911RN

Chicken pox usually occur on warm parts of body first- axilla, inner thighs etc, however, they usually do pop out randomly on different parts. Not all in one spot. They are not usually flat--usually have a small papular rise to them. The best description is a "dewdrop on a rose leaf." Get moist then crusty over course of time/illness. Teardrop shaped. HTH.

Why not a chest xray for Pneumonia? That is the gold standard for diagnosis and resolution?

So, after all this....was there any suggestion on how to HELP your child?? If this is the 3rd Psych with no diagnosis...do they have any suggestions or meds to suggest that will improve all these symptoms. Diet is great but doesn't sound like it should be the only answer or end all, be all for symptoms. Has he been on any psych meds? This is thoroughly frustrating for you...I know!! I have been there, done that for 9 years. My kid NEVER fit in any definable box. Every doc that has ever seen him has said the same thing weather it was Peds, Neuro, Psych or NeuroPsych. Every teacher that has ever had him has told me they have never met another child like him. I got to where I told docs--I don't want you to diagnose him-- I already have.He has Purple Polka Dotted Flying Elephant Disease. (PPDFED). It's one of a kind, nobody has ever seen it and nobody knows how to treat it. I told them this diagnosis was just as right as anything they could give me or as right as all the conflicting diagnosis I had rec'd over the years from multiple specialists. I want you to suggest how we can "TREAT" him to make some of this better. I got to where treating just a symptom was OK- let's not try to call it a disease or condition to treat. Lets work on depression or let's look at the OCD behavior or the anxiety and just try to tackle one symptoms at a time. Docs got my point and started working with me and not against me... for a better boy. Not perfect, but better and manageable. Not saying you have to do this but this is the tactic I arrived at and it worked better for us. Lamictal helped my son with anxiety. He, too, once ripped all the skin from his toes and soles. Chewed all the skin off his hands. Prozac worked then switched to Zoloft (helped with depression and OCD behavior). We have never needed more prescription medication than that. Not sure if this is helpful...feel your pain.

Your kids sound like mine--they act sorta goofy like they can't read or see. Fake running into walls and stuff etc. Glad it went well:)

I am sorry you are going through this...here is something you may find helpful: These are "The Four Agreements" by Don Miquel Ruiz: The Four Agreements are: 1. Be Impeccable with your Word: Speak with integrity. Say only what you mean. Avoid using the Word to speak against yourself or to gossip about others. Use the power of your Word in the direction of truth and love. 2. Don’t Take Anything Personally Nothing others do is because of you. What others say and do is a projection of their own reality, their own dream. When you are immune to the opinions and actions of others, you won’t be the victim of needless suffering. 3. Don’t Make Assumptions Find the courage to ask questions and to express what you really want. Communicate with others as clearly as you can to avoid misunderstandings, sadness and drama. With just this one agreement, you can completely transform your life. 4. Always Do Your Best Your best is going to change from moment to moment; it will be different when you are healthy as opposed to sick. Under any circumstance, simply do your best, and you will avoid self-judgment, self-abuse, and regret. In other words.... 1. Do what it says 2. Your father leaving has nothing to do with you 3. Reach out to your brother--perhaps, he does not really know how much you need his support--even from long distance in Alaska. 4. Do what is says...under sick or healthy circumstances. Perhaps, you can take your love of dogs and volunteer at animal shelter or veterinary office?? Transform this into a way to get out of the house...with potential job opportunity in the future. Volunteer for Special Olympics event in your area...somehow get involved with Autistic children. Parents of this group often have caregiver stress and fatigue. Are over burdened with responsibilities. Often, have NO extra support, baby sitters etc. Perhaps, you could find employment to sit for autistic children and this will allow you some outlet for music therapy with this special group of children. Volunteer work can often lead to gainful employment if you have a special interest in a particular area. Both of these interests are under served by the general population. I.E animal shelters and services for special needs children. Hugs to you!

Chemar, you are correct- my son is not TS...more post infectious encephalitis/PANDAS.

I take my children every 2 years to Peds Ophthalmologist and yes, h dilates their eyes every time. To look at retina. Can't see it without pupil dilation. The drops usually wear off after a few hours. Wear sunglasses and it helps when outside. My children have been able to read and do homework later in the evening even with late afternoon appts. (1-3pm-ish). I have not ever noticed any increase in tics afterwards but I suppose everyone is different. I had mine done in the last 2 years and it wasn't that bad. Effects did not last that long...few hours then I was back to normal. I was able to drive home OK, also. Many doctors make you have a driver--mine did not?? Anyway, I prepare my children for the effects and they have always seemed to tolerate well. I think they even have a little fun with it until it wears off.

My son does the same thing...has since about age 4 and he is 13. Same exact content as your son--eerie deja' vu when I read your post because I could have written the same beginning paragraph. If Metadate is Ritalin based--I can only say it will make this behavior worse. Wish I had some answers but just wanted to know I feel your pain. Our neurologist believes self talk is more of a compulsive tic than echolalia or palalia. My son, too, is able to "suppress" it for awhile and be quiet when asked but then like any tic--comes back. Can drive me crazy in some days--especially in public and it can have some impact in the classroom also. can be distracting to other students.

How can tests come back normal if you are clearly seeing blood? They are not picking up blood (RBC's) on urinalysis? That would be most unusual. Frank hematuria is not difficult to see. Hard to believe urine would not be positive for blood, at very least? This is not a normal finding in a child. Glad doc is doing additional tests.

Can have a couple of conditions that cause blood in urine that are not UTI related or kidney stones: 1. Benign Familial Hematuria- not usually of any concern- macroscopic/microscopic blood in urine. Runs in families. 2. IgA Nephropathy- this can be a sequelae of Strep. My older Non PANDAS son has had it from about age 6 after Strep infection. IgA antibodies normally live in the throat--after Strep- goes screwy and goes to kidneys. The antibodies attack the kidneys. The main concern is not the blood, itself, but protein in the urine. Protein is a large molecule and difficult for kidneys to pass. Can cause long term kidney damage if too much protein. Sorta like PANDAS theory of antibodies attacking basal ganglia. Anyway, with any type of illness, fever, dehydration---it is common for kids with IgA Nephropathy to have visible and/or microscopic blood in urine. My son was followed by Pediatric Nephrologist for 6 years (not Urologist). This is a kidney disease not a urine condition. He is 16 now with no adverse effects from disease thus far. He will be at higher risk to develop hypertension due to this history and should be treated with ACE inhibitors if he ever develops HTN. His protein levels were never in danger level. His kidney US etc were all normal---that is not useful test for his disease. They will usually do a 24 hour urine and then follow with simple urinalysis to look for protein levels on regular basis. Very non invasive testing and monitoring for this condition. I would collect specimen that has frank hematuria and take to Peds or nephrology. This should not be ignored without confirmative diagnosis. Blood in urine is not normal unless you have Benign Familial Hematuria. Hope this helps!

My son had T&A at age 5.5 and he never required anything for pain. We were given Rx for Lortab elixir--he didn't like the taste. Think I may have given him Tylenol once or twice after he was home. He just never seemed to have any pain, complained and denied when asked if his throat hurt. So, I don't think you have to dread it. May come through it rather pain free?? The anesthesia used for these procedures is very short acting. I don't think you need to be worried about long term effects with central apnea.

My son sees Neurology...he is not a complete naysayer on PANDAS, however, doc is just not sure how it should be treated correctly for resolution or improvement. MD was actually not against long term management with antibiotics and had actually done this before. However, his experience has been that the effects wane after about 6 months. My son was on high dose Azithromycin daily for 90 days (prescribed by peds not neuro) which arrested his symptoms from an almost choreic state to a more normal state but then he seemed to creep back to a more normal baseline (still has some tics and OCD behavior). The Neuro was not really against this but had just had limited success in changing or turning kids around with antibiotics alone. I respect his stance and he respects mine although we often agree to disagree on "these kids." There is just not enough evidence based research on the gold standard for treatments for PANDAS for docs to give them guidelines on how to treat and prescribe. Remember, they can lose their licenses for practicing "bad", faulty or what may be deemed malpractice. This is low bar- "what a reasonably prudent peer person would do" in similar circumstance. That is why there are few docs willing to go out on a limb for this diagnosis. There's no real practice guidelines accepted across the board.

It is very unusual for allergist to recommend allergy shots with only one positive allergen. Dust mite proof bedding and wet dusting weekly may be all you need to do??? I have very allergen prone family. The bedding and dusting made a BIIIIG difference for our family. Also removing carpet from room(s)-- (if possible) and put down laminate or similar wood flooring will help. Use area rugs that can be washed.

Ditto what Hopeny said. Pediatric cardiologist is warranted and ASAP. Cyanosis in a child is not normal, especially transient cyanosis. Things can be wrong that listening to a heart with a stethoscope will not pick up. Listening to heart sounds is the most basic, non invasive modality- tells you only if heart beat is regular/irregular and if heart sounds are normal. If no murmur then one "assumes" valves are OK. THAT's it!! It is not a diagnostic tool to say that heart is fine with no worries. She needs full scale cardiology work up with EKG, Echo and maybe even stress test?? Keep us posted!

Nancy, Soo happy for you, DS 16 and your family! My oldest is driving this summer- his little PANDAS brother (now 13) is anxious to follow in his foot steps! Hope he can succeed in the driving arena one day, as well.

Thanks for this tip...I'll look it up. See if it fits. I used to supplement with 3-6-9 Omegas then switched to just the 3's because I read something negative about the 6 and 9 for his status---can't even remember what it was now. To do with ticcing or OCD or something. How much zinc, P-5-P, and ESO do you use?

My son did not seem to tic any more or less on NAC but he had definite newly formed anger control issues. We only used it for short time and stopped- anger went away with stopping medication. Interestingly, my son has had this same vocal tic all summer-- a grunting throaty tic followed by a puffing sound with lips. This is about the only vocal he has had, little to no motor. It has been repetitive, relentless and drives me crazy although he is sooo totally unaware of doing it. I ran out of Fish OIl- use Omega 3 only and noticed this vocal tic went away. Did not replace fish oil in pill keeper this week and we are going on nearly 1 week to 10 days with no tic. Hhhmmm... I'm keeping him away from the Fish oil and see what happens.

Bug bites typically don't itch- they hurt! The are normally pretty good size---not like a mosquito bite. Get "welt-like" and red. I have seen them on several folks coming to ER. If it looks like photos of similar on internet as you said- you can google the photos- I would be concerned. Make sure you did not bring them home in your luggage. Look on sides of mattresses for evidence of bed bugs, look between mattress and box springs for bugs.

Thanks for this link...checked all manufacturers of our medications- we are good, thankfully. Seems like this goes back to 2004!!!

The tuberculin skin test is to test for exposure to TB- it is to see if one has had unknown exposure to TB. You can be "exposed" by someone coughing in a grocery store line. Does not mean you have TB as a disease. One gets the skin test then waits 48 hours and it is "read" for results. It is deemed positive-meaning you have been 'exposed' to TB if there is redness and induration- usually 10 mm or more. Induration is a hard, swollen red area. Hard to miss once you have seen a "positive" TB skin test. If a skin test come back positive then you never receive skin test for TB again- will always be positive. Usually they follow positive skin test with chest xray to see if there is any evidence of TB as a disease. If not, then there is usually no worry. Over half of health care workers will sero- convert to TB positive skin tests although they never have evidence of TB as a disease. TB is not a disease we are immunized against- in other words, you would want a lack thereof response. It does not sound as if the TB skin test on your child was positive. Your description sounded negative to me. I have never seen the Candida or diptheria/tetanus 'skin test' done so I am not able to speak to that. These are typically read by nurses or MD's- I am surprised they would allow you to interpret it yourself and not come back to have it checked. Health care workers get TB tested every year. Our hospital is so strict- if you do not have it read and signed within the 48-72 hour window (by another nurse) as designated on the form then they make us repeat it.

Bactrim is a good choice-tolerated well by children. I would go with medications by mouth before IV (if possible). As would most MD's- they will exhaust sensitivity for meds by mouth before going to IV. Yes, Gentamycin can have ototoxicity which may cause hearing problems. Usually dose related, length of treatment related. Longer you are on it and if higher dose- more risk.

The culture is the way to go..Impetigo can be Staph or Strep. Get a culture and sensitivity and that way you know that whatever you are treating with is going to be the right drug for the right bug.

Is he allergic to Penicillin? If not, I would suggest a one time Bicillin injection. I believe this is one of the most under utilized methods to treat Strep avoiding use of oral antibiotics.

Our ER docs do not prescribe Cipro to children at all. It is not indicated for children under 17 except in extreme cases when that is only antibiotic that will work as proven by culture sensitivity or particular disease process. I don't think of it as a horrible drug having had to take it myself numerous times. I found it to be very easy to tolerate although, I was adult taking it. However, It is not recommended for children.

Sorry, I am late to this thread. However, I am wondering why he has been weaned from Prozac to begin with? Was there a particular reason? Would it be wise to try another SSRI if he is clearly this much distress? Was he better on Prozac?