation of it, so far I don't know specifically of people with PANDAS getting these drugs.
One caution - it must be used with great caution in people with choric/recurrent infections, and though it's not routine, I would also make sure that she is not immunodeficient before giving it, given that many kids with PANDAS do seem to have poor immunity and this could in principle increase the risks associated with treatment. But if it were my kids and all of that stuff looked good, and they were still experiencing bad inflammatory symptoms of any type, I personally would give it a try. I have seen lives changed so amazingly with these drugs; they are like miracles for the right set of patients.
Even if such drugs are effective against PANDAS, I think they would not be often used given that many and maybe even most PANDAS kids do have underlying/recurrent infections and poor immunity. But I do wonder about their use in severe cases where underlying infections cannot be detected and where the immune system seems to be healthy - especially if conditions such as Crohn's, psoriasis, etc. are also present.
DD14 started with GI problems at 4 weeks. She was diagnosed with ASD at 2 years. First PANDAS episode can be traced back to 2.9 years with overnight onset of symptoms though I suspect she had strep before that. Colonoscopy/endoscopy at age 5 showed severe colitis. Our GI specialist thinks GI problems may have led to PANDAS. No longer on autism spectrum but she has severe PANDAS (in remission this time for only 1 month). We're going to scope again next week...almost 10 years later. Although we cleared up colitis with monthly glutathione IVs (she was GFCF for years and we have done chelation, anti-fungals, and supplements over the years but I am sure it was the glutathione IVs that cleared up the colitis), I'm sure we will find serious inflammation in gut after 7 years on antibiotics! GI specialist said he is seeing good results with Remicade. Anyone have experience with this anti-inflammatory?Nancy
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This is all so interesting. My ds6 has no trouble with this stuff - in fact, he was doing the 50-states puzzle and other hard things like that before he was 2. My ds4, however, still misses those simple cues like edges, etc - which I never understood. The interesting thing is that he DOES seem to be able to do a jigsaw puzzle that has A, B, C, etc in order - if the cues are print cues, he gets that. But a puzzle of animals or trucks is harder for him. He also has a harder time with handwriting than my ds6 did at this age.
It reminds me of 2 things about myself, too - one, I also lose things easily and get very stressed about finding them. When I look for something (usually my keys or sunglasses) that is not in sight, I get that same almost panicky/hopeless feeling that I get when I get lost while driving, like my brain just isn't going to help me out with the task.
The other thing is that I can't draw worth a darn - I can't even draw as well as a 5 or 6 year old. My handwriting is fine, but I cannot look at an image and figure out how to reproduce it. I can copy something like a chart just fine (pie chart, flag, etc.) - something with logical patterns that I can process "intellectually", but my pictures of animals, people, etc. are embarassing. It seems to have a parallel with my 4 yo's puzzle process. If the order of the alphabet ("pattern") helps him out, he can put all the pieces together, but as soon as it gets more purely shape-driven, it gets harder.
My 6 yo, in contrast, is an amazing artist, much better than I am - so obviously it's not univeral PANDAS.
On the other hand, my 6 yo canNOT follow a line of sight. If you point to something in the distance, he will look in completely a different direction. He cannot triangulate at all the direction of your figurepoint and your gaze, and what he then looks at. He also doesn't seem to be able to coordinate hearing and visual cues very well - he can't search effectively for a singing bird in a tree.
I also wonder if this has any relationship to coordination and athletic ability. One of the most striking things we noticed about steroid burst and then IVIG was that suddenly my 6 yo was getting the basketball into the basket almost every time, and my then-3 year old was catching a football almost every time (near range, but still - a real catch). This has been one of the starkest differences we've seen since starting treatment.
Come to think of it, we haven't tried puzzles etc. since IVIG - gotta give that a try.
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Are you trying to get at where PANDAS patients live now, or where they caught what gave them PANDAS? We live in LA area, but my family caught Strep while in Lafayette and that particular episode is what set it off.
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C3D is complement. Inflammatory cytokines include interleukins (e.g. IL-1, IL-6) and TNF-alpha. You can find loads of references about inflammatory cytokines and depression, anxiety, etc. by googling. Below are a couple that came to the top of my google search just now. It is my thesis that in PANDAS, we have excessive upregulation of proinflammatory cytokines in response to immune challenges, and insufficient downregulation by antiinflammatory cytokines. I have a very long "rap" on this topic that I'll spare you.
http://www.psy.cmu.edu/~scohen/healthpsych%202002.pdf
http://www.sciencedirect.com/science?_ob=A...c59876ba90c9914
http://www.jad-journal.com/article/S0165-0...0091-2/abstract
In addition to their own (thought to be) direct effects on the brain, their mucking about with the endocrine system, and their upregulation of antibody responses, they also increase the permeability of the BBB, hence a quadruple-whammy for PANDAS during infections.
Inflammatory cytokines are not generally measured clinically - I don't even think that the tests are commercially available, at least they weren't a few years ago. Ibuprofen and steroids downregulate inflammatory cytokines, as do high EPA omega-3 fatty acids and SAM-e.
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I had similar results when I was a kid. I had IQ and other cognitive testing done twice, both during my anorexia years. Everything came out very high except for the spatial scores, which came out below average. The difference was so striking that the testing team told me that I must have brain damage of some sort - some major insult to the tissue. They said that absent that, the kind of disparaties I had would not be normal.
I still feel that way with some spatial things. I have the world's worst sense of direction - get lost constantly, and every time I park my car in a big parking lot, I'm sure that I will never be able to find my way back to it. I get spatially disoriented very easily. I cannot remember how to get from point A to point B (driving), even if I've done it a lot of times. I have to call my husband frequently when I'm out and about to get directed properly.
I haven't noticed those problems in my kids; in fact, my 6 y.o. often reminds me how to get places when I get disoriented (backseat driver!). With my 4 y.o., it may be too early to tell.
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Don't know. Keep in mind that my kids' PANDAS is "classic" - sudden onset, classic symptoms (albeit mild), associated with Strep, responds to abx and steroids, context of immune deficiency and other autoimmune conditions, etc. - so they have the least controversial kind of PANDAS. We didn't talk about Mycoplasma or anything like that, so I don't know their take on that. Still, I thought the info was useful. For us, it would have been very useful to have known about this group 2 years ago.
I thought Mama2alex went to UC Irvine and was disappointed, no? Was it UCLA?
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I haven't read this whole thread (running out to see Eclipse!) but also don't forget that there is more to autoimmune disease than misdirected autoantibodies/molecular mimicry. Inflammatory cytokines, which can be influenced by things other than infections, also create their own set of psych symptoms. Just to give one example.
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http://psy.psychiatryonline.org/cgi/content/full/50/4/425
I can explain it more if you like. When the child's Crohns stopped responding to infliximab, presumably because of neutralizing antibodies, he soon after also had a flare of OCD -- as the adalimumab started working, the OCD also got back under control. They interpreted it differently in this report, but I've worked with these drugs for a while and this was my interpretation... I could be wrong.
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No updates. I got overwhelmed with work in the spring but am getting back to PANDAS now - have reserved a bunch of time this summer to try to make progress on such leads.
Re. Canada, I also thought it was interesting that it's covered there. Countries with nationalized health care typically follow "treatment guidelines" put together by experts based on literature review, and they don't have to follow what's e.g. FDA approved or "on the books" or whatnot. Obviously there must be experts that Canada drew upon who are believers and who considered the research that was out there and the fact that antibiotics and psych meds don't work for everyone. I recently heard that Denmark also pays for even CamKinase etc. testing for citizens with suspected PANDAS, and that's also considered experimental at this point.
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For those of you in Southern Cal who have struggled to find local PANDAS treatment for your kids...
We tried to call UCLA a while back to find someone with expertise in PANDAS, and failed - I think that the people at the desk must not have known what we were talking about, or somehow we must have gotten the wrong department. Today, for (long story) insurance reasons, we went to the pediatric immunology department there to see an immunologist about my kids' immune deficiencies. I was prepared to have to make arguments about why they get higher than usual doses of IVIG, why they're still on antibiotics, explain how treatment for immune deficiencies intersects with treatment for PANDAS, etc. - and I was not looking forward to it.
Lo and behold, I mentioned PANDAS to Dr. McGee and he knew exactly what I was talking about, didn't even consider it controversial. They treat PANDAS there regularly. He agreed completely with Dr. B's IVIG dosing regime and although he wants to try a trial with them off of antibiotics soon (they have been clear of infections for quite a while now), he said that if there were any problems at all, he'd put them right back on.
I asked if they treated PANDAS in patients withOUT immune deficiencies, or if they only saw it as a feature of some of their immunodeficient patients. He said that Dr. Steam (sp?) there has a lot of PANDAS patients without immunodeficiencies. He generally starts treatment with antibiotics, but he believes that Dr. Steam also gives IVIG for PANDAS in some cases, even without immunodeficiency.
And of course at UCLA, they participate in just about every insurance. They do the IVIG as part of a doctor visit, so for us, the fee is only $40 per kid per treatment - insurance picks up the rest.
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It is probably the rule, more than the exception, to see multiple autoimmune conditions in one person. They need not all be infection triggered, but many of them can be.
There is a very interesting case study about treatment for Crohn's resulting in complete remission of OCD, in fact.
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Have you had your thyroid hormones checked lately? The interplay between thyroid hormones and the immune system is complex.
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I just wanted to mention that I had the same exact thing a number of times in the past with arthralgias and everything starting when I was a young lady. My SED rate was checked many times, and was always normal, to everyone's surprise. However, eventually, like I said I think for the first time at around age 30, my heart issues did develop into mitral valve prolapse, and by early 40's I had additional cardiac issues (was checked many times before this without those issues). Based on my family history (which also includes a lot of RF), I do think that there is a relationship of PANDAS to heart issues for us, but it seems to be very slow moving and relatively benign. Many of us have mitral valve prolapse, but other than some occasional pain, it is inconsequential. And the other blockages due to inflammation appear to have been very slow moving even without treatment. I do have an aunt, an uncle, and a grandmother who all needed bypasses, but they were in their 70's-80's by the time that happened and with poor diets/exercise/overweight (in 2 cases)/postmenopausal, and they all recovered. Other relatives who keep themselves in better shape have not needed cardiac treatment. My grandmother finally did die of heart disease at age 88.
Recall, also, that neither I nor my adult relatives were ever treated as kids, so this may be worst case. Also, at least judging by me and my kids, we have very high CamKinase levels (182, 187, and 199). So if I had to guess, I would guess that my family's history would probably be on the worse end of the PANDAS spectrum.
There is a widely published link between anxiety disorders (particularly panic disorder) and mitral valve prolapse in adults, and of course also between RF and MVP. But I don't recall ever having seen anything about heart conditions already becoming apparent in childhood anxiety.
I'm reading this thread with extreme interest. My daughter has had a very rheumatic fever like illness along with her PANDAS symptoms,3 different times. She developed a heart murmur and had palpatations and chest pain (among many many other symptoms that were RF like.) None of the doctors around here would listen to me, and I self referred her to a cardiologist here (a very RUDE, condescending cardiologist.) Her echo was normal. She also had a normal SED rate, and her pediatrician felt that if it had been rheumatic fever her SED rate would have been elevated. But in every way, the illness mirrored rheumatic fever. She was ill for months each time, and barely unable to be on her feet more than minutes at at time. The rheumatologist she has now called it post strep arthralgias, but it was so much more than that. I do sometimes worry about her heart, and wonder if it should be monitored more closely. We are just now getting some appointments for her PANDAS, so I'm going to bring up the heart issues when we go.Pam
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By the way, the insurance did NOT consider my heart "disease" to be sufficient reason to approve IVIG. They denied every possible appeal.
Anonymous Survey Monkey
in PANS / PANDAS (Lyme included)
Posted
Re. HIPAA, my understanding (and I'm not exactly an expert, so take it with a grain of salt) is that you can collect whatever you want with proper consent, but what you can do with it - in particular, sharing it - will depend on whether it was collected in a HIPAA-compliant manner. For example, my understanding is that the experts will not read Diana Pohlman's collection of cases because it would violate HIPAA rules for them to be shared (don't quote me on this). That is why we are trying to develop a sophisticated, HIPAA-compliant method for organizing and analyzing all of the self-reported information that I'm sure we can get. We've actually gotten pretty far!
In the mean-time, Buster, if you do want any help analyzing anything you're collecting, I've been analyzing survey data for 6 years so could probably help. I also have the statistical software to do anything - as long as I could get data in Excel.