PANS Clinic
As a physician treating families and working in the mental health space, I began seeing cases of PANS/PANDAS and noticed that these families struggled to find doctors who knew about this condition. It is particularly close to my heart as my son is one of those children, and we have been in the position of looking for care. I resolved to carve our space in my practice to see and treat these families. I believe you are experts in your bodies and in your children's care. My role is as a partner in that care to help empower you to find health and balance through a holistic approach.
Consultations
Making an Appointment
All consultations are virtual (by zoom). You will meet directly with Dr Roth for 30 - 60 minutes dependiding on what is needed. For many parents and patients this is the first time they have had a chance to be fully heard.​
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Intake: Please fill out the intake form before your appointment​
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Enrollment: Open your (or your child's) chart and lines of communication with the doctor through your enrollment. This is for one consult (month), and you can then decide if you wish to continue beyond that.
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Scheduling: Self-scheduling is available for appointment between 2am - 7pm EST Sundays and Tuesdays. If you need an alternative time, please reach out (Welcome@DrRothMD.com).
Note: For young patients, I prefer to meet the patient even for a few minutes. Sometimes this is not possible or desired and parents are simply looking for information and to speak with the doctor, and this is fine for a first discussion.
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What to expect:
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We will review the symptoms and diagnosis and discuss your questions.
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We may order labs though they are often not necessary for the diagnosis (made clinically).
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We may decide on a medication regimen in which case these will be prescribed to the pharmacy of your choice.
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Cost and Payment:
I am committed to keeping care as affordable and accessible as possible, and therefore use a "Direct Care" model which means you having unbroken access to your doctor. This is critical for staying on top of your child's help and eliminating the barriers and red tape which is so frustrating. ​
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​No insurance necessary. As a solo practice, I do not have the ability to process insurance yet.
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The cost is $299 for a consultation ($170 upon scheduling and $129 upon completion). If you decide to remain in my practice under my care, it is $129/month for access to the doctor, prescriptions, ongoing questions. Email, text, easy access to appointments and refills (no long waits), and flexibility without having to pay per interaction.
Consultation
Get a diagnosis and treatment at a single meeting
Monthly Membership
Get continuous access to your doctor for ongoing check-ins and care
Referrals
Get a letter to your pediatrician, PCP, or other; or referrals for IVIG
Common Questions
Could my child have PANS/PANDAS?
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Did you notice a sudden start to OCD or Restrictive Eating Disorder?
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Does your child also experience 2+ of the following: anxiety, sensory amplification or motor abnormalities, behavioral regression, deterioration in school performance, mood disorder, urinary symptoms and/or sleep disturbances
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Symptoms are not better explained by a known neurologic or medical disorder
How do you evaluate a child for PANS?
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The history (i.e. the description of the illness and its development) is primary. We also check for other things to be thorough.
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Rule out acute rheumatic fever. Examine for a murmur. If the child has a history of joint complaints, involuntary muscle movements/swallow/headaches, rashes, also refer to a pediatric cardiologist to exclude valve damage rheumatic carditis.
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Evaluate for Group A streptococcal infection. Throat, skin, anal swaps and exam. Send to lab.
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Check for other infections. Optional: Blood test - mycoplasma IgM for active infection. If urinary symptoms are present, obtain a urinalysis. In PANS, this is likely to be negative and suggest that the urinary urgency, frequency or secondary enuresis are manifestations of PANS, rather than a urinary tract infection.
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Consider necessary referrals: Psychologist, Cardiology, Rheumatology, Immunology, Neurology, Sleep, Otolaryngology, and/or Infectious Disease
What are the treatment options?
We can decide together whether to do the workup first then treat, or to try treatment empirically (as a trial) to see if there is a dramatic change. Treatments may include:
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Prescribe 14 days of antibiotics (Penicillin/amoxicillin,¹ azithromycin, cefdinir, Augmentin, or others). Consider an initial 3-4 week course or long-term coverage depending on the case.
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Consider a 5-7 day course (up to 6 weeks depending on severity) of NSAIDs (ibuprofen) and/or prescribe a 5-7 (up to 30) day steroid burst³ or 6 weeks of a NSAID at immunomodulatory dose.
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Ensure the family has access to CBT/ERP (Cognitive Behavior Therapy/Exposure and Response Prevention) and parent support.
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Consider initial psychiatric treatment with medication and a referral with a psychiatrist to help with symptom management.
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IVIG is sometimes used for more advanced cases, but this is something I am not able to administer yet.
What to expect with treatment:
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Unlike traditional OCD, some studies have shown improvement in neuropsychiatric symptoms in patients with PANDAS after 2–6 weeks of antibiotic treatment. It is unclear if these improvements are from treatment of a latent infection or from some other non-microbial effects.
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PANS OCD has a relapsing remitting course. Most children will experience at least one recurrence of symptom onset due to a PANS trigger. Parents need to understand there is no “quick fix”. Traditional OCD is characterized by a waxing and waning course with modest changes in severity. However, with PANS OCD, the course is relapsing-remitting, with dramatic, abrupt exacerbations of OCD and other PANS symptoms.
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Residual OCD may persist despite any treatment of infection, inflammation, CBT, or medications. Cognitive-behavior therapy (specifically exposure with response prevention - ERP) can be helpful as well as anti-obsessional medications, but we “start low and go slow.”
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Partners and Resources
Contact
Please feel free to message me questions or set an appointment. Let's connect.