When a Child Changes Overnight: PANS, PANDAS & the Overlap Between Pediatric and Mental Health Care

 

[00:00:00] Tanya Altmann, MD: Yeah, now we have open evidence and you can just toss anything in and find out all the medical research and papers 

 

[00:00:05] Adelina Brisbois, LMFT: I just learned about open evidence. That's so cool. It's like a chat GPT for doctors. 

 

[00:00:09] Tanya Altmann, MD: Something really unusual is going on with my daughter, Tanya, and I'd love for you to help me figure it out.

 

[00:00:14] Tanya Altmann, MD: And I thought, well, you're a pediatrician at a major university in Los Angeles with access to all the experts. Why do you wanna drive an hour to see me? And she said, no one believes me. And when I talk to some ENTs, they will say, you know, even if the tonsils look okay on the outside, when we do take them out, there's so much infection hidden under there that we didn't realize, and it's so close to the brain.

 

[00:00:33] Tanya Altmann, MD: Could that be why it's feeding this inflammation in the brain? 

 

[00:00:39] Narrator: Welcome to Look for the Helpers, A podcast by Engage Therapy in Agora Hills, California. Hosted by Adelina Brisboy, licensed Marriage and Family Therapist and her husband, Dr. Blake Brisboy, licensed psychologist. Thanks for being here. 

 

[00:00:59] Adelina Brisbois, LMFT: Okay, so hi Tanya.

 

[00:01:01] Adelina Brisbois, LMFT: Welcome. Thanks for joining me. 

 

[00:01:03] Tanya Altmann, MD: Thank you for having me. 

 

[00:01:04] Adelina Brisbois, LMFT: Um, I am excited to introduce you to our audience. This is Dr. Tanya Altman. Um, she's a pediatrician with Calabasas Pediatrics in ca in Calabasas, a mom and a book author and a really good friend of ours, an expert in the things that we don't know. We always call you to help, you know, figure out problem solve.

 

[00:01:24] Adelina Brisbois, LMFT: Um, you know, I know recently there was a. They closed Los Robles pediatric, uh, unit, and the first person I thought to call was you, you know, what do we do, Tanya? How do we handle this in the future? Let's be prepared, and you're right there for us to think about together and, and have a plan for the clients that we see.

 

[00:01:42] Adelina Brisbois, LMFT: So we're very appreciative for your time and joining us today and to share your knowledge with our audience. So, um, we have a lot to talk about. Um, I don't know if you wanna share a little bit about yourself in terms of, you know, your background and how you feel like your pediatric experience relates to mental health and.

 

[00:02:02] Adelina Brisbois, LMFT: What you've seen in your time. 

 

[00:02:04] Tanya Altmann, MD: Sure. Well, thank you for having me today. And I love our community and how collaborative we are as well because I often need mental health, professional, um, ideas and brainstorming and help with my own families since it all goes together. So I trained at UCLA and I've been practicing pediatrics in the community here for 25 years.

 

[00:02:21] Tanya Altmann, MD: For the first 15 years I was in a more traditional insurance based practice where I was really lucky to practice with some. Older, very wise pediatricians that really thought outside the box. And that's what I love about general pediatrics is that every child doesn't fit into a protocol. And every week we were getting cases that we really had to sit and brainstorm and think about and figure out.

 

[00:02:45] Tanya Altmann, MD: What can we try that's different to help this family? And then 10 years ago when I had my third, I have three boys and there's a fairly big age gap there. They're 20, 18 and 10 right now. So 10 years ago, I decided I wanted to jump out of the insurance based system where instead of spending 15 minutes with a family, I could spend an hour or two with them to really delve more deeply into complex situations and preventive health and work on nutrition and sleep.

 

[00:03:14] Tanya Altmann, MD: You know, more mental health, wellness and school success as well. And that's when I opened Calabasas Pediatric Wellness Center, which is a concierge practice where we really do take that extra time with families and keep the practice smaller. Mm-hmm. So that's sort of how, um, how I've evolved. I also, over the last 10 years, um, got trained in integrative pediatrics because I feel like pediatrics is so much more than just ear infections.

 

[00:03:36] Tanya Altmann, MD: Right. Kids today are stressed, they are overtired, they're not getting proper nutrition. The families also need help and counseling to really figure out what is going on with their, their fa with their kids. And we also see new things every day. And I think that's one of the things we're gonna talk about today.

 

[00:03:53] Tanya Altmann, MD: But I'm seeing more kids with anxiety. And autism and pans or pandas and mental health issues, or just recurrent infections, more autoimmune issues, more obesity, things that we didn't see as much of 25 years ago. And I find that that all takes more time to really be able to best help my families. 

 

[00:04:12] Adelina Brisbois, LMFT: Well, yeah, you have to dive deep and kind of try to understand when this started and, and it's like a puzzle, right?

 

[00:04:17] Adelina Brisbois, LMFT: You're trying to. 

 

[00:04:18] Tanya Altmann, MD: It's a 

 

[00:04:18] Adelina Brisbois, LMFT: mystery. 

 

[00:04:19] Tanya Altmann, MD: And that's what's so fascinating and also exciting about it and why I love general pediatrics is that you really get to help work with parents, um, to put these complex puzzle pieces together and figure out the best solution or treatment plan for the kids, 

 

[00:04:33] Adelina Brisbois, LMFT: right? 'cause you have to work together.

 

[00:04:34] Adelina Brisbois, LMFT: The parents have information and you have information. And if you put that information together, maybe you get somewhere new. I, this is what I, we, I love this about you, that you're not afraid to explore. Think outside the box. I didn't realize. So you. You were trained with people who were willing to think outside the box and that I 

 

[00:04:51] Tanya Altmann, MD: was, even though though we didn't have time and we were super busy back then, we would still meet after work and discuss the um, unusual cases.

 

[00:05:00] Tanya Altmann, MD: Mm-hmm. And you know, and this was also when I trained at UCLA and when I was first practicing. We didn't have super easy access to the internet. The charts were still paper, right? And so it really took collaboration and discussions and going to libraries and pulling old papers and studies and looking stuff up to sometimes figure out the cases that we were faced with.

 

[00:05:19] Adelina Brisbois, LMFT: Probably took a lot more time than it did does today. Yeah, you could just look it up now. 

 

[00:05:23] Tanya Altmann, MD: Yeah, now we have open evidence and you can just toss anything in and find out all the medical research and papers 

 

[00:05:28] Adelina Brisbois, LMFT: I just learned about open evidence. That's so cool. It's like a chat GBT for doctors, is 

 

[00:05:33] Tanya Altmann, MD: that correct?

 

[00:05:34] Tanya Altmann, MD: It's, and it can pull all the studies, so I'll say, you know, find me all the research papers on a child that has strep throat and sudden onset OCD or something like that, whatever is going on, 

 

[00:05:45] Adelina Brisbois, LMFT: and then you can do your own research. Like you have access to your own research. You can read those papers and deduce what you want from that.

 

[00:05:53] Tanya Altmann, MD: Exactly. I don't have to drive all the way to UCL anymore and go to their medical library, which has shrunk in size over the years. Sure. 

 

[00:05:59] Adelina Brisbois, LMFT: Because of 

 

[00:05:59] Tanya Altmann, MD: this 

 

[00:05:59] Adelina Brisbois, LMFT: probably. 

 

[00:06:00] Tanya Altmann, MD: Yes. 

 

[00:06:01] Adelina Brisbois, LMFT: So, speaking of which, so you know, we are, we worked with kids. We've worked with kids for a long time and actually before we had kids, you taught us about pans and pandas.

 

[00:06:11] Adelina Brisbois, LMFT: Um, I don't know if you remember that you did like an in-service where we were working. I remember learning about it and thinking, oh, man, that's, that's really an intense thing that would happen to somebody. And then. It, it was close to our hearts. It, it kind of came really close to our family and so we, and, and some friends.

 

[00:06:29] Adelina Brisbois, LMFT: And so I started to dive really deep into learning more about it. Um, and you taught me the most about it, and you put me in touch with amazing referrals and resources of places that no more. So, um, I'd love to for you to just chat a little bit about that. Because I think there's a lot of families and, and clinicians that could know more, a little bit more about it.

 

[00:06:51] Tanya Altmann, MD: Definitely. And you know, I don't think I'm by any means an expert, but I always say when families come to me with new things that I don't know, I will be your partner in helping you figure this out. Because that's what my role is as a general pediatrician. 

 

[00:07:03] Adelina Brisbois, LMFT: Mm-hmm. 

 

[00:07:04] Tanya Altmann, MD: Now talking about my old practice in Westlake Village, um, with the amazing mentors I had, I remember even back then having a child come in with strep throat.

 

[00:07:13] Tanya Altmann, MD: Who seemed to get better and then all of a sudden came back in with OCD and ticks and really acting crazy and still had a sore throat. We rechecked it was still again strep, and so we retreated them with a more broad. Spectrum antibiotic and they got better. And that was one of those interesting cases that we all met about after work to talk about, 

 

[00:07:35] Adelina Brisbois, LMFT: because it didn't fit into a 

 

[00:07:36] Tanya Altmann, MD: box.

 

[00:07:36] Tanya Altmann, MD: It didn't fit into a box. And that was sort of my first like, Hey, is there something here going on? And then as the years went on, you know, we really would see more cases. And I remember. Another case, I had a pediatrician called me up and said something really unusual is going on with my daughter Tanya, and I'd love for you to help me figure it out.

 

[00:07:55] Tanya Altmann, MD: And I thought, well, you're a pediatrician at a major university in Los Angeles with access to all the experts. Why do you wanna drive an hour to see me? And she said, no one believes me. Mm-hmm. And I'd like to tell you my daughter's story and see if you can help me put the pieces together. And her story was her child was three.

 

[00:08:12] Tanya Altmann, MD: Caught chickenpox had one vaccine at age one as we usually do, but wasn't old enough yet to get the second. 

 

[00:08:17] Adelina Brisbois, LMFT: Okay. 

 

[00:08:17] Tanya Altmann, MD: So she caught chickenpox and immediately went into this spiral where, um, she started having separation anxiety and OCD and ticks and her handwriting deteriorated and her behavior deteriorated.

 

[00:08:29] Tanya Altmann, MD: And we went on this journey where we really delved into research around the country and realized that Dr. Sue Sudo had recognized pandas and pans as an actual. Disease state back in the late nineties at the NIH and done a lot of research more specifically with strep. And so what PANDAS is, it is a pediatric autoimmune neuropsychiatric disorder associated with strep and pans is pediatric acute onset neuropsychiatric syndrome.

 

[00:08:57] Tanya Altmann, MD: And essentially what it is, is a child will get an infection and then anywhere from days to weeks or even months later as their body is mounting an antibody response to help get rid of that infection. It somehow attacks their brain, specifically the basal ganglia, and they really kind of turn psychotic even overnight.

 

[00:09:16] Tanya Altmann, MD: And they can have a, which 

 

[00:09:17] Adelina Brisbois, LMFT: can be so scary 

 

[00:09:19] Tanya Altmann, MD: for parents. It is so scary. So scary. And when you know your patients well, or your kids well, and you see this change, it's like, this isn't my child anymore, right? This isn't my patient anymore. And um, the most common presentation would be a child has strep throat and then three to six weeks later, but it can vary.

 

[00:09:36] Tanya Altmann, MD: They will start having OCD. Ticks and behavioral changes and separation anxiety and frequent urination, especially at night, um, and even sometimes psychosis. Yeah. And we've been seeing more and more cases over the last 25 years that I've been practicing really to now where I really see it as a general pediatric disorder.

 

[00:09:56] Tanya Altmann, MD: And so I like to teach general pediatricians about it and how to recognize it. To be able to start treatment, even if they then do need to refer out to centers and hospitals like UCLA. Yeah. And bring therapists in. And I find it's both a medical and a psychiatric treatment. So ultimately the goal is to find that underlying.

 

[00:10:18] Tanya Altmann, MD: Cause if you can and treat that. But then there is also a mental health aspect. 

 

[00:10:23] Adelina Brisbois, LMFT: Right. 

 

[00:10:24] Tanya Altmann, MD: The other thing I wanna say, which I think is really important is over the last five years we have seen skyrocketing cases of pans and pandas from mycoplasma, pneumonia. And sometimes these are kids as young as preschool where they just have a runny nose and a cough.

 

[00:10:40] Tanya Altmann, MD: All year long because preschoolers have runny nose and coughs. That's all year long. 

 

[00:10:44] Adelina Brisbois, LMFT: Is that the one that's called walking pneumonia? 

 

[00:10:46] Tanya Altmann, MD: Exactly. Walking pneumonia. Unless you do a specific test for it, which now we can do a nasal swab test for it or throat swab. Whereas years ago it took a blood test to actually look for, to diagnose it.

 

[00:10:59] Tanya Altmann, MD: To diagnose it. Um, sometimes you can hear it on exam, but not always. And it's a little less clear because. Kids that age are constantly sick, right? 

 

[00:11:09] Adelina Brisbois, LMFT: They're always snotty. 

 

[00:11:11] Tanya Altmann, MD: Exactly. 

 

[00:11:11] Adelina Brisbois, LMFT: Especially they go to school or daycare. 

 

[00:11:13] Tanya Altmann, MD: Exactly. And so sometimes it takes that detective work when parents say, my child changed overnight, or they started having sudden onset ticks.

 

[00:11:22] Tanya Altmann, MD: And there's um, a neurologist at Cedar-Sinai who has been extremely helpful with my patients Dr. Jane tab. And um, and then there's also a rheumatologist at UCLA, Dr. Patrick Waylan and other experts in the community. And sometimes I even have to go out of state to Arizona. 

 

[00:11:39] Adelina Brisbois, LMFT: Yeah. 

 

[00:11:39] Tanya Altmann, MD: Um, or back east sometimes to, to get help.

 

[00:11:42] Tanya Altmann, MD: Um, but I've learned from every single conference I've been doing, every single expert I've talked to about how to help these patients. 

 

[00:11:49] Adelina Brisbois, LMFT: Yeah. It's really complicated. I think people, you know. Um, when their kids change overnight in their behavior, I think people go to blaming either themselves or the kids.

 

[00:12:01] Adelina Brisbois, LMFT: Like, it's like they're doing this on purpose. 'cause, you know, last week you could do, you could, you could handle this, and now all of a sudden you can't. So I think, I think it's true. I've heard a lot of people just not being believed, you know, because it, it doesn't really make sense. And that's part of what I think is so scary about this, which is why I, I want more people to know about it.

 

[00:12:20] Tanya Altmann, MD: Yeah. And the other thing I think, you know, um. Medicine is so great that we know. We do know so much, but new things pop up that we don't know yet. And during those 10 to 20 years where the research is evolving and the treatment plans are evolving, a lot of people seem to call things controversial or we don't know what to do.

 

[00:12:36] Tanya Altmann, MD: Or pediatricians might be younger, pediatricians might be scared to treat it when. As long as it's not dangerous. Alternative, really wacky therapies, like, you know, your job as a pediatrician, it's more of an art than a science sometimes. Mm-hmm. To really look at all the tools we have. So if children have, you know, recurrent.

 

[00:12:56] Tanya Altmann, MD: Symptoms of mycoplasma pneumonia, or they have high titers on blood work or strep or varicella or anything else, and the history is clearly there, then you do need to take a step back and look kind of at that underlying treatment. So, for example, um, we use a lot of Zithromax initially in these kids because it tends to cover mycoplasma and strep.

 

[00:13:17] Tanya Altmann, MD: Pretty well, but also it has an anti-inflammatory component. And while some of the component is treating the underlying infection, there's also decreasing all this inflammation in the brain, 

 

[00:13:27] Adelina Brisbois, LMFT: right, which is the basal ganglia. That's why we see the change in behavior and the potential psychosis and.

 

[00:13:33] Adelina Brisbois, LMFT: Dysgraphia. Right, 

 

[00:13:35] Tanya Altmann, MD: exactly. Exactly. And so that's why anti-inflammatories can also play a role. So whether it's ibuprofen or there's been some research that Aleve, actually Nexxen can work better than Ibuprofen in kids. But I find a lot of my patients don't tolerate Aleve as well as ibuprofen. Okay. Um, and.

 

[00:13:51] Tanya Altmann, MD: It's also so specific, so I have so many kids that respond well to Ibuprofen, so we will start them on the Zithromax and the Ibuprofen and see how they do while we also work on nutrition and supplements and meditation and mindfulness, and find them a therapist or psychiatrist. And sometimes we have to even bring in those medications as well, depending on how severe these kids are.

 

[00:14:12] Tanya Altmann, MD: I mean, I think. One of the hardest things about pans and pandas is that you have a percentage of kids that are very severe. Mm-hmm. And that's what's so scary about it. And those may even need to go on to getting IVIG. Or um, or other serious treatments, plasma, it's longer trajectory for some kids. Yeah, exactly.

 

[00:14:31] Tanya Altmann, MD: But there are some that if you catch them early and they're young, they can be treated very quickly with weeks or months of antibiotics, um, anti-inflammatories and therapy, and you don't really know until you start. So often when pediatricians call me and one called me from the city last week to say, Hey, I need your advice.

 

[00:14:49] Tanya Altmann, MD: I have this case. That I think could be pans or pandas. It was after mycoplasma, um, or strep. I forget because I hear from pediatricians on a weekly basis and while I'm waiting to get into UCLA in a few months, what should I do? And the patient got better. So much better after two weeks, the Zithromax and the Ibuprofen and the Magnesium and the Omegas and all the other two that we use.

 

[00:15:11] Tanya Altmann, MD: Um, and she was so thankful. And I, and I love that because I think the goal is like hitting them hard with everything to see if they get better. 

 

[00:15:18] Adelina Brisbois, LMFT: Right. 

 

[00:15:18] Tanya Altmann, MD: And lifestyle plays a big role too. So a lot of these kids are overscheduled, they're not getting enough sleep. They nervous eating too much. Junk system.

 

[00:15:25] Adelina Brisbois, LMFT: Yeah. Their nervous system is already high. And then now we have this biological change and. It's making it worse for the time. 

 

[00:15:31] Tanya Altmann, MD: Yeah. It's on overdrive, so it's like, okay, let's cut out a lot of these activities. Let's try to get rid of screens, right? Let's try to get them outdoors more in nature. Let's try to do these calming, regular bedtime routines.

 

[00:15:44] Tanya Altmann, MD: Let's really look at their diet, nutrition, and focus on. The protein and the healthy fats and the antioxidants and the fruits and vegetables and, you know, I use a lot of supplements too, you know, in, in that, in that realm as well, which I feel helped. You know, some, some don't. But I do think those can also help because I find that kids can't eat enough of that often on their own.

 

[00:16:03] Tanya Altmann, MD: Um, and a lot of these kids also, if we do poke them, and I don't poke all these kids 'cause I really don't like poking kids. You don't need to. 

 

It's 

 

[00:16:09] Adelina Brisbois, LMFT: if they're in a high. State, a high heightened state, it might be really hard. 

 

[00:16:13] Tanya Altmann, MD: Yes, exactly. But if we do have to get blood work, I often check a ferritin and vitamin D level as well, because I find that low ferritin, which so many kids nowadays have, which is a better indicator, I think, of low hemoglobin when you're looking for anemia.

 

[00:16:27] Tanya Altmann, MD: Um, and just getting that ferritin up can often help them with sleep, right? It can help them with behavior, it can help them get sick less often. Um, and then vitamin D as well. Too many kids nowadays have low vitamin D and that can also play a role, whether it's allergies or whatever's going on. We wanna get their vitamin D level optimized, but we also have to be careful because you can't overdose on vitamin D, right?

 

[00:16:46] Tanya Altmann, MD: Because it's fat soluble. 

 

[00:16:47] Adelina Brisbois, LMFT: And, and does that, all of that helps with inflammation, 

 

[00:16:51] Tanya Altmann, MD: right? It does, 

 

[00:16:52] Adelina Brisbois, LMFT: it does. So it kind of doesn't hurt. So this is my question. The stakes seem pretty low in the treatment of it, right? Like antibiotics, omegas, magnesium, vitamin D. What's the harm? 

 

[00:17:05] Tanya Altmann, MD: So I mean, I would say that I don't love putting kids on antibiotics long term, especially sometimes when we don't know if they need it because it is going to mess with their gut microbiome.

 

[00:17:14] Tanya Altmann, MD: Right. Right. Which I think is so important and probably one of the reasons that we're seeing, so more, more of these issues in kids now is because we know that babies aren't born with that bifidobacterial level that they need. Um, 

 

[00:17:25] Adelina Brisbois, LMFT: right. 

 

[00:17:25] Tanya Altmann, MD: A recent study, my baby biome showed that nine out of 10 kids in the US.

 

[00:17:29] Tanya Altmann, MD: Weren't born with the important infant specific bifidobacteria, infantis and others that babies need. And that's why we're seeing more autoimmune issues, inflammation, obesity, diabetes, allergies, you know, whatever. It's, and so I and my patients that are totally healthy, I try to correct that birth right away.

 

[00:17:45] Adelina Brisbois, LMFT: So 

 

[00:17:45] Tanya Altmann, MD: I'm really big on. The right probiotics, the right nutrition, the right lifestyle changes, um, for your babies early on. That's actually my next book I'm working on. Oh yeah. It's gonna be a longevity and wellness book for infants, um, and, and kids of, of all ages. And so hopefully I'll, I'll come back on when that's available in the next year.

 

[00:18:05] Tanya Altmann, MD: That would be great. I can tell you more about that. But my goal is preventing all of this, 

 

[00:18:08] Adelina Brisbois, LMFT: right. 

 

[00:18:09] Tanya Altmann, MD: Um, which I do in half my families, then the other half of the families I am trying to figure out. Why their kids have these unusual things that we need to, you know, work on and help them with. '

 

[00:18:17] Adelina Brisbois, LMFT: cause you don't always get people at baby, at the baby time.

 

[00:18:20] Adelina Brisbois, LMFT: Right, exactly. And sometimes when you know all this information, it's still hard to do it all. Um, I get, yeah, so I mean, my generation, when I grew up, I had, I was on antibiotics all the time and I think it did mess up my gut, actually. Um, so I totally understand why we don't wanna over-prescribe that. I, I don't like to give that to my kids either.

 

[00:18:39] Adelina Brisbois, LMFT: In this case, when the symptoms are so bad and the situation is really scary, then it feels like of the, of the medication to give, that feels like a less scary option. 

 

[00:18:51] Tanya Altmann, MD: And I agree with you. I mean, I just had a conversation yesterday with a specialist because I have a patient who's been on Zithromax for a year and a half.

 

[00:18:58] Adelina Brisbois, LMFT: Oh wow. That is a long 

 

[00:18:59] Tanya Altmann, MD: time due to mycoplasma, um, pans. But on Zithromax, he is an essentially normal child and he's doing amazing. But he's so sensitive to Zithromax that as soon as we wean him off. He basically turns psychotic again. And it's so interesting. That's 

 

[00:19:14] Adelina Brisbois, LMFT: so 

 

[00:19:14] Tanya Altmann, MD: hard. And um, and so the question is, is how long can he be on this?

 

[00:19:18] Tanya Altmann, MD: And of course, we're also supporting the gut and the rest of his body, and he's doing everything great. But if we miss two days in a row, he is having his ticks and his OCD and waking up at night again. And having what he calls brain episodes during the day at school where he says, and, and what's interesting to me is little kids with pans and pandas, they tend to just act crazy and psychotic.

 

[00:19:40] Tanya Altmann, MD: But the older kids, the ones that are 9, 10, 11, 12, especially the ones that are very smart, they can describe what's going on and they will say things like, my brain feels like it is jumping around in my head trying to get out. Or I have a nest of bees in my head trying to buzz and help themselves out. Or there's something in my body that needs to get out.

 

[00:19:59] Tanya Altmann, MD: Make it stop happening, and they're jumping up and down trying to get it out of their body, and it's just. So that's kids feel 

 

[00:20:07] Adelina Brisbois, LMFT: they just don't have the words. 

 

[00:20:08] Tanya Altmann, MD: Exactly. Exactly. And it's so heartbreaking to me. And so, um, sad but also interesting to really hear them describing it. Like they'll come up from school and they'll say, I had three brain episodes today.

 

[00:20:20] Tanya Altmann, MD: Um, one was two minutes when I was taking my test at school. One was during recess when I was playing this, and they can literally describe it to you and then they'll say like, I haven't had a brain episode for a few weeks. I'm so glad you think it's gone. Or when am I gonna be able to stop taking these medications and supplements?

 

[00:20:39] Tanya Altmann, MD: Um, so, but yes, if it's helping, we usually tend to continue it. Now there are kids where nothing helps and then I'm referring them to specialists and we are doing stronger things like IVIG. Mm-hmm. Um. Another area that I'm learning about now are herbal supplements, and that's something that I really don't know much about, but a lot of herbals can act as antimicrobials.

 

[00:20:59] Tanya Altmann, MD: Okay. And also maybe be helpful in addition to the antibiotics. Um, so that's something that I'm trying to learn more about because when I've sent kids patients to specialists, they come back sometimes on antimicrobials that are helping, I'm sorry, on herbal herbs that are helping like 

 

[00:21:13] Adelina Brisbois, LMFT: preventative for the next infection, or still trying to get rid of the infection that is already existing.

 

[00:21:19] Adelina Brisbois, LMFT: Both. 

 

[00:21:19] Tanya Altmann, MD: It's a good question and it, it could be both. Again, I'm learning more about this. Um, and again, this goes back to like ancient medicine, right? 

 

[00:21:27] Adelina Brisbois, LMFT: Yeah. 

 

[00:21:27] Tanya Altmann, MD: And some of the plant therapies and things that, um, I wonder 

 

[00:21:30] Adelina Brisbois, LMFT: about that. 

 

[00:21:31] Tanya Altmann, MD: Yeah. And, and again, it's an area I don't know about, but I'm willing to learn when I have patients on it, I look it up and I see, oh, this combination.

 

[00:21:39] Tanya Altmann, MD: Of herbs, which seems safe and aren't dangerous anyway, you know, may help decrease mycoplasma levels or strip levels or you know, whatever it is going on. Oh, and in the case of the varicella, it was antivirals that helped. And in fact, 

 

[00:21:52] Adelina Brisbois, LMFT: I was gonna ask you about that. 'cause 

 

[00:21:53] Tanya Altmann, MD: she improved so much from an antiviral that we actually started a study on giving kids with tics, acyclovir, and antiviral to see if it helped.

 

[00:22:03] Tanya Altmann, MD: And it helped in about half of the cases 

 

[00:22:05] Adelina Brisbois, LMFT: really. 

 

[00:22:05] Tanya Altmann, MD: Now we ended up, you know. Not finishing the study because we were doing other things and it wasn't helping everyone. And you know, there's also reasons not to give kids antivirals if we don't know, since there are some ticks that are self-limiting and we'll get better on their own, but.

 

[00:22:21] Tanya Altmann, MD: I do feel that the basis for a lot of ticks in kids is infectious. And I think we need to learn more about that. 

 

[00:22:28] Adelina Brisbois, LMFT: And I think a lot of people are not looking at it like that, you know? 'cause for us as mental health clinicians, we get the behavior piece. We get the kids that are coming to us because. The parents are wanting us to help with that piece.

 

[00:22:40] Adelina Brisbois, LMFT: The behavior, sometimes the OCD May and, and I think a lot of times people don't even see behavior as O-C-D-I-I actually, yeah. When, because, so you, when you taught us this in like, I don't know what it was, probably 2017. Um, I, you know, 'cause I've worked with little kids for my whole career. And I, I think back and I think, how many of these cases did I miss over time?

 

[00:23:02] Adelina Brisbois, LMFT: Because, you know, I would've probably seen a kid that came in like this and I would just do what I knew how to do. I wouldn't necessarily think about it in this lens that we're talking about, where it's like multifaceted with medication, because that's not my scope, right? As a clinician, as a, as a MFT, my scope has nothing to do with medication.

 

[00:23:23] Adelina Brisbois, LMFT: But once I, I learned more about this, like I said, through doing my own research, my own experience with friends and family, I realized that, um. Sometimes the, our job as the clinician is to give the resources, like, go to your pediatrician and ask for this and like, do your own research and see if this fits for you.

 

[00:23:43] Adelina Brisbois, LMFT: And sometimes parents are really afraid. Like they do the research and they read about the really scary 

 

[00:23:49] Tanya Altmann, MD: yes 

 

[00:23:49] Adelina Brisbois, LMFT: situations and they're like, I, this is not my kid. I don't want this to be my kid. And then sometimes they feel really relieved. And say, yes, this explains it. This, this, you know, fits for me. Um, I think it's hard because I think we don't, there's so much we don't know.

 

[00:24:03] Adelina Brisbois, LMFT: Like even when you, you what you were just describing about the few cases, there still seems to be some mystery, some pieces of the puzzle missing. Right? 

 

[00:24:13] Tanya Altmann, MD: There are, and don't forget that a lot of these symptoms also can be normal in little kids, right? For example, like. Three-year-olds are going to go arrange the pillows in your house the way that you had them at the beginning and not like when they're out of order, is that OCD or is it not Right?

 

[00:24:29] Tanya Altmann, MD: Or when they line up their stuffed animals before they go to bed in a certain way. Mm-hmm. So it's when a lot of these things start really interfering with. Behavior or when you have a child that was jumping outta the car, excited to go to preschool and all of a sudden they are kicking and screaming and refuse to get outta the car.

 

[00:24:44] Tanya Altmann, MD: That is separation anxiety. Right? And yes, if you had a crazy day before and they didn't sleep and they ate too much sugar in the morning and a lot of other things were lined up, it could just be that they were having separation anxiety that morning when they're three. But when these things continue and they're waking up at night and, and you know, and having a lot more frequent urination and all the different symptoms, and that's why pans and pandas is more of a clinical.

 

[00:25:05] Tanya Altmann, MD: Diagnosis and there are some great tools online now. There's the Pan Pandas network, there's the Pace Foundation, there's the, um. Stanford has a group. Mm-hmm. The Neuro Immune center. And, and the 

 

[00:25:18] Adelina Brisbois, LMFT: Arizona. 

 

[00:25:19] Tanya Altmann, MD: Arizona, that's the, the Pace Clinic. Oh yeah, 

 

[00:25:21] Adelina Brisbois, LMFT: that's 

 

[00:25:22] Tanya Altmann, MD: right. And, um, they, they have a lot of checklists too to help you figure out, um, what is going on and even.

 

[00:25:29] Tanya Altmann, MD: Ticks, for example, like a lot of neurologists will say, oh, it's just a benign tick. And yes, a lot of times it isn't. It will get better anyway when stress levels go down, when kids are healthy again. But then sometimes it's the beginning of a spiral and it can be something else. The other thing I find unfortunately is some kids, we will get them better and, and, um, typically I find it takes months to a year to really get better and then they're good.

 

[00:25:56] Tanya Altmann, MD: For a few years and then they get another infection, another strep infection, 

 

[00:26:00] Adelina Brisbois, LMFT: and it comes 

 

[00:26:00] Tanya Altmann, MD: back or another mycoplasma infection and then all of a sudden it comes back overnight. And as a parent, you're like always on, on high alert. Um, and that's something we also didn't talk about, but in some of these cases.

 

[00:26:11] Tanya Altmann, MD: We may recommend, um, getting the tonsils out if there are frequent, oh yes, that's strep cases or other infections. And when I talk to some ENTs, they will say, you know, even if the tonsils look okay on the outside, when we do take them out, there's so much infection hidden under there that we didn't realize and it's so close to the brain.

 

[00:26:27] Tanya Altmann, MD: Could that be why it's feeding this inflammation in the brain? Um, and again, we don't really know when You don't wanna have kids have surgery if they don't need it. Of course. So that's sort of one of the issues. It depends on the situation. Yeah. It really depends on the situation. And so sometimes you're deciding between tonsils out or IVIG or other medications.

 

[00:26:46] Tanya Altmann, MD: And again, like often at that case, there are specialists involved and I'm helping families navigate this, but it's, it's not me making those, you know, making those decisions. 

 

[00:26:55] Adelina Brisbois, LMFT: But same with the tonsils. Like when I was a kid, I remember everyone got their tonsils out. If you got sick a couple times in a year, you got your tonsils out.

 

[00:27:01] Adelina Brisbois, LMFT: Like my brother got his tonsils out. I, I, I remember it, you know, it wasn't uncommon. And I, I am imagining, you know, that it probably, the standards have changed, right? For care, 

 

[00:27:12] Tanya Altmann, MD: the pendulum is swinging back again. So you're right. Tonsils and even adenoids out were very common when we were younger, and I'm a lot older than you's.

 

[00:27:20] Tanya Altmann, MD: And then we went through a period where we didn't wanna do surgery on kids. Um, but now that we're back to seeing more infections, more issues with sleep, um, I am in my practice finding more kids for all sorts of reasons that. Do unfortunately need their tonsils and adenoids out because they have snoring, sleep apnea, recurrent infections.

 

[00:27:42] Tanya Altmann, MD: And um, and again, I think a lot of this has to do with just the increase in illness and autoimmune and inflammation that we are seeing. Whether it stems back from the gut microbiome, you know, the COVID pandemic when we were all indoors and not exposed to things and now we're all being exposed again. Um, you know, I don't really know.

 

[00:27:59] Tanya Altmann, MD: Right. But, um, but there are people a lot smarter than me that are working on trying to figure this out. 

 

[00:28:05] Adelina Brisbois, LMFT: I think it's interesting about autoimmune diseases in general. You know, I, I think that we don't know that much. I don't know about that much about them, and, um, I wonder how much we'll know in the next 10 years about Yeah.

 

[00:28:17] Adelina Brisbois, LMFT: How to, what to do about it. 

 

[00:28:19] Tanya Altmann, MD: There also is in kids with pans and pandas, we often find that there is a parent that has an autoimmune condition, but sometimes the parents don't know yet. Right, right, 

 

[00:28:28] Adelina Brisbois, LMFT: right. 

 

[00:28:29] Tanya Altmann, MD: Or there's some family history of a little bit. Like they might say, oh yeah, dad had ticks when he was younger and has celiac or rheumatoid arthritis.

 

[00:28:38] Tanya Altmann, MD: But that's could be a setup, you know? And there's so many. Genes and variants that we don't know about. In fact, I was recently at an autism genomics conference again, because I'm always looking to, to learn new things to help my patients and um, and there is a lot that's passed on from kids, from parents to kids.

 

[00:28:56] Tanya Altmann, MD: But when you look at autism, we're also learning that half of the gene variants are actually de novo, which means they develop when parents are pregnant as well. 

 

[00:29:05] Adelina Brisbois, LMFT: Oh 

 

[00:29:05] Tanya Altmann, MD: really? Um, so, so therefore it doesn't always mean there's gonna be a family history. And, um, and that's another whole area that, again, I'm trying to learn about, but it can also be overwhelming, you know, as a, as a pediatrician, how much time do you have?

 

[00:29:19] Tanya Altmann, MD: Um, you know, and often I'll refer my, my patients out to those who know more. But I have done some genomics testing from intellect, DNA in my families that have pans, pandas, autism, or, or other things that we're just trying to figure out. 

 

[00:29:32] Adelina Brisbois, LMFT: Do you feel like it gets confused sometimes? Like misdiagnosed? Those, those the pans or autism or any other neurodivergence.

 

[00:29:41] Tanya Altmann, MD: I mean, I think there can be a lot of overlap too. Mm-hmm. So it can be, it can be tricky, right? 

 

[00:29:45] Adelina Brisbois, LMFT: It could be both. And 

 

[00:29:46] Tanya Altmann, MD: yeah. When I talk to autism specialists, um, which I am not, but those who see, um, you know, a great portion of autism kids in their practice, they do feel that they see more pans, pandas in the children with autism.

 

[00:30:01] Tanya Altmann, MD: And that can be tricky to which one came 

 

[00:30:04] Adelina Brisbois, LMFT: first, you know? 

 

[00:30:06] Tanya Altmann, MD: You know, I, I don't know. I think I'm, you know, in, in many cases you can see signs of autism younger Oh. And then the pan pandas might all of a sudden suddenly happen. Right. And again, that went, that would be more of a developmental behavioral pediatrician that would probably Sure, sure.

 

[00:30:19] Tanya Altmann, MD: Yeah. Refer to, and I did a podcast with Dr. Chu Batra, who's amazing, um, neural developmental, um, pediatrician in, um, in Westwood. And we were, we were talking about this, it was more of, it was a. Podcast where we talked about autism and Luca Vaughn and some of the stuff that's been in the media recently and our thoughts on that.

 

[00:30:37] Tanya Altmann, MD: And you know, I defer to her on a lot of that since that's her specialty. 

 

[00:30:41] Adelina Brisbois, LMFT: Yeah, I, I know it, there's, there's a lot, there's a lot of conversation about this subject and it's hard because when you're, when we work with parents, usually parents just want to help their kids. That's it. End of story, whatever it is.

 

[00:30:54] Adelina Brisbois, LMFT: And sometimes a diagnosis is helpful and sometimes it's really not. Sometimes it's, yeah, it's just a name and just a label. And, but really they, people say to me like, but what do I do about it? How do I just get my kid to not be suffering? Because that's what we don't want. Right. You, you, the examples you gave and we've seen in our office, um, just kids suffering.

 

[00:31:17] Tanya Altmann, MD: Yeah. And that is, that is really hard. And you know, something that I. I try to help with, and I feel like as a pediatrician I wanna help and fix everybody, but that's not, you know, always possible. So I'll just do my best. Um, in terms of the diagnosis, you're right. In some cases we just wanna help the symptoms and it doesn't matter what the diagnosis is, but in some cases it can help guide us.

 

[00:31:36] Tanya Altmann, MD: And I, I talk about this a lot when I'm talking about. Um, A-D-H-D-I do a lot of integrative A DHD in my practice. And, um, I find that sometimes you do need that full neuropsych evaluation because there's a lot of overlap between A DHD and anxiety. 

 

[00:31:51] Adelina Brisbois, LMFT: Exactly. 

 

[00:31:52] Tanya Altmann, MD: Or PTSD, and they're treated differently. 

 

[00:31:55] Adelina Brisbois, LMFT: Right.

 

[00:31:55] Adelina Brisbois, LMFT: And if you're treating the wrong one and it's not getting better, it's 

 

[00:31:58] Tanya Altmann, MD: not gonna help. Yeah. And I find that like, especially with A DHD, which I know isn't what we were necessarily talking about. But there are so many ways you can help kids with A DHD really succeed in school and life. And sometimes when they're not, I find it's because there's another diagnosis that's missing, that's 

 

[00:32:12] Adelina Brisbois, LMFT: hiding.

 

[00:32:13] Adelina Brisbois, LMFT: Maybe it's, and I 

 

[00:32:13] Tanya Altmann, MD: wanna take a step back and re-look at the evaluation and find out if there's something else going on there that we were missing. 

 

[00:32:19] Adelina Brisbois, LMFT: I'd actually love to talk about that a little, if it's okay with you. 'cause I think that. You're right. I mean, we see this too. There's a, like we treat in our intensive outpatient program, we treat depression and anxiety, right?

 

[00:32:30] Adelina Brisbois, LMFT: But that can look like so many different things in, in how the kids present. And sometimes they come in, we think it's anxiety, but then the more we get to know it, it's actually turns out to be something more specific. Maybe it's an eating disorder, maybe it's OCD. Maybe it's a DHD and so much of our job ends up being the detective work, you know, ruling out, trying to understand it, sending people to testing sometimes, you know, to, because like you said, it's very helpful at times.

 

[00:32:58] Adelina Brisbois, LMFT: Um, and I would love to know more about your experience. Uh, I don't. I dunno. 

 

[00:33:05] Tanya Altmann, MD: Yeah, I mean, and you mentioned the restrictive eating or eating disorders and that's actually also can play a role with pans and panties, which we mentioned. Mm-hmm. And again, that's not my expertise, but I actually share office space with Dr.

 

[00:33:16] Tanya Altmann, MD: Leslie Kaplan, who does specialize in eating disorders and arfid and restrictive eating. So luckily, you know, she can help my families when it, when it comes to that. That also can be a flag that there's something else you need to look for. Um, but I agree it can be, um, hard to put the pieces together or to kind of figure out what's going on, and that's why I'm so thankful that I can spend more time with my families.

 

[00:33:38] Tanya Altmann, MD: Yeah. And also refer out to specialists because. I am not the best one to really differentiate always is this A DHD, anxiety, PTSD, what is going on? But when I refer to the therapist, the psychologist I work with the neuropsych right specialist, they can help. And that's why I love having conversations and I love that I have time to do that.

 

[00:33:58] Tanya Altmann, MD: Um, and I'm so thankful when people like you call me and say, Hey, I was just working with one of your families. Have you thought of this? And I'm like, oh. Well, thank you for seeing it from a different lens and helping me take another look at how we could maybe, you know, tackle their problems and try to help treat them.

 

[00:34:12] Adelina Brisbois, LMFT: Yeah, because we're looking at, like, I'm asking different questions that you're, than you're asking probably, you know? Yeah. Because I, I have a different scope, so I might get information that you may not get and vice versa. Um, and I think for parents, like guiding them too, guiding them on what to look for.

 

[00:34:27] Adelina Brisbois, LMFT: Like the questions that I ask now are different than the questions I used to ask. You know, I have, I just have seen more things. So when someone calls and just says like, yeah, my child was doing just fine, you know, and in school and with friends, and then all of a sudden there was a change. My next question is always, have they been sick?

 

[00:34:45] Adelina Brisbois, LMFT: When's the last time, you know, they had an illness? And then, you know. Sometimes that's helpful and sometimes it's really not. Sometimes parents are like, I don't know. Why are you asking that? It feels random. It feels out of the conversation, and so I'll explain a little bit as to why. I do think that there is, um, with kids to see each kid as what they have and what they're showing and what they're struggling with.

 

[00:35:09] Adelina Brisbois, LMFT: Like with A DHD, is it, is it impacting them? Is it disrupting them or is it okay? Is it so far serving them? You know, because some kids do just fine with these symptoms and they still function.

 

[00:35:25] Tanya Altmann, MD: If I leave, well, as long as I leave here at 1130, I'll be okay. Okay. Yeah, yeah, yeah, yeah. 'cause it's at noon is my, is my patient, so, or Okay. I didn't know if that was me, so it wasn't me. Okay. So maybe like 10 more minutes and then 

 

[00:35:40] Adelina Brisbois, LMFT: we'll, okay. Um, okay. Uh, there's so much I have, I have so much to ask you. So, okay.

 

[00:35:48] Adelina Brisbois, LMFT: What were we saying? We were talking about parent. Oh, parents. She'll come back. Yeah, I know. I'm excited about that. Well, that's a whole nother subject with this, which is about babies, which I feel 

 

[00:35:58] Tanya Altmann, MD: at any age, it's never too late to really start working on healthy lifestyle and nutrition. And gut and 

 

[00:36:06] Adelina Brisbois, LMFT: why don't more people talk about that?

 

[00:36:08] Adelina Brisbois, LMFT: That's what I wanna know because I, you know, I've been, I always, I had some, I had stomach issues my whole life and turns out it was probably heavily anxiety related that I just didn't know because I was, my family and myself, we were not in the world of knowing that anxiety can have somatic symptoms.

 

[00:36:25] Adelina Brisbois, LMFT: And for me it was stomach aches and still is at times where that's how I feel my stress. But, um. I just wish more people knew about and talked about. Gut. The gut and how important it is. 

 

[00:36:39] Tanya Altmann, MD: Yeah, I mean, I think there's also so much we don't know, right? So like sometimes I do do gut microbiome testing on my patients.

 

[00:36:46] Tanya Altmann, MD: I use tiny health um.com, which anyone can order. But again, we're still learning how to interpret it and what it means and what are the good gut bacteria. I mean, we know that. For babies, bifidobacteria infantis plays a big role. Other bifidobacteria such as breve and longum. Um, but then you also, you not only need the good gut bacteria, but you need to feed them with the HMOs, the human milk, oligosaccharides, and breast milk or the healthy fiber.

 

[00:37:12] Tanya Altmann, MD: And then as you get older, the gut diversifies and so, so it changes what it changes. You know, I think there's, there's a lot we don't know. When I talk to some gut microbiome specialists, they will actually tell me, Hey, by looking at a teenager or adult's gut, I can actually predict if they have any diseases, if they have inflammatory bowel disease.

 

[00:37:31] Tanya Altmann, MD: Um, I talked to one gut, 

 

[00:37:32] Adelina Brisbois, LMFT: like the leaky gut is that, that's an indicator. 

 

[00:37:35] Tanya Altmann, MD: So, so leaky gut is a term that was used when there's increased permeability in the gut, which does have to do with some microbiome changes. Okay. But also just that certain. Um, things are passing through, which necessarily shouldn't, or there's a breakdown like in the lumen and.

 

[00:37:52] Tanya Altmann, MD: It's hard to test for. It's very complicated and complex, and I think we don't have a lot of definitive answers on that yet. Mm-hmm. Um, so I think in general, you know, taking a good quality probiotic, eating fermented foods, drinking keefer, eating kimchi if you will, um, kombucha, high fiber cereals, lots of fruits, vegetables.

 

[00:38:11] Tanya Altmann, MD: Those are all good. We know those are great. Mm-hmm. No one's gonna argue with that. Okay. But when you get down to the nitty gritty of. You know, what bacteria do you need and what level and how you should take them and are they gonna stay put and colonize? I think that's where, you know, there's, we need more research.

 

[00:38:25] Tanya Altmann, MD: Um, and so I think, I think it's hard on a population level mm-hmm. To give guidelines when there's still so much we don't know. But I think that's one of the great things about being a general pediatrician or general practitioner, is that you look at every child differently and it's not just protocols and when.

 

[00:38:43] Tanya Altmann, MD: You know when a child has stomach pain, like you were saying, and you've already ruled out all the serious stuff, right? Yeah. So you've made sure it's not inflammatory bowel disease and celiac and ulcers and reflux and h pylori, you know, then we can dive a little deeper into, um, you know, some of these things and see if anything helps.

 

[00:39:01] Tanya Altmann, MD: But, um, one of the other things that I sometimes see, and this sort of kills me, is that. Some practitioners go straight into the integrative, holistic stuff, and then the kids get to me and I'm like, whoa, no one's ruled out the serious things and your child actually has something more serious going on.

 

[00:39:16] Adelina Brisbois, LMFT: Yeah. 

 

[00:39:17] Tanya Altmann, MD: So I think it is important to really look at all of that. 

 

[00:39:20] Adelina Brisbois, LMFT: There's a balance between it 

 

[00:39:21] Tanya Altmann, MD: all. Yes. And I always say like, I couldn't have practiced integrative medicine right out of residency. I needed that 15 years of really medical, serious, you know? Um. 

 

[00:39:32] Adelina Brisbois, LMFT: To rule out 

 

[00:39:33] Tanya Altmann, MD: the big stuff. Yeah. To be able to rule out the big stuff.

 

[00:39:35] Tanya Altmann, MD: And training at UCLA makes you realize like when, how you can tell if kids are really have something's real serious or not. Um, I had a college student come into me last week, um, complaining of gut issues. And honestly my feeling was that even though I was gonna do the whole workup, it was probably gonna come out being stressed.

 

[00:39:53] Tanya Altmann, MD: Poor nutrition. Some of the substances college students like to take. And, um, and that we really need to just work on nutrition supplements and gut microbiome. But we actually discovered that she might have inflammatory bowel disease and she's getting a workup from a GI doctor. And, um, and so taking those first few steps to really reel out the serious things was really important.

 

[00:40:12] Tanya Altmann, MD: Yeah. Um, you know, before we went on the other things. So you don't wanna miss anything serious that does need treatment. Right. 

 

[00:40:18] Adelina Brisbois, LMFT: I remember being very young and having to do a colonoscopy and endoscopy, and I remember, I remember it. I mean, it was terrible. I was a little kid. Um, but yeah, it was that, that was them ruling out all the big stuff probably.

 

[00:40:31] Adelina Brisbois, LMFT: Yeah, exactly. And they concluded that, you know, it was probably just anxiety, which it was, I mean, what I know now, you know, working with kids totally was, but um, the somatic way that our bodies express it, sometimes people miss that. 

 

[00:40:47] Tanya Altmann, MD: Yeah. And we also didn't talk about the role that biofeedback or neurofeedback mm-hmm.

 

[00:40:51] Tanya Altmann, MD: Could also play. But there are other tools out there which I've anecdotally seen be very beneficial in my patients. 

 

[00:40:58] Adelina Brisbois, LMFT: And again, the risk is low. I think when it's your kids, you don't wanna take risks. So, um, all the stuff that we're talking about today just has felt like, okay, well, what's the harm? That's always what I tell my friends.

 

[00:41:09] Adelina Brisbois, LMFT: Like, when my friends are like, what do you think about this and that, I always say, well, what, let's look at what, how could this hurt your kid? And then if there's, if there's real reasons, then maybe you have more caution. But if. Like an Epsom salt bath is an example that I think is really low stakes. 

 

[00:41:24] Tanya Altmann, MD: Yes.

 

[00:41:24] Adelina Brisbois, LMFT: Like really it is not gonna hurt. 

 

[00:41:26] Tanya Altmann, MD: I agree. And we do know that magnesium is important. Yeah. And when I've looked at gene variants in some of my patients with neurodevelopmental issues, I've found they don't absorb magnesium through their gut. So in that case, a magnesium bath, which is relaxing, is a good nighttime routine.

 

[00:41:40] Tanya Altmann, MD: You're doing that anyway. Routine anyway. Yeah, exactly. And um, you know, and so sometimes I say, you know, when is the science enough? Mm-hmm. Because it's gonna take 10 years to 20 years to really solidify some of these things. 

 

[00:41:54] Adelina Brisbois, LMFT: Exactly. And we're gonna wait that 

 

[00:41:56] Tanya Altmann, MD: 10 years, but when there are a few studies there, when you do show that it has helped patients and um, and it doesn't cause any harm, then yes.

 

[00:42:06] Tanya Altmann, MD: I feel like my role as a pediatrician is to keep looking and searching and trying things until I really feel like we've done everything we can to help this patient. Sometimes I search around the country and around the world too. 

 

[00:42:16] Adelina Brisbois, LMFT: I know. And I so appreciate that about you. I think that's really special and I hope that that more people could, you know, seek knowledge that way because I think that's how we can help.

 

[00:42:27] Adelina Brisbois, LMFT: And speaking of being a helper, and this is why we look for the helpers like you. And I guess lastly. What would you say to parents listening that maybe are worried about their child? What are, what are the things they can do to look for, or who do they call? Where do they start? 

 

[00:42:43] Tanya Altmann, MD: I mean, I think starting with your pediatrician is really important.

 

[00:42:47] Tanya Altmann, MD: I know a lot of families. Due to our crazy healthcare system, may not feel like they have a great relationship with their pediatrician. Or they'll go once and if they don't like the answer, they'll jump to someone else. And I say, you actually wanna keep going back and getting to know them because they take steps.

 

[00:43:00] Tanya Altmann, MD: They have to rule out some of the serious things and really work on it before they get to the point. Like, okay, now it's time to think outside the box. Mm-hmm. So please stick with your pediatrician. Develop that relationship, keep going back. And then, you know, hopefully they can refer you to mental health providers, but they can also look for mental health providers on their own.

 

[00:43:18] Narrator: Mm-hmm. 

 

[00:43:19] Tanya Altmann, MD: Um, and that can play such a role in helping kids. I mean, we know how important that support is as well. And read and listen to podcasts like yours and, um, and keep searching because parents. They will do anything to help their kids. Yes. And I've learned as a pediatrician, listen to parents. Yes.

 

[00:43:37] Tanya Altmann, MD: They're not crazy. They know what's going on 

 

[00:43:39] Adelina Brisbois, LMFT: because no one cares about this kid more than their, their parent, 

 

[00:43:43] Tanya Altmann, MD: you know? Exactly. 

 

[00:43:44] Adelina Brisbois, LMFT: And I know when anything happens to my kids, it's like the mama bear comes out, you know, I'm nice and friendly, but if you mess with my kids, I, it's different, like a different part of me, you know?

 

[00:43:53] Adelina Brisbois, LMFT: And I, and. You know, when we work with parents and we see they're in distress, they're scared. They're not always the best version of themselves because they're just trying to survive and get their kid the help. And I, I respect it, but it is difficult sometimes because, um, when people are in fear. They're struggling.

 

[00:44:11] Tanya Altmann, MD: So that's, yes, they are. It can be disruptive for the entire family. Exactly. When the entire family isn't sleeping because the child is up running around the house all night long. Of 

 

[00:44:19] Adelina Brisbois, LMFT: course 

 

[00:44:19] Tanya Altmann, MD: it's everybody suffers 

 

[00:44:21] Adelina Brisbois, LMFT: and then you go, you spiral like, well, what you know, is this gonna be forever? What does this mean?

 

[00:44:26] Adelina Brisbois, LMFT: Is there something wrong? Like, are they gonna be able to have a job? You know, like that. The natural thing that parents do. Um, so I just really appreciate you sharing what you know and, um, 

 

[00:44:38] Tanya Altmann, MD: and what I don't know 

 

[00:44:39] Adelina Brisbois, LMFT: and what you don't know, because that's really real and vulnerable too, like Yeah, I think people need to remember that, that we don't know everything that.

 

[00:44:46] Adelina Brisbois, LMFT: Um, I know that a lot of my friends and also, um, clients, they want answers and they say like, well, what do I do? Gimme an exact protocol on what to do. 

 

[00:44:57] Tanya Altmann, MD: Yeah. 

 

[00:44:57] Adelina Brisbois, LMFT: And it's really hard because there's not one size fits all because we're all so different. And so anyway, I just thank you for your time and um, yes, we will have you back so you could talk more about the other, many, many subjects we could talk about.

 

[00:45:10] Adelina Brisbois, LMFT: We could probably have a couple episodes together. 

 

[00:45:13] Tanya Altmann, MD: Well, thank you for today. Thank you so much for having me.