i am new...any help?

[1koolteacher]

hi i am new here and i was reading some posts....any help/advice would be greatly appreciated! thanks so much!!

 

my daughter started last nov to have a stomach tic/twitch/spasm. it has been called many things but the neurologists mostly call it a tic. no medication was given because it was not affecting anything. eeg was done at this time to be sure. it came back fine. we have no other tics, OCD, ADD, mental illness in our family. now she did have a high blood test strep that i was supposed to get repeated however it got overlooked for a few reasons. first it was the holidays, my daughter had not had strep so i am thinking why would her test be high, she wasn't complaining of anything. now i look back and i realize i really should have gotten the blood test repeated. ok so you are thinking what a horrible mother i am at this point? well about feb, she started to complain of stomach ache, still had tic and had lost about 27 pounds (again what a horrible mother i am for not realizing sooner:( )

so her ped doc sent us to the er of a local children's hospital, they did a ton of tests, everything came back fine. we also had pscyh consult to check for eating disorder. told us to follow up with a nutristionist and a gastro doc. so within a week and me being very persistant, we were in to see the gastro and they did gastro work up and again everything came back fine. however, they said she was malnourished, so she was admitted for about 9 days and tube fed. neuro docs still said tic but that it shouldn't effect her stomach. so since march, i have had to make her eat or she probably wouldn't eat enough. she says her stomach hurts all the time and more when she eats. she got really depressed/angry so we went to psych route again and they have her prozac and that has really helped her mood. i worry about the side effects. they also have her on reglan wich is supposed tohelp with food emptying her stomach (again side effects!) one psych said the reglan can help with tics but so far it has not and when we go back to the docs i am going to mention taking her off ( i have asked about it before and they say it is fine for her to be on). she also gets headaches, dizzy, tired easy, conspitated but i really think that is because she is not eating enough.

we are going this monday to get the blood test repeated and the reason i have not sooner is because i really thought the hospital would have done that test since they told me there is nothing else to test her for, she just needs to eat and she will feel better, however i realized when i got her records that the blood test of strep had not been done, also my daughter is sooo sick of hospitals, docs, she thinks they don't know what they are doing.

so other than getting that blood test repeated, does anyoen have any ideas for me?? i read on other posts that the strep blood test can cause the tics, right?

[bmom]

Do you know why she is not eating? Is it because her stomach hurts? I am asking because you have referred to PANDAS- which is strep related tics. In some PANDAS children, anorexia has been noted as well. You can look on www.webpediatrics.com which talks about PANDAS some and mentions the anorexia connection. I have talked to a person who is involved in a PANDAS case where the child would not eat. I believe in that situation, the child had a fear of choking. It did not come out until later that it was the problem. I have read a few other cases where in PANDAS the children developed anorexia nervosa as well. Since the titers are high, and your doctor must have some knowledge as he at least knew to run the blood test, would he be willing to do a prescription for azithromycin? The girls case that I referred to went through many medications and was admitted to the hospital because she would not eat as well. On day 5 of the azithromycin, she started eating. It did take 5 weeks on it before her tics went away, but at least she was eating. She did a long preventative dose. She went through Pen V and Amox. and none helped. Day 5 of Azithro. and she was much better. I would look at the PANDAS connection first as she has both the anorexia symptoms, high titers, and tics. If it is that she is not eating because her stomach really hurts, maybe digestive enzymes would help. Or look at food allergy testing. Is she old enough that you could really talk to her about why she is not eating? Would she tell you the truth if it was a fear of choking or psychological? That might help which direction to go. Just some ideas which I hope it helps.

[CSP]

Welcome, 1KT

 

You did not say how old she is? Is she a young girl or a soon to be/teen? Just wondering why the eating disorder was mentioned.

 

You could start with a spoonful of organic coconut oil for the constipation.

 

We would never think you were a bad mother, we fight off everyday our own thoughts of not measuring up.

 

I'm not a PANDAS mom but do how you fine answers here.

 

Good Luck,

CP

[1koolteacher]

thank you so much for your replies...i really appreciate it! also thanks for the website, i did check it out.

 

oppps i forget her age...she is 11 so she is still a little girl in some ways but she also was starting to go through puberty when all of this started. i think that is why the whole eating disorder is important and a very real possiblilty except for the fact that she claims she wants to eat, is not worried about being "fat" and gain weight.

 

and of course, the stomach tic is another part of the question. i did read on here somewhere about someone reported seeing their child finger sniffing...i did not even think of that as sign but after thinking back, i think i remember my daughter sniffing her fingers as one of the very first odd thing i noticed maybe even before the stomach started to twitch. she simply puts her first two fingers to her nose and when i have asked her about it, she just kind of shrugs her shoulders and says i don't know why i do it.

 

she claims she wants to eat but doesn't because her stomach hurts and hurts more when she eats. it doen'st matter whether she drinks water, eats ice cream, pizza she says it all hurts the same.....

 

her MD doc doesn't think it is the typical eating disorder case, he says. he says she will feel better and her stomach would stop hurting, if she would just eat. i really want to take her somewhere else. but she is sooo sick of docs and doesn't want to go anywhere else...i try to explain her to that we could find answers and to keep looking but she just doesn't want to....i feel kind of trapped...if that makes any sense. for know we are dealing with the depression, seeing the therapist and psychtrist and taking a break from the medical part (well not me as i am constantly on the web...looking for anything)

[ilovedogs]

As someone who suffers from stomach problems, I can tell you that there are many days when all I eat is toast and ginger ale! I have IBS and reflux problems sometimes so severe I get stomach pains and vomiting. Changing her diet might be really helpful and finding out if she has any food allergies. The tics are probably just making things worse for her. Have you tried feeding her a simplified diet? Boiled chicken, rice, bananas, toast, potatoes? Keep her off of milk maybe for a few days and see how she does.

Also, anxiety can cause stomach problems even if she doesn't seem anxious to you. I would try to find a good whole food supplement in a drink mix form so you can get her antioxidant levels back up and maybe even a chocolate protein drink, as well. That way even if she's not eating real food very much, maybe it will help her nutrition levels.

I have a friend who vomited and had stomach pain all during her childhood. The docs said she was just an anxious child but they took her to an allergist for seasonal allergies and mentioned the gastro symtpoms. He tested for food allergies and it turns out she had a casein allergy. Once they removed milk(they were farmers) from her diet, she started to heal.

 

You've gotten some great info about the PANDAs here so I hope you explore that option, as well. I just thought I'd chime in about the food allergy stuff. Many kids with tics have immune system problems and histamine levels are off so she may be having trouble digesting foods. Many parents on here have their kids on digestive enzymes and probiotics to help clean up the gut flora, etc. You may want to search this website for more info. on that! Good luck!

 

Bonnie

[CSP]

1KT,

 

Do you think she is having some food allergies? Has she been tested? When my youngest was little (she is also 11 now) after she ate she would tell me her tummy would hurt. Started when she was maybe 3yo. This did go away but she ate so little food and took forever to eat. She is not the reason I'm on board here, it is her 14yo brother who has TS, but it is funny how I remember things that before I just thought, "Oh well, that's what comes with having children."

 

My son has an allergy to peanuts and the tummy ache is the first reaction he gets before the hives. He would have a tummy ache after a cookie, but would not get the hives. Then it dawned on me about the nuts and how cookies could have nuts even if I baught a cookie without nuts.

 

Keep searching, you will find answers,

CP

[faith]

deleted post.

[kim]

1KT,

 

Since you mentioned the use of Reglan and also concern over side effects, maybe you are already aware of this but thought it was well worth posting.

bolding mine

 

http://lasvegas.injuryboard.com/defective-...googleid=245100

 

Dangerous Drugs: Digitek and Reglan August 04, 2008 - 09:46 PM

Category: Defective & Dangerous Products

 

We know, drug manufacturers often place profits over people. This profit motive can be seen in many problematic drugs on the market today. In the case of Reglan (also known as metoclopramide). Wyeth failed to properly warn of the real risk of tardive dyskinesia. When Reglan (metoclopramide) was first approved, Wyeth told the FDA that the risk of contracting tardive dyskinesia was 1 in 500. But, it was not. The real risk of tardive dyskinesia has been estimated as 1 in 8. Since the drug is widely prescribed many people are at risk.

http://en.wikipedia.org/wiki/Metoclopramide

 

Metoclopramide was first described by Dr. Louis Justin-Besançon and C. Laville in 1964.[1] It appears to bind to dopamine D2 receptors where it is a receptor antagonist, and is also a mixed 5-HT3 receptor antagonist/5-HT4 receptor agonist.

[1koolteacher]

Hi Kim,

 

Thank you for the info/link! I knew of the side effects from reading the pamphlet that comes with the drug and researching online. I did not know the risk was sooo high...i think the article you sent me said it was 1 in 8...Oh my gosh!! Do you believe I have asked at least three or four doctors (the MD my daughter is seeing, two psychtrists and two phamachists) about this drug?? Out of all those people, I feel one of the phamachists which I have gotten to know at our local CVS, has been the most knowledgeable/honest with his concerns for this drug. The rest of them have told me nothing to worry about for this drug!! We are going to the doctor on Tuesday and he had told me we could take her off then...why i couldn't when i emailed him, i don't know? I have lost all respect for the medical profession, sadly. I have no faith in them. i just don't know what to do anymore. My daughter really has lost any believe in them too. I have tried to explain that maybe if we keep looking, we may find someone who will do more for her....she is really at a tricky age i feel (11 years). Sorry to complain so much...ijust needed to vent.

[EAMom]

Hi,

 

My 8 year old daughter had PANDAS Anorexia Nervosa and was hospitalized for a week several months ago due to malnutrition (she had gone from 47 pounds to 42 pounds in a matter 2 weeks). (FYI her tics started late, after 2mo, but every PANDAS kid is different.)

 

I would get *throat cultures* on everyone in the household (including your daughter and siblings). Insist on the 48 hour culture if the rapid tests are negative. Our daughter cultured postive. She had had a fever (which we realized later was strep since other kids from her class were sick with strep at that time) 2 months previously and that's when the behavior changes and restrictive eating started. Her younger sister (no symptoms...a carrier we assume) also was also postive for strep. (Note: there could also be strep hiding out elsewhere in the body so a neg. throat culture is not the end all.) Interestingly, by the time my daughter was hosptalized and strep titers were drawn they were *not* elevated...despite the positive cultures (but that's another discussion.)

 

SSRI's were somewhat helpful with the depression/eating but the real cure came after several months when we finally put her on Azithromycin. By day 5 she was yelling at us less, a few days after that she decided she wanted to get better, then she started eating 3 meals a day. After4 weeks of Azithromycin she was pretty much back to normal, eating like a regular kid with no more questions about "will this make my stomach grow?, does this have sugar in it? will this make me fat?", tics were almost entirely gone. She is still on Azithromycin...we have no plans to take her off in the near future after 5 months of OCD, insane behavior, depression, and anorexia nervosa. Note: after diagnosis she and her sister were on several antibiotics once we found out about the strep and Azthromycin is the one that "cured" my older daughter and cleared the younger one of the carrier state.

 

If your daughter is severely underweight re-feeding will be critical as well. A malnourished brain cannot function or heal well. If she is severely underweight she is immunocompromised.

 

Suprisingly, we also discovered Advil (Ibuprofen) was helpful with my daughter's PANDAS AN symptoms. We discovered this before Azithromycin and continued the Advil until recently. (I don't know if I would rec. Advil for your daughter if she is complaining of stomach pain but something others may find helpful.) She is still on a low dose of Prozac (a little added insurance to keep the AN away), the Azithromycin, a multi-vitamin and probiotic.

 

If your daughter (or siblings) have strep I would also change toothbrushes a few days into a the course of antibiotics. Give each kids their own toothpaste as well. This will help prevent reinfection.

 

Good luck. I know Anorexia Nervosa is a huge nightmare and am so relieved that it is over (knock on wood) for me. If your daughter does turn out to have PANDAS AN keep in mind that you are facing an uphill battle since most pediatricians, dieticians, ED specialists do not understand or even *believe* in PANDAS.

[Diana]

Ditto everything EAMom said. The doctor who will get you the Azithro is Dr. Kovacevic in Chicago - folks have mentioned him a few times here. Or, frankly, because this PANDAS thing is such a mess with doctors/antibiotics - go online and get 'em from Canada. It is a pretty benign treatment.

 

 

 

Hi,

 

I my 8 year old daughter had PANDAS Anorexia Nervosa and was hospitalized for a week several months ago due to malnutrition (she had gone from 47 pounds to 42 pounds in a matter 2 weeks). (FYI her tics started late, after 2mo, but every PANDAS kid is different.)

 

I would get *throat cultures* on everyone in the household (including your daughter and siblings). Insist on the 48 hour culture if the rapid tests are negative. Our daughter cultured postive. She had had a fever (which we realized later was strep since other kids from her class were sick with strep at that time) 2 months previously and that's when the behavior changes and restrictive eating started. Her younger sister (no symptoms...a carrier we assume) also was also postive for strep. (Note: there could also be strep hiding out elsewhere in the body so a neg. throat culture is not the end all.) Interestingly, by the time my daughter was hosptalized and strep titers were drawn they were *not* elevated...despite the positive cultures (but that's another discussion.)

 

SSRI's were somewhat helpful with the depression/eating but the real cure came after several months when we finally put her on Azithromycin. By day 5 she was yelling at us less, a few days after that she decided she wanted to get better, then she started eating 3 meals a day. After4 weeks of Azithromycin she was pretty much back to normal, eating like a regular kid with no more questions about "will this make my stomach grow?, does this have sugar in it? will this make me fat?", tics were almost entirely gone. She is still on Azithromycin...we have no plans to take her off in the near future after 5 months of OCD, insane behavior, depression, and anorexia nervosa. Note: after diagnosis she and her sister were on several antibiotics once we found out about the strep and Azthromycin is the one that "cured" my older daughter and cleared the younger one of the carrier state.

 

If your daughter is severely underweight re-feeding will be critical as well. A malnourished brain cannot function or heal well. If she is severely underweight she is immunocompromised.

 

Suprisingly, we also discovered Advil (Ibuprofen) was helpful with my daughter's PANDAS AN symptoms. We discovered this before Azithromycin and continued the Advil until recently. (I don't know if I would rec. Advil for your daughter if she is complaining of stomach pain but something others may find helpful.) She is still on a low dose of Prozac (a little added insurance to keep the AN away), the Azithromycin, a multi-vitamin and probiotic.

 

If your daughter (or siblings) have strep I would also change toothbrushes a few days into a the course of antibiotics. Give each kids their own toothpaste as well. This will help prevent reinfection.

 

Good luck. I know Anorexia Nervosa is a huge nightmare and am so relieved that it is over (knock on wood) for me. If your daughter does turn out to have PANDAS AN keep in mind that you are facing an uphill battle since most pediatricians, dieticians, ED specialists do not understand or even *believe* in PANDAS.

[michele]

Diana, Do you order you azith from Canada or from Dr. K? Do you think it is important to be treated for PANDAS or is it okay to go with treatment for tourettes? Don't you think if you treat both you can have success? We do the Abilify for the tourettes and ADD and the Omnicef for the PANDAS immune issues. I would like to try him on the azith but have never found an immunologist to prescribe it yet. Even Dr. Murphy said pen vk or augmentin or omnicef for the PANDAS. Right now we are having some bad emotional issues with temper flair ups. I am thinking it is frustration and worry about school next week. I have been working all summer to get him to ride a bike but he freaks out and screams and loses control. Lately he is afraid of so much. Every scratch is a huge matter and he just seems hyper sensitive to everything. Today we see the neurologist for the tourettes. I get mad because he is great for tourettes but doesn't believe in PANDAS. I know Dr. K would be good to see but he is a distance and I already went to Florida to see Dr. Murphy. I don't know what else he could do or us other then prescribe the Azith if he does that. Also is it common for these kids to get defiant? Lately he is so difficult it is exhausting to deal with. He even hits his head against things in anger.

 

Michele

 

 

Ditto everything EAMom said. The doctor who will get you the Azithro is Dr. Kovacevic in Chicago - folks have mentioned him a few times here. Or, frankly, because this PANDAS thing is such a mess with doctors/antibiotics - go online and get 'em from Canada. It is a pretty benign treatment.

 

 

 

Hi,

 

I my 8 year old daughter had PANDAS Anorexia Nervosa and was hospitalized for a week several months ago due to malnutrition (she had gone from 47 pounds to 42 pounds in a matter 2 weeks). (FYI her tics started late, after 2mo, but every PANDAS kid is different.)

 

I would get *throat cultures* on everyone in the household (including your daughter and siblings). Insist on the 48 hour culture if the rapid tests are negative. Our daughter cultured postive. She had had a fever (which we realized later was strep since other kids from her class were sick with strep at that time) 2 months previously and that's when the behavior changes and restrictive eating started. Her younger sister (no symptoms...a carrier we assume) also was also postive for strep. (Note: there could also be strep hiding out elsewhere in the body so a neg. throat culture is not the end all.) Interestingly, by the time my daughter was hosptalized and strep titers were drawn they were *not* elevated...despite the positive cultures (but that's another discussion.)

 

SSRI's were somewhat helpful with the depression/eating but the real cure came after several months when we finally put her on Azithromycin. By day 5 she was yelling at us less, a few days after that she decided she wanted to get better, then she started eating 3 meals a day. After4 weeks of Azithromycin she was pretty much back to normal, eating like a regular kid with no more questions about "will this make my stomach grow?, does this have sugar in it? will this make me fat?", tics were almost entirely gone. She is still on Azithromycin...we have no plans to take her off in the near future after 5 months of OCD, insane behavior, depression, and anorexia nervosa. Note: after diagnosis she and her sister were on several antibiotics once we found out about the strep and Azthromycin is the one that "cured" my older daughter and cleared the younger one of the carrier state.

 

If your daughter is severely underweight re-feeding will be critical as well. A malnourished brain cannot function or heal well. If she is severely underweight she is immunocompromised.

 

Suprisingly, we also discovered Advil (Ibuprofen) was helpful with my daughter's PANDAS AN symptoms. We discovered this before Azithromycin and continued the Advil until recently. (I don't know if I would rec. Advil for your daughter if she is complaining of stomach pain but something others may find helpful.) She is still on a low dose of Prozac (a little added insurance to keep the AN away), the Azithromycin, a multi-vitamin and probiotic.

 

If your daughter (or siblings) have strep I would also change toothbrushes a few days into a the course of antibiotics. Give each kids their own toothpaste as well. This will help prevent reinfection.

 

Good luck. I know Anorexia Nervosa is a huge nightmare and am so relieved that it is over (knock on wood) for me. If your daughter does turn out to have PANDAS AN keep in mind that you are facing an uphill battle since most pediatricians, dieticians, ED specialists do not understand or even *believe* in PANDAS.

[1koolteacher]

Ditto everything EAMom said. The doctor who will get you the Azithro is Dr. Kovacevic in Chicago - folks have mentioned him a few times here. Or, frankly, because this PANDAS thing is such a mess with doctors/antibiotics - go online and get 'em from Canada. It is a pretty benign treatment.

 

 

 

Hi,

 

I my 8 year old daughter had PANDAS Anorexia Nervosa and was hospitalized for a week several months ago due to malnutrition (she had gone from 47 pounds to 42 pounds in a matter 2 weeks). (FYI her tics started late, after 2mo, but every PANDAS kid is different.)

 

I would get *throat cultures* on everyone in the household (including your daughter and siblings). Insist on the 48 hour culture if the rapid tests are negative. Our daughter cultured postive. She had had a fever (which we realized later was strep since other kids from her class were sick with strep at that time) 2 months previously and that's when the behavior changes and restrictive eating started. Her younger sister (no symptoms...a carrier we assume) also was also postive for strep. (Note: there could also be strep hiding out elsewhere in the body so a neg. throat culture is not the end all.) Interestingly, by the time my daughter was hosptalized and strep titers were drawn they were *not* elevated...despite the positive cultures (but that's another discussion.)

 

SSRI's were somewhat helpful with the depression/eating but the real cure came after several months when we finally put her on Azithromycin. By day 5 she was yelling at us less, a few days after that she decided she wanted to get better, then she started eating 3 meals a day. After4 weeks of Azithromycin she was pretty much back to normal, eating like a regular kid with no more questions about "will this make my stomach grow?, does this have sugar in it? will this make me fat?", tics were almost entirely gone. She is still on Azithromycin...we have no plans to take her off in the near future after 5 months of OCD, insane behavior, depression, and anorexia nervosa. Note: after diagnosis she and her sister were on several antibiotics once we found out about the strep and Azthromycin is the one that "cured" my older daughter and cleared the younger one of the carrier state.

 

If your daughter is severely underweight re-feeding will be critical as well. A malnourished brain cannot function or heal well. If she is severely underweight she is immunocompromised.

 

Suprisingly, we also discovered Advil (Ibuprofen) was helpful with my daughter's PANDAS AN symptoms. We discovered this before Azithromycin and continued the Advil until recently. (I don't know if I would rec. Advil for your daughter if she is complaining of stomach pain but something others may find helpful.) She is still on a low dose of Prozac (a little added insurance to keep the AN away), the Azithromycin, a multi-vitamin and probiotic.

 

If your daughter (or siblings) have strep I would also change toothbrushes a few days into a the course of antibiotics. Give each kids their own toothpaste as well. This will help prevent reinfection.

 

Good luck. I know Anorexia Nervosa is a huge nightmare and am so relieved that it is over (knock on wood) for me. If your daughter does turn out to have PANDAS AN keep in mind that you are facing an uphill battle since most pediatricians, dieticians, ED specialists do not understand or even *believe* in PANDAS.

 

Hi,

 

I have an appointment with the Infectious Disease Specialist tomorrow. I am going to mention the throat culture and antiobodics. Thanks so much for all of your help!!

 

Just wondering if you get a minute can you explain your story about unelevated ASO results but positive throat cultures? thanks!

[1koolteacher]

Okay dumb question...only certain docs will presribe these meds for Pandas or even believe in it? I guess that makes sense because one doc did blow me off about the high ASO results and pandas just last week. He is not a neuro doc just a regular Ped/Adolescent doc. sorry spelling:)

[peglem]

Okay dumb question...only certain docs will presribe these meds for Pandas or even believe in it? I guess that makes sense because one doc did blow me off about the high ASO results and pandas just last week. He is not a neuro doc just a regular Ped/Adolescent doc. sorry spelling:)

 

The thing with a PANDAS dx is that is has not been widely recognized by the medical community or insurance companies as a legitimate disorder. There is no diagnostic code for it. I sometimes wish they'd just call it atypical syndenham's. (it seems to me like PANDAS is just a less severe form of Sydenham's chorea). My daughter's pcp believed the PANDAS dx, but felt he needed something to justify prescribing profilactic antibiotics to the insurance company and to the group practice he is a member of. So, even though she was getting antibiotics everytime she tested positive for strep (which was almost always-when she wasn't actually on antibiotics), He hesitated to go profilactic...felt he needed the +test to justify each time. As soon as we got a specialist (in this case a rheumatologist) to agree to profilactic antibiotics, her pcp became very comfortable with prescribing them...he had a back up in case it was questioned. The rheumatologist said that he'd love to dx her with PANDAS because its such a rare disorder (sometimes I think rare disorders are only rare because doctors never consider them) but she didn't have high ASO titers. (which are NOT neccessary according to dx criteria, but I'll bet he didn't know that) I just told him out of total frustration that I didn't care if it was PANDAS or not, we just know that it improves when she's on antibiotic...so he said, let's try profilactic antibiotics. Before, we were going to the dr. about every 2 to 3 weeks to get the strep test done and get more antibiotics.

 

I'm rambling now, but the acronym PANDAS was applied to this disorder before the autoimmunity was proven. In fact, the autoimmune component was never proven. What they found was a temporal association between strep and the sudden onset of behaviors (tics, OCD) and that is the dx criteria. But, with the PANDAS acronym, most believe it is definately an autoimmune disorder and discount the possibility of PANDAS if the titers are not high. (the reason for titer testing is just to confirm a recent strep infection in case of a negative culture). My daughter had + strep tests up the yinyang...all associated with OCD behaviors (indeed, I knew from her behavior to bring her in for the strep test). So, why the low titers? And if it IS autoimmune, where are these antibodies that are supposed to be attacking the basal ganglia? I think, in my daughter's case, her immune system is not responding to the strep attack (no sore throats, inflamation or fevers) and the symptoms are a result of the neurotoxins given off by the strep bacteria themselves. I think the case may be different for those with elevated titers...There's more going on here, that has not been studied, but PANDAS research has largely been discontinued.

 

And while I'm on a good ramble.....This whole "carrier" status for strep just doesn't make sense to me. If the strep bacteria are there, they are eating and giving off toxins...or they're dead. It seems to me if there is no immune response, then there's something wrong with the host's immune system...not some kind of magical "benign strep". The immune system is one complicated piece of machinery, and for all my efforts, I don't understand it very well...if anybody has a very good explanation for "carrier" status, I'd sincerely like to understand how this can be.