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Started IVIG with Dr. Bouboulis


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Peglam,

 

I hope you don't mind that I use your quote as an example as many apply to my concern..are you talking about "true PEX" plasmapherisis with IVIG (taking out your bad antibodies and putting in good donor antibodies)??

 

I recently have seen PEX used and referred to as plasmapherisis. It confused the heck out of me so for the newbies out there (which was me not to long ago) and for those that have been incorrectly using the word "PEX" when they are actually describing plasmapherisis. Let's define...

 

This is Buster's "very easy to understand" description...

 

PEX is plasma Exchange -- you put in someone else's for your child's

 

Plasmapherisis -- you take out your plasma and replace it with Albumen

 

IVIG -- no removal of your plasma, you just add a very sterilized version of someone else's in addition

 

 

For instance, peglem just got back from Dr. L. and apparently she did not give a go for PEX for her girl, altho I beleive she has low Igg's (I think). I don't understand what all this means. I almost feel like the protocol re PEX and IVIG is everchanging and its all a matter of who can or can't affort it, or if it is covered, or who pushes the most for it. don't really know. sorry to put this out there, but you said to discuss.

 

Yes, My daughter has low IgG. But, I think the reason for not doing PEX was more because she thought my daughter would pull out the line. I think she's got a point there- when we contemplated PEX, this was one of our concerns-also, getting our daughter to stay on the bed while the procedure is in progress. We'll have the same challenges with IVIG, I suppose, but we'll deal with it.

 

I think to a certain extent, the treatment for PANDAS is a bit experimental and it gets shaped as more is learned and more experience is gained. There isn't a standardized protocol. I actually appreciate the lack of "checklist" here. My daughter is wildly atypical and doc who we have seen that do the whole protocol checklist, cannot place her- so they don't know what to do, and do nothing. One of the things I liked about Dr. L is that she considered what would work for THIS child, not what works for THESE kids. My experience with DAN doctors has been the opposite- more a lets try what works with these kids-it can't hurt to try it scenario.

 

What is known about PANDAS is that there is an immune problem, but I don't think its necessarily a matter of over or under active immune system. First off, Science doesn't have a comprehensive understanding of the immune system, or autoimmunity. I know for us, we cannot wait for the research to be completed. My daughter needs help years ago...So, I want to try what may work, what makes sense to try based on the information we do have. We know she has abnormally high anti-D2 antibodies (it makes sense to me to remove them if we can). We know her antibodies are low. We suspect her immune regulation is poor- its suppose to knock out these rogue antibodies that are interacting w/ self tissue. So, if her own system is not working properly, it makes sense (to me), to give her immune system components from other people.

 

I want science to keep trying to find out why this happened to my daughter and to learn how to prevent this happening to others and more certain treatments for when it does happen-but, my daughter can't wait for that to happen.

The ball was dropped on PANDAS research- but the study that was done on PEX/IVIG did show that they were beneficial treatment for PANDAS. But the slice of PANDAS that was looked at was narrow- did not include a wide variety of PANDAS kids, and I know that my daughter certainly would not have qualified for that study.

Mostly, I think there needs to be a balance in medicine, between the art and science. I think its skewed right now in the direction of science. Doctors hesitate to try things that they believe may help a patient because it hasn't been proven yet in the laboratory. I think there needs to be more room for physician discretion so that I don't have to run half way around the world to get help for my daughter.

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Lynn, I was using PEX to mean plasmapheresis+IVIG (more or less)- filtering antibodies out and adding donor antibodies back in. But, I didn't know that plasmapheresis replaced plasma w/ albumen. I thought it just filtered antibodies from blood and then put that blood back into the body.

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Faith,

 

I just wanted to say my son has seen continued marked improvement from the treatments he has received and no major set-backs. I think you are over analyzing people's experiences....... sure some have had set backs but marked improvement over initial onsets.

 

Dr. K has been treating for 10 years now and you would think if he has been continually unsuccessful and didn't know the outcome he'd give up on treating. I just don't want someone new to the boards to read your post and expect worse for their children if they follow recommended treatments. There has been tremendous success with IVIG for many auto-immune illness and do not consider it a risky proposition at all given the alternative.

 

I'm looking forward to our annual check-in on the forum when our son 120% and I can spell out what worked for all of my children.

 

-W

 

 

 

 

Regarding pex and ivig-

 

unfortunately for all of us, the science is just not there yet for our kids. So, to some degree this is all experimentation. That being said, these medications and procedures themselves are not experimental. They seem to work for some kids, not for others, and for varying lengths of time.

 

My daughter had pex. She was extreme in the sense that she had an overnight onset, and had a lot of trouble functioning in daily life. Getting to school, and enjoying simple things became hard for her. We did antibiotics and steroids, she would improve, and then we would have another trigger. I vowed to pursue treatment aggressively. I pursued pex for Julia with Dr Latimer. Luckily, our insurance pre approved (although are now denying). At the time we went for pex for a few reasons: a family in my neighborhood had great success with it, many who had ivig on the board were relapsing or not seeing great improvement at the time, we wanted to avoid introducing a blood product if possible. This being said, we were, and still are, very open to the possibility of ivig in the future.

 

The pex showed us the real Julia. She was 110% immediately post procedure. Obviously it was not a cure, because a pandas episode was triggered by H1N1 not too long after. We were able to stop that episode immediately thanks to steroids. I do believe she is closer to her true baseline today, because of the pex.

 

I have heard Dr T and Dr B's concern about pex for immunecompromised patients. The HemOnc team at Georgetown did immune testing prior to pex, and Julia passed. I am sure if there was any concern for a child, they would discuss it with the parent. What was explained to us, was that pex removes the antibodies (good and bad) from the blood. It does NOT remove the immune memory. According to the docs there, the immune system is back to normal within a few weeks, and if exposed to something in the meantime- the immune memory would create antibodies. How does this differ if you are immune compromised- I am not sure?

 

Unfortunately, for the milder pandas kids, like my older daughter- the obstacles to these kinds of procedures are great. There are risks, they cost a lot, they are stressful, and there are no gaurantees. So I can imagine for parents of these kids, the constant agony of whether to pursue them or not. Most of the great docs for pandas, will help you get the treatment you want and your child needs. I doubt if any of them will say your only choice is to do this... or you must do this... Unfortunately, you need to evaluate the info, your child's condition, and do what feels right to you. Impossible, I know.

 

dcmom

thank you, I think you explain in a nutshell what some of us are up against, and your last paragraph says it well. If my child was severe enough, I would probably move forward on the express train. Not saying he is mild, because we have struggles with multiple tics, ocd getting more prevalent, and all those other fun issues. however, he is functional, goes to school, is bright enough and social enough to go under the radar with most of these issues, altho a waxing of a tic can be somewhat noticeable. I've dealt with this stuff for years, and while I'd love for it to be a distant memory, I think my fear is not that it "won't work", my fear is that I will create more problems and possibly set up a scene for him to actually get worse. Some of the 'setbacks' or 'relapses' for some here (wether re steroid, IVIG, PEX, or whatever) have pushed a few farther back than they were before the treatment. We have good days and bad days here, without those treaments, so I struggle to understand if the reasons for these setbacks are conclusive. I'm petrified (and this is with all modalities, not just PANDAS treatments) of doing something that may make my child worse off than he was in the first place, for sure my husband wiould bury me in the backyard if I pushed for something that is not a guarantee, and the result was adverse. :wacko: You guys know I like to fully understand things before I jump in. I wish we could know wht the right thing to do is, I don't even think these doctors really know for sure what the outcome would be. If they don't know what it will be, how do they know it won't be adverse? the gamble is very frightening to me.

 

Faith

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Faith,

 

I just wanted to say my son has seen continued marked improvement from the treatments he has received and no major set-backs. I think you are over analyzing people's experiences....... sure some have had set backs but marked improvement over initial onsets.

 

Dr. K has been treating for 10 years now and you would think if he has been continually unsuccessful and didn't know the outcome he'd give up on treating. I just don't want someone new to the boards to read your post and expect worse for their children if they follow recommended treatments. There has been tremendous success with IVIG for many auto-immune illness and do not consider a risky proposition at all given the alternative.

 

I'm looking forward to our annual check-in on the forum when our son 120% and I can spell out what worked for all of my children.

 

-W

 

 

 

 

Regarding pex and ivig-

 

unfortunately for all of us, the science is just not there yet for our kids. So, to some degree this is all experimentation. That being said, these medications and procedures themselves are not experimental. They seem to work for some kids, not for others, and for varying lengths of time.

 

My daughter had pex. She was extreme in the sense that she had an overnight onset, and had a lot of trouble functioning in daily life. Getting to school, and enjoying simple things became hard for her. We did antibiotics and steroids, she would improve, and then we would have another trigger. I vowed to pursue treatment aggressively. I pursued pex for Julia with Dr Latimer. Luckily, our insurance pre approved (although are now denying). At the time we went for pex for a few reasons: a family in my neighborhood had great success with it, many who had ivig on the board were relapsing or not seeing great improvement at the time, we wanted to avoid introducing a blood product if possible. This being said, we were, and still are, very open to the possibility of ivig in the future.

 

The pex showed us the real Julia. She was 110% immediately post procedure. Obviously it was not a cure, because a pandas episode was triggered by H1N1 not too long after. We were able to stop that episode immediately thanks to steroids. I do believe she is closer to her true baseline today, because of the pex.

 

I have heard Dr T and Dr B's concern about pex for immunecompromised patients. The HemOnc team at Georgetown did immune testing prior to pex, and Julia passed. I am sure if there was any concern for a child, they would discuss it with the parent. What was explained to us, was that pex removes the antibodies (good and bad) from the blood. It does NOT remove the immune memory. According to the docs there, the immune system is back to normal within a few weeks, and if exposed to something in the meantime- the immune memory would create antibodies. How does this differ if you are immune compromised- I am not sure?

 

Unfortunately, for the milder pandas kids, like my older daughter- the obstacles to these kinds of procedures are great. There are risks, they cost a lot, they are stressful, and there are no gaurantees. So I can imagine for parents of these kids, the constant agony of whether to pursue them or not. Most of the great docs for pandas, will help you get the treatment you want and your child needs. I doubt if any of them will say your only choice is to do this... or you must do this... Unfortunately, you need to evaluate the info, your child's condition, and do what feels right to you. Impossible, I know.

 

dcmom

thank you, I think you explain in a nutshell what some of us are up against, and your last paragraph says it well. If my child was severe enough, I would probably move forward on the express train. Not saying he is mild, because we have struggles with multiple tics, ocd getting more prevalent, and all those other fun issues. however, he is functional, goes to school, is bright enough and social enough to go under the radar with most of these issues, altho a waxing of a tic can be somewhat noticeable. I've dealt with this stuff for years, and while I'd love for it to be a distant memory, I think my fear is not that it "won't work", my fear is that I will create more problems and possibly set up a scene for him to actually get worse. Some of the 'setbacks' or 'relapses' for some here (wether re steroid, IVIG, PEX, or whatever) have pushed a few farther back than they were before the treatment. We have good days and bad days here, without those treaments, so I struggle to understand if the reasons for these setbacks are conclusive. I'm petrified (and this is with all modalities, not just PANDAS treatments) of doing something that may make my child worse off than he was in the first place, for sure my husband wiould bury me in the backyard if I pushed for something that is not a guarantee, and the result was adverse. :( You guys know I like to fully understand things before I jump in. I wish we could know wht the right thing to do is, I don't even think these doctors really know for sure what the outcome would be. If they don't know what it will be, how do they know it won't be adverse? the gamble is very frightening to me.

 

Faith

 

Wendy --

:mellow: ......just so many variables here. you are confident. don't forget that not everyone is 100% positive that PANDAS is the case for their child and not everyone is reading almost every post here. I am in information overdrive......... :wacko:

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There are a lot of variables and there will be different outcomes for each child because of those variables. Its fine if you don't think your child is PANDAS but sometimes it feels like you are trying justify 'your inaction/indecision about PANDAS' by making negative statements. Which is fine, just be prepared to be corrected. Can you imagine, if somebody new to the forum read your post and thought geez, if I try 'antibiotics, steroids, PEX or whatever' my kid will get worse. I guess every other person on this forum is nuts for trying those things in an attempt to make their children well.

 

I am confident that my son will recover from this illness and I'm often sadden by your posts...... sometimes 'FAITH' believing is half the battle. At some point, you will have to make a decision and if its PANDAS you will have to trust the Dr.'s with experience. There will be no guarantees when it come to PANDAS for maybe the next twenty years and then it will be potentially too late for your son.... I truly don't think Dr. B, C, K, T, L, etc. would stake their careers on negative outcomes. They are doing it because its helping and they know its working.

 

-Wendy

 

Wendy --

:mellow: ......just so many variables here. you are confident. don't forget that not everyone is 100% positive that PANDAS is the case for their child and not everyone is reading almost every post here. I am in information overdrive......... :wacko:

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SFMom :mellow: ,

 

I read your post to Faith and really found it to be pretty harsh and I just had to chime in a bit in Faith's defense.

 

I personally don't find any of Faith's statements to be negative...anyone who has been on here a long time, like Faith, and many others including myself, know that she is just trying to figure things out and asking questions..that is all...that is what this forum is here for, right?

 

Saying she is justifying her inaction/indecision is really presumptuous of you and it really seems cruel.....she is certaintly not "inactive" in trying to help her son...far from it...and not being sure he is PANDAS...well, so what?? Many here struggle with that....it is really hard in the less clear cut cases. And do you really feel the need to tell her to prepare to be corrected?? I don't think any of us are the "know it all" that can make such a claim to someone.

 

I think it is very important for newcomers on here to see ALL sides of this...including Faith's posts. Indeed, some children DO/HAVE gotten "worse" with some of these treatments. Newcomers should be aware of it.

Yes, AT SOME POINT, we all have to make a decision to pursue one treatment or another..or non at all. But, in who's time frame should this decision fall....yours???

 

And the guilt you can potentially lay on someone by telling them if they do not go this route or do these treatments, that it may potentially be "too late for their son,"....wow, think about what you are saying!

 

You actually said it quite clearly in your post..."there are no guarantees when it comes to PANDAS for maybe the next 20 years."....BINGO...need I say more??

 

And I don't know how Faith feels, but, I really wish you would stop using her name against her.

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PMom,

 

I appreciate your perspective and understand your defense of Faith.

 

I don't know, sometimes I do get frustrated, don't you? I feel like I'm doing an injustice to the potential children in need if I let broad sweeping statements pass without comment. Does it seem mean, maybe. Was it meant to be, maybe. Will I get called out on the carpet it, yes! Will I feel badly that I was harsh, yes!

 

Ultimately, I want all our children well and I just feel if we expect anything less than 100% recovery. We will get less. Our children are potentially paving the way for millions more suffering. We've taken huge risks... but someday it won't be that way for others.

 

Sorry, Faith for my harshness....... I am obviously aggressive in my tone at times (its the stress of having three kids with PANDAs). I apologize.

 

-Wendy

 

 

 

 

 

SFMom :mellow: ,

 

I read your post to Faith and really found it to be pretty harsh and I just had to chime in a bit in Faith's defense.

 

I personally don't find any of Faith's statements to be negative...anyone who has been on here a long time, like Faith, and many others including myself, know that she is just trying to figure things out and asking questions..that is all...that is what this forum is here for, right?

 

Saying she is justifying her inaction/indecision is really presumptuous of you and it really seems cruel.....she is certaintly not "inactive" in trying to help her son...far from it...and not being sure he is PANDAS...well, so what?? Many here struggle with that....it is really hard in the less clear cut cases. And do you really feel the need to tell her to prepare to be corrected?? I don't think any of us are the "know it all" that can make such a claim to someone.

 

I think it is very important for newcomers on here to see ALL sides of this...including Faith's posts. Indeed, some children DO/HAVE gotten "worse" with some of these treatments. Newcomers should be aware of it.

Yes, AT SOME POINT, we all have to make a decision to pursue one treatment or another..or non at all. But, in who's time frame should this decision fall....yours???

 

And the guilt you can potentially lay on someone by telling them if they do not go this route or do these treatments, that it may potentially be "too late for their son,"....wow, think about what you are saying!

 

You actually said it quite clearly in your post..."there are no guarantees when it comes to PANDAS for maybe the next 20 years."....BINGO...need I say more??

 

And I don't know how Faith feels, but, I really wish you would stop using her name against her.

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I sympathize with what you said, Faith. Like yours, my kids are "mild" in the sense that they're functioning well socially, in school, etc. Even though life is stressful with its various ups and downs, I know that it could get much worse if we were to take a wrong turn, and that's scary. In my experience, the doctors freely admit that they don't have it all figured out. All treatments have risks, and sometimes it does seem like PANDAS treatment has an element of gambling to it. Heck, I even tried a new antibiotic back in my 20's -- seemed pretty harmless -- and wound up with a lupus reaction to it. Took a while to get back on my feet. @#$% can happen when you have a whacked immune system, no question about that.

 

Good news is, this field sure is a lot more advanced than it was a couple of decades ago. I think about what my parents went through watching me fall from 97 to 57 pounds with anorexia, being told that I was "atypical" and the doctors didn't know what to do with me, coming in to say good-bye because I was about to die and they had no more options... it gives me great comfort to know that, even though they are not fully researched, we do have a lot more options these days and are much closer to solutions. I don't really worry about my kids dying of this. 20+ years ago, kids died of this, no doubt about it.

 

 

Regarding pex and ivig-

 

unfortunately for all of us, the science is just not there yet for our kids. So, to some degree this is all experimentation. That being said, these medications and procedures themselves are not experimental. They seem to work for some kids, not for others, and for varying lengths of time.

 

My daughter had pex. She was extreme in the sense that she had an overnight onset, and had a lot of trouble functioning in daily life. Getting to school, and enjoying simple things became hard for her. We did antibiotics and steroids, she would improve, and then we would have another trigger. I vowed to pursue treatment aggressively. I pursued pex for Julia with Dr Latimer. Luckily, our insurance pre approved (although are now denying). At the time we went for pex for a few reasons: a family in my neighborhood had great success with it, many who had ivig on the board were relapsing or not seeing great improvement at the time, we wanted to avoid introducing a blood product if possible. This being said, we were, and still are, very open to the possibility of ivig in the future.

 

The pex showed us the real Julia. She was 110% immediately post procedure. Obviously it was not a cure, because a pandas episode was triggered by H1N1 not too long after. We were able to stop that episode immediately thanks to steroids. I do believe she is closer to her true baseline today, because of the pex.

 

I have heard Dr T and Dr B's concern about pex for immunecompromised patients. The HemOnc team at Georgetown did immune testing prior to pex, and Julia passed. I am sure if there was any concern for a child, they would discuss it with the parent. What was explained to us, was that pex removes the antibodies (good and bad) from the blood. It does NOT remove the immune memory. According to the docs there, the immune system is back to normal within a few weeks, and if exposed to something in the meantime- the immune memory would create antibodies. How does this differ if you are immune compromised- I am not sure?

 

Unfortunately, for the milder pandas kids, like my older daughter- the obstacles to these kinds of procedures are great. There are risks, they cost a lot, they are stressful, and there are no gaurantees. So I can imagine for parents of these kids, the constant agony of whether to pursue them or not. Most of the great docs for pandas, will help you get the treatment you want and your child needs. I doubt if any of them will say your only choice is to do this... or you must do this... Unfortunately, you need to evaluate the info, your child's condition, and do what feels right to you. Impossible, I know.

 

dcmom

thank you, I think you explain in a nutshell what some of us are up against, and your last paragraph says it well. If my child was severe enough, I would probably move forward on the express train. Not saying he is mild, because we have struggles with multiple tics, ocd getting more prevalent, and all those other fun issues. however, he is functional, goes to school, is bright enough and social enough to go under the radar with most of these issues, altho a waxing of a tic can be somewhat noticeable. I've dealt with this stuff for years, and while I'd love for it to be a distant memory, I think my fear is not that it "won't work", my fear is that I will create more problems and possibly set up a scene for him to actually get worse. Some of the 'setbacks' or 'relapses' for some here (wether re steroid, IVIG, PEX, or whatever) have pushed a few farther back than they were before the treatment. We have good days and bad days here, without those treaments, so I struggle to understand if the reasons for these setbacks are conclusive. I'm petrified (and this is with all modalities, not just PANDAS treatments) of doing something that may make my child worse off than he was in the first place, for sure my husband wiould bury me in the backyard if I pushed for something that is not a guarantee, and the result was adverse. :mellow: You guys know I like to fully understand things before I jump in. I wish we could know wht the right thing to do is, I don't even think these doctors really know for sure what the outcome would be. If they don't know what it will be, how do they know it won't be adverse? the gamble is very frightening to me.

 

Faith

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I have to also chime in here.

 

I certainly took the route of treating this aggressively with my youngest- that is what I felt comfortable doing- she was a textbook case of pandas, and wasn't able to function. My older daughter is much milder, and more of a variant, so making the decisions for her are a little tougher.

 

We also are lucky enough to live by Dr L, meaning we did not have to fly across the country to go to a strange doc. Our insurance also approved our procedure, meaning we didn't have to lay money (that many people don't have laying around) out up front.

 

Before we decided on pheresis for Julia, I did lots of research by talking to some experts, reading on the forum, reading studies and talking to other parents. The ONLY thing I really learned from all of this is there are NO gauarnatees with any of the treatments. I spent a lot of time reading lists of post by individual parents. It was heartwrenching to retrace their stories of coming on the forum, devestated looking for hope- and since then have had a roller coaster of ups and downs. Many have gone for IVIG, and it hasn't helped or they have relapsed. Since my dd had her treatment- many have also relapsed after pheresis.

 

I want to go into any treatment for my daughter with my eyes open. I don't want the rosy picture. I need to plan for the positive and the negative outcome. And I feel as a parent on this board, it would be dishonest to tell a newcomer there is an easy cure.

 

YES, this can be managed at worst, and at best your child can go into a long term (or maybe permanent) remission.

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In reading the posts above I am impressed with the courage of parents who have faced seemingly insurmountable odds (a child's neuro-psychiatric illness) and have stepped up to the plate to TRY to help...

 

I appreciate the honesty and courage in seeking answers, as we confront this illness.

 

We have been helped enormously by the parents on this forum--I cannot tell you--

THANK YOU! --for the questions, answers, and "I tried this, it worked" testimonies.

 

We must keep testifying to what has worked for our child's ILLNESS.

 

--this is not something "new", it is something that is "little known"--

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O.K. now that I've had some sleep....

 

I guess I was trying to point out that the treatments are working for many. Not if, a child needed them. For me, the treatments gave me a tremendous amount of hope. We have seen drastic improvement for our son and expect additional improvement with each further treatment.

 

I mean, chime in if you regret have taken aggressive measures for your child.

 

Anyway, I'm running out the door to catch a flight to Chicago for our son's third IVIG infusion.

 

-Wendy

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;) ..... .....It's ALL MICHAEL'S FAULT.!........ ^_^

 

I'm not going to add much more to this, I see I don't hve to, but thanks for those that understand what I was trying to convey. I know I'm not alone in these thoughts and feelings. I understand we all have our struggles here, and we shouldn't be afraid to discuss them. our kids all have varying degrees of symptoms. I know Dr. Trif has said he thinks that some treatments should be reserved for the more severe cases, and I did kind of get that drift from Dr. L. when we saw her, so I guess I'm kind of in agreement with that in some way. I'm taking it one day at a time, one step at a time. While I am fearful, I admit, I also don't want my fears to cause me to panic and jump too fast on something that may not be the right answer (for my child)..... while I wish more than anything that these treatments are the miracle cure for all our kids, and I don't like hearing about those that have had not so good outcome as yet, maybe in some wierd way, it helps in making some of our decisions or direction a little easier. We really need to know 'all' the facts. jumping up and down shaking pom poms in our hands without knowing the real score doesn't help anyone.......

 

Wendy.... if I may add....I have no issues with 'faith'........sometimes I just struggle with 'hope'........... :mellow:

 

hey, group hug at the tiki bar? its two for one nite!................ What!!??........... :)

 

-Faith

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Good luck in chicago wendy I know you guys are going to be fine as you will settle for nothing less! I just want to add that wendy really believes in these treatments because she is seeing the results at home. She may come across as "harsh" but I think she feels that if we are brave and sometimes bold then other parents will be inspired to give it a shot too. I am seeing real progress in my daughter too and want other parents to know that its working for us.

 

 

 

O.K. now that I've had some sleep....

 

I guess I was trying to point out that the treatments are working for many. Not if, a child needed them. For me, the treatments gave me a tremendous amount of hope. We have seen drastic improvement for our son and expect additional improvement with each further treatment.

 

I mean, chime in if you regret have taken aggressive measures for your child.

 

Anyway, I'm running out the door to catch a flight to Chicago for our son's third IVIG infusion.

 

-Wendy

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  • 1 year later...

If deficient in pneumococcal titers is considered a Specific Antibody Deficiency, my son receives Ivig for this. The infant receives 4 doses of Prevnar, child and adult is the Pneumovax. Dr T thinks this vacc made my sons Pandas worse. But they use it to determine if a true pneumo deficiency when tested before and after.

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