Conversion Disorder

[Kiera]

First let me say, converting mental stress into physical symptoms is real, I have seen it. I have been a nurse for 20+ years and currently work in a trauma ICU and have seen ONE case of CD (psycogenic we called it). This was the case of a teenage boy involved in a motor vechicle accident, in which his friend, the driver, was killed before his eyes! The kid could not move his legs, despite me inflicting considerable pain pressing on his toenails (which normally would elicit an automatic withdrawl). He was awake, alert and seemed totally normal, except he couldn't move his legs! He was in shock, having just gone through a traumatic event, and his brain had a protective response by causing the paralysis, kinda like kids with prolonged abuse can develop multiple personalities as a way of coping! This resolved within a day or two, when he had sufficient time to process what just happened and realised he was going to be OK!

 

Secondly, one of my other jobs was performing Tilt Table Tests to test people for a benign fainting disorder. We would have them come in fasting, attach to monitors, strap to table tilted upright and watch. We could see their heart rate speed up due to the stress of everything, the BP would drop, then the heart secretes chemicals to slow the heart rate and the patient would lose consciousness due to low heart rate and low BP. They would always shake briefly prior to this, kinda like the "pseudo-seizures" of the LaRoy girls. This is the mechanism by which people faint with the sight of blood, shots etc, there is a physiological mechanism induced by stress that results in a faint!

 

HOWEVER :

 

Having said all that, there's one glaring problem with the LaRoy girls diagnosis of CD. All the precedents for CD or mass psycogenic illness that have been put forth, have been examples of the body shutting down, body parts not working - eyes not seeing, legs not moving, passing out (from low BP). The cases of nausea/vomiting etc can be explained by the parasympathetic system inducing this due to stress (like jitters before performing). I have yet to see an example of CD causing the opposite, activation of the body - increase in motor activity, ie tics! Is there any precedent, anywhere, for CD causing tics, especially such violent ones?? If not, these experts are jumping the gun way to fast, with nothing to base it on!

 

And Dr McV stated on the webcast how these girls tics got worse when she was looking directly at them and slowed down or stopped when she looked away, well yes, it is well known how stress increases tics (adrenalin surge). You can imagine a self conscious teen getting stressed, even momentarily, when the Dr directly questions or looks at her, then relaxes briefly when the attention is averted to her parents or eleswhere. Still doesn't explain the underlying presence of a tic dirorder, which now just varies hourly and daily, depending on the stress responses that are coming and going.

 

Glad I got that off my chest!

[MomWithOCDSon]

Kiera --

 

What do you think accounts, then, for the "piling on" of other docs, even ones who seemingly accept PANDAS as a viable diagnosis in some cases, with the Dr. CD's and Dr. Minion's "diagnoses"? I'm thinking, in particular, of Seigel.

 

I mean, if you, as a nurse, have seen GENUINE cases of CD (the one you described sounded very similar to the one Dr. Jenikie described on the Anderson Cooper Show . . . same kid?), then surely some other doctors have seen GENUINE cases themselves and, like you, can clearly distinguish the difference between those and these LeRoy girls?

 

Is this like the police force, circling the wagons around the corrupt cop, just because they don't want one of their own held accountable for misjudgements or crimes?

 

If so, seems to me there's a higher standard to be met here . . . something called the Hippocratic Oath, perhaps?!?!

 

Incredibly frustrating. I guess, like someone else said on an earlier thread, we're just going to have to trust that these girls' families are willing to take the potentially long slog through all the possible underlying issues and get REAL help for their kids. Not much else we can do. Although I do think our posts here are finding their way to many a Google search for "LeRoy," "PANDAS," etc., and that ain't all bad!

[Kiera]

Dr Jenikie's patient was an adult male, in a wheel chair for 1 1/2 years!! He did not go into specifics as to whether or not it was preceded by a severe trauma. All he said was he had OCD severe enough to paralyse him. Now, as to what caused the OCD - Pandas, or garden variety OCD, who knows. The kid I was referring to, resolved within DAYS, and occurred immediately post severe trauma.

As regards Dr Seigel, don't be too quick to throw him under the bus. He was indeed one of the 1st Drs on TV to mention Pandas when the story 1st broke. I think he does indeed believe in Pandas but I just think he doesn't have as deep a knowledge about it as the Drs in the trenches who are actually treating it. I think he has a peripheral understanding (still more than most) I think he's seen both - CD and Pandas, and the problem comes in discerning which of these girls has which. I think he feels some genuinely have pandas and some CD as a result of the pandas cases. He's trying to walk the tightrope so both Drs may be right in some cases. Afterall, I don't think Dr S. has examined any of the girls himself, and even if he did, he's not a pandas expert so would not know entirely, how to rule that in or out.

I still have the problem with a psycogenic response resulting in such a severe motor problem.

But, you are right. Anderson Cooper said he's never heard of Pandas, like most of America. But after LeRoy, I think alot of people will now say "oh yah, Pandas, I've heard of that" even though they don't know what it is, so that can only be good, regardless of the LeRoy outcome!

[trggirl]

Kiera, you hit on what my problem with all this is. What is the mechanism of what is going on if it is conversion disorder? Everything in the body has a mechanism. Depression, panic attacks, muscle movement, constriction or dilation of veins, fainting, breathing, blood sugars. There is a mechanism going on in the body for everything. Just go pick up any pharmacy book and you can read about the mechanism of how a particular body process is working and how a drug will help that process. While we obviously don't know how everything in the body works, I can promise you there is a mechanism.

 

These doctors are saying "conversion disorder", but they can't tell us anything about it. If they could do that, I might be willing to listen. But they can't because they don't know. And I can't accept that. And I don't think any parent that has a suffering child should accept that. We should be searching and looking and not leaving any stone unturned. I think it is a cop-out for the doctors. Why is it so hard for them to simply say "I don't know". Then we could all move forward in saying "I don't know, but lets dig for answers".

 

Sorry for the rant. I'm just so upset with the LeRoy situation.

[EAMom]

Thank you Kierra!

 

I just wanted to add that in the almost hour long interview with the Dent docs, it came out that Dent sees/diagnoses CD on a daily basis. Doesn't anybody else see something weird with that? I mean, Colleenrn said she works at a pscyh. hosp. and NEVER saw CD. What is wrong with this picture?

 

Yes...trggirl...

that is what I want to know, what is the pathophysiology of CD? Is there any? Is there any science behind it? Or is there a magic fairy that "converts" stress into "real physical symptoms". PANDAS has molecular mimicry. What science does CD have behind it?

Edited February 10, 2012 by EAMom

[EAMom]

I just want to add that there is something called "fibrocartilaginous embolism". I don't believe there is any "test" for it. (Diagnosis is only post-mortum--so you can't "see" it on an x-ray, or even an MRI.) Here's a blurb on it.

 

http://www.ncbi.nlm.nih.gov/pubmed/20825469

 

The reason I thought of it was b/c many years ago, I knew someone who had a dog with it. The dog became acutely paralyzed by this, but eventually, many weeks later, regained the ability to walk, and was then completely normal. X-rays were normal. It is not a painful condition and one thing that helped the vet diagnose it was b/c it is supposed to be more common in mini schnauzers (which this was). (Oh, and also vets never diagnose conversion disorder!!)

 

So, I wonder how many of these cases of "Conversion Disorder" where the patient can't walk are actually something "real" (like Fibrocartilaginous Embolism). How would the DENT docs (according to one article, 15% of the cases diagnosed there are C.D....say what?) know that someone that that suddenly couldn't walk have FCE and not CD?

[PowPow]

We actually had an elderly family member who become unable to walk suddenly and was diagnosed with conversion disorder. It was heartbreaking, as several family members who did not "understand" really felt as if the family member was manipulating or just depressed or lazy. The family member became wheelchair bound and never again walked. The elderly family member not only lost the ability to ambulate, but had to endure, at times, uncaring treatment from doctor and family members who thought it was "all in her head".

I am sure there manipulators who would create a symptom for their own purposes, but when symptoms are REAL, it is because something REAL is causing them. DUH.