Unlock the mysteries of Pediatric Autoimmune Neuropsychiatric Disorders as we host the remarkable Dr. Adame, a pediatrician who advocates for a "Veggies Over Pills" approach to health. Our enlightening conversation traverses the challenging landscape of PANS and PANDAS, conditions that often confound both parents and healthcare professionals alike. Dr. Adame's insights into the immune system's missteps that lead to these disorders are not only informative but also pivotal in reshaping how we perceive and treat neuropsychiatric symptoms in children.
With Dr. Adame's guidance, we explore the vital role that primary care physicians occupy in the early detection and management of these autoimmune conditions. The episode is filled with personal accounts that underscore the importance of a comprehensive, integrative medical approach. We combine conventional medical therapies with nutritional and lifestyle strategies, helping to demystify the journey for families and practitioners. Emphasizing the significance of parental intuition, our discussion provides hope and practical advice to support the brain and immune system for those affected by PANS and PANDAS.
As our episode reaches its conclusion, Dr. Adame and I delve into an array of integrative treatment options that promise to ignite wellness and recovery. From dietary interventions to innovative therapies, we lay out a blueprint for restoring balance to both the brain and the body. This episode is not only a call to action but also a heartfelt invitation to embrace an approach that nurtures the entire family's health, empowering our listeners to become proactive participants in their children's well-being. Join us for this transformative journey towards understanding and compassion for those navigating pediatric autoimmune neurological disorders.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Hokehe Eko (00:00):
Hello parents, welcome to another episode of
Brain Power with Dr Eko.
I have an amazing guest.
I know I say that every week,but really I mean it.
All my guests are amazing in mybook.
So I have the amazing Dr Adamehere.
She's a pediatrician, but notjust a pediatrician, she's an
integrated pediatrician, justlike I am, and she focuses on
(00:20):
treating the entire familythrough.
I mean leading them to holistichealth, and it's the entire
family that counts.
So, without further ado,welcome to the show, Dr.
Adame.
Dr. Noemi Adame (00:32):
Oh well, I'm so excited to be here.
I'm Dr Adame.
I'm also known as the VeggiesOver Pills.
Doctor, that's our tagline theVeggies Over P pills doctor.
I am a board certifiedpediatrician, but I'm also a
Whole Foods, plant-based homecook and baker.
I'm a writer, I'm a publicspeaker.
(00:52):
I'm a holistic wellness expert.
I own a small clinic calledCulver Pediatric Center and it's
a pediatric clinic that helpstransform the mind, body, spirit
, health of children byempowering and educating their
families, communities andschools in holistic nutritional
wellness.
So in addition to my generalpediatrics residency training,
I've also completed additionaleducation on nutritional
(01:14):
wellness through the AmericanCollege of Lifestyle Medicine
and on the integrativemanagement of ADHD and autism
through the Andrew WeilInstitute for Integrative
Medicine.
I write a regular column forour local newspaper called the
Culver Citizen that's titled GetHealthy with Dr Adame.
I host a monthly radio showcalled the Veggies Over Pills
Radio Show with Dr Adame at alocal radio station and I wrote
(01:38):
a journal to help guide adultsor parents in holistic wellness
called the MetamorphosisHolistic Wellness Journal.
Dr. Hokehe Eko (01:45):
I holistic wellness called the
metamorphosis holistic wellnessjournal I like that word
metamorphosis, because isn'tthat what we're all trying to?
Butterfly behind us, yeah yeah,chain into the best version of
ourselves.
Wow.
So typically that whole biomeans that she's extremely well
educatededucated, and you shouldgo see her.
Dr. Noemi Adame (02:06):
That's what all I'm saying.
Dr. Hokehe Eko (02:08):
Yeah, because she has great tools in her
toolbox to help your entirefamily reach holistic wellness.
So let's dive into what we'regoing to talk about today.
We're going to talk about pansand pandas in children, and the
very first question is what'spans and pandas?
Because we need to break thatdown, of course.
So that's all about it.
Dr. Noemi Adame (02:30):
And it's going to be interesting.
So if a family has already donea deep dive into PANS and
PANDAS, they will know so muchmore than anything I'm going to
talk about here.
But for someone who isunfamiliar with the term, pandas
is an acronym for PediatricAutoimmune Neuropsychiatric
(02:53):
Disorder Associated withStreptococcal Infections.
That's what PANDAS is.
It is an autoimmuneencephalitis, which is a fancy
way of saying that after a childhas a strep infection, they
develop antibodies or thosesoldiers to fight the strep.
(03:15):
Then, the way I explained it tothe families, you have these
soldiers right, these antibodiesin their blood and they're
attacking the strep to fight it,just like it's supposed to do,
just like the immune system issupposed to do.
But then the immune systemstarts to misbehave and those
antibodies turn on the brain, onthe child's brain, and they
start to attack the brain,specifically a part of the brain
(03:39):
called the basal ganglia.
And PANDAS is a subset of alarger umbrella term called
pediatric autoimmuneneuropsychiatric syndrome or
PANS.
So all PANDAS is PANS, but notall PANS is PANDAS.
(04:02):
So the main difference is whenthe symptoms are due to strep.
When the autoimmuneencephalitis or the autoimmune
psychiatric neuropsychiatricsymptoms are due to strep, we
call it PANDAS when it is due toanything else and triggers
include COVID.
I've had patients that COVIDwas the trigger.
It could be EBV, it could bemycoplasma, it could be herpes,
(04:30):
coxsackie, all these otherviruses.
If it's all these other thingsother than stress that caused
the initial presentation, thenwe call it PANS and a lot of
people use the terminterchangeably.
I usually, when I write aboutit, I use PANS and PANDAS to be
inclusive of families.
Dr. Hokehe Eko (04:41):
Right, so important.
I'm glad that you broke downthe differences between them,
and that's why we always sayit's so important.
If your child is havingpersistent sore throats, you
want to make sure you're gettingthem chets, because untreated
stress can lead to what she'stalking about today, right.
Dr. Noemi Adame (04:58):
Right, exactly, exactly.
And you know it's interestingbecause the symptoms I remember.
When I was in medical schoolthis is over 20 years ago we got
one slide about pandas.
I remember this was whenPowerPoint was new and it was
this blue slide.
All the slides were blue backthen, they weren't fancy and
just the white lettering and itsaid you know, pandas, molecular
(05:23):
mimicry, all these symptomsafter a strep infection, and I
thought it sounds fake.
It sounds fake.
But then when in the samelecture they discussed other
types of molecular mimicry andautoimmune conditions due to
strep-like rheumatic fever, life, iga, nephropathy, I didn't
think, oh, that sounds fake.
And so it really shows that,even as a medical student, you
(05:46):
know, we just have thatautomatic bias against anything
that is psychiatric and mentalhealth.
And I am, you know, and I saythat transparently and with the
shame that I felt about feelingthat way because it and this is
exactly why the traditionalmedical system has failed these
families, because these familiesare, are ignored or are just
(06:09):
not not given the treatment thatthey need onset in pre-puberty,
before puberty, of changes inmood, including obsessive
compulsive disorder, moodlability, anxiety, separation
(06:30):
anxiety, very debilitatingseparation anxiety like these
kids can't go to school, someprocedural learning, changes
like handwriting changes,changes in school performance,
changes in school attendance.
The other is tics, like asudden and dramatic onset of
vocal and motor tics, attentionissues, sensory issues.
(06:50):
Parents have sent me videos oftheir children that are
encephalopathic, screaming andbeing aggressive.
It is a very, very debilitatingand distressing condition,
especially because a lot of likemy families will tell you and
this is this is one of thecriteria that it's sudden and
(07:12):
immediate Like I have had familytell me on this day is when we
were sitting on the couchwatching TV when, all of a
sudden, he started perseveratingthat you know, someone was
going to come in the house andkill us and saying that they
didn't want to sleep bythemselves, they wanted to sleep
with us because they did, orthat they did not want to go to
school.
Like very sudden and dramatic.
(07:33):
If I ask a family, have theyalways been this way?
They say yeah, yeah.
So then probably not pandas,right, that doesn't mean I can't
help you, but it's not pandas.
So we have to go anotherdifferent route.
Pandas, and PANS is usuallyvery, very sudden presentation.
Dr. Hokehe Eko (07:47):
Right, and how soon after the infection like
strep, untreated strep has itshown up?
I mean, I know it's not settime, but what has the research
shown.
Dr. Noemi Adame (07:58):
So it can happen like very, very quickly
after the strep infection, likewithin a week.
But I have had families thatsay within about six weeks after
the strep infection.
The other problem is a lot oftimes it's a little hard to
(08:19):
pinpoint because I just had afamily that joined that the
rapid strep was always negative.
It was always negative.
But they present it with verysimilar with diagnostic criteria
that was said okay, no, this isPANDAS.
And then when we check theblood work, the ASO and the
(08:41):
anti-DNHB are elevated,indicating at some point this
child had strep, even though alltheir rapid streps were
negative.
In some of these families eventhe culture was negative.
So it is very nuanced and that'swhy, you know, I always tell
families PANDAS is a clinicaldiagnosis.
It is not a laboratorydiagnosis.
But some of these labs, likethe AS, which is an anti-DNA SV,
(09:05):
which basically just showrecent or past strep infection,
they can give us a clue as towhat the molecular or what the
infectious trigger was.
But yeah, it's anywhere from aweek to several weeks.
I've even had families wherethey get it.
They have like their firstpresentation and it's not too
(09:28):
bad, they can handle it, butthen they get another infection
with either strep or somethingelse and like one family
described it, and they fell offa cliff, and they fell off a
cliff, just, and so it's not.
It's every child is differentand we have to treat each child
individually.
But yeah, that's a very longanswer to your question that it
(09:49):
can be anywhere from a week toseveral weeks.
Dr. Hokehe Eko (09:51):
No, I like long answers to the questions because
it gets.
You asked me the exact samething.
You asked me one question andI'm like no, no no, no, no.
Dr. Noemi Adame (09:59):
I'll answer 10 questions.
Dr. Hokehe Eko (10:02):
But then for anyone listening, that's where
the wealth of information,life-changing information,
because they're like holy wings.
So then you know what to do andwho to reach out to, and so
thank you for that answer, forsure.
And so parents are saying, okay, so maybe this sounds like my
kid, so now what do I do?
Dr. Noemi Adame (10:23):
Right, so if the first thing to do I am a
pediatrician, generalpediatrician, primary care
doctor at heart so the firstthing that anyone should do if
they suspect that their childhas PANS or PANDAS is go to
their pediatrician first or goto their family doctor, go to
(10:44):
the primary care doctor thatknows their child, knows, their
family knows and they have atrusting relationship with and I
say that with some sadnessbecause we don't see that as
much anymore because thecorporate medical system and the
insurances have gotten inbetween and eroded that
relationship.
(11:04):
But the closest thing that afamily has to a regular
physician, a primary care doctor, that's who they should go to,
because that doctor's going toknow wait a minute, this is not
the same child that I saw attheir last wellness six months
ago or a year ago or even twomonths ago.
So that's why it is soimportant to first make a
(11:26):
connection with their primarycare doctor and then that doctor
can then say you know what?
Hey, I am familiar with PANDAS,I'm familiar with the PANDAS
Physicians Network treatmentalgorithm.
Let's do treatment and takecare of your child.
And if that happens, great.
(11:46):
If their doctor says okay, Iremember, I know that we have to
start antibiotics for PANDASand we can do that, but then
beyond that I'm just not thatcomfortable.
Then I suggest for families togo to the pandasppn.
org website and there is aphysician directory so they can
look within their state orwithin their zip code for a list
(12:10):
of doctors that are PANDASliterate and PANDAS and PANS
informed.
Dr. Hokehe Eko (12:16):
Okay, wonderful, and we'll have that in the show
notes.
That's really important.
Dr. Noemi Adame (12:24):
You know I don't know if you have
physicians listening.
My guess is I'm a physician andI listen to your podcast, so
you probably do.
And so physicians specificallyspeaking to primary care
physicians, family doctors andpediatricians you can treat
PANDAS.
There is no secret.
The treatment is no secret.
There is literally a beautifulalgorithm with articles backing
(12:49):
the evidence and thepandaspositionnetworkcom website
.
No reason why pans and pandasshould not be something that
primary care doctors who takecare of children take full
ownership of this.
Families are suffering.
They do not have time to waitsix months to see a neurologist.
(13:12):
They do not have time, oh, tosee a rheumatologist, for
example, which is the othersubspecialty that sometimes
treats pandas here in Indiana.
It's six months to a year andin the meantime, families are
suffering, children aresuffering.
So this needs to be owned byprimary care and I will say that
(13:33):
if you do have a physician,that is like okay, but I need a
little guidance.
I'm happy to guide them throughtheir first patient, because
you know what?
Someone guided me.
Someone guided me through myfirst patient and it made a
world of difference.
And so there's this, drCourtney West, I think she's out
in Pennsylvania.
I met her at a conference andshe guided me through my first
patient and I will pay itforward also.
Dr. Hokehe Eko (13:54):
Yes, thank you.
So my fellow physicians who arelistening to this, thank you.
So my fellow physicians who arelistening to this, reach out
and ask for help.
We all are learning.
Dr Adame and I had no ideaabout integrative medicine until
we went and got extra training,so there is no shame in not
knowing.
We're lifelong learners and sowe're here to help you.
(14:15):
If you need help, if you needpointers on where to go to learn
how to take care of yourpatients holistically, we will
be happy to point you in theright direction.
And actually I'll just put someresources in the show notes so
that anyone listening can gothere and seek help.
Yes and yes.
It's so important, even whenparents come and they ask for
(14:39):
help, help that we don't justsay, even if it's something
you're not familiar with, let'ssay, okay, let me go search for
stuff and then I will get backto you, than dismissing the the
concern, because I remember ourparents know those children more
than anybody else.
so it's so important for us tobe the first to be advocates for
(15:02):
our patients.
I know that's part of the issueis that we're rushing and we
don't have that much time, butplease, Right.
Dr. Noemi Adame (15:11):
No, I agree, and I do think you know, because
I think if I was back in theworld of corporate medicine, I
do wonder did I encounterchildren with pandas?
Yeah, but because I had 10minutes with him, I said, okay,
I'm going to send you to psychor I'm going to send you here
and just funnel them furtheraway, because and that does
(15:35):
haunt me, that does haunt me Nowthat I have my own concierge
direct primary care practice, Ican spend the time I can spend.
I can block two hours for afamily for their initial visit,
and that's after having met witha family for another hour just
gathering information, so thatwhen they do bring the child to
the clinic, we're not spendingan hour gathering information.
(15:57):
I, you're right, you know so,we've already.
So it just yes, there's thisbeautiful act to treat pandas,
but beyond the algorithm, whatfamilies need is time,
compassion and someone to listento their story and their
journey.
That's the main thing thatfamilies affected by Pants and
(16:18):
Pandas need.
Dr. Hokehe Eko (16:20):
Yes, because it definitely upends their world as
they know it and, like youpointed out, it's sudden.
So definitely we need lots ofcompassion and just holding
their hand and walking themthrough it and letting them know
there is hope.
You know it's not hopeless.
Your child can get better.
We just need to get started onthe right things to do for your
(16:41):
child.
I'm going to say something hereIf anyone is listening and
knows a family that isstruggling, please send this
episode to them so that they canlisten to it and reach out and
figure out who can take care ofthem, reach out to their doctors
and all of that, so that we'reall.
Let's pass this on as kindness.
Let everybody share thisepisode and share some kindness
(17:05):
today, because there aremillions of families struggling
and have no idea what to do.
Dr. Noemi Adame (17:10):
Right, Exactly, exactly, and they just need to
find the right resources.
There's several active Facebookpandas, parents groups and
really parents are turning to,but they're not feeling heard by
the traditional medical systemor they already have a great
pediatrician.
I have several families,especially the ones that live
(17:43):
further away.
They're like you know, can youjust be my PANDAS doctor?
And I said, yeah, absolutely.
Third type of family that joinsour practice is they've already
received the traditional, thealgorithm treatment, but they
(18:04):
want to see can I unmedicate mychild?
So they're looking for anintegrative approach to see if
it is possible to unmedicate andand go into remission without
needing any more antibiotics orsteroids and and and and.
So we've had families that that.
That's that's why they lookinto our practice and we're here
regardless of where they are ontheir journey.
Dr. Hokehe Eko (18:22):
We are here to help yes, wonderful.
So let's talk about theintegrative approach to pandas.
Dr. Noemi Adame (18:28):
Yes, yes, so you know, like I said, I always
tell families I am a Westerntrained, board certified,
science-based physician, so Iwill follow the diagnostic and
treatment algorithm from thePandas Physician Network, but I
also integrate what I havelearned about integrative
medicine on ADHD and autism,because there's a lot of overlap
(18:49):
.
It's all about protecting thebrain, right?
It's all about reducinginflammation and protecting the
brain.
About protecting the brain,right.
It's all about reducinginflammation and protecting the
brain.
So I will also, for example, aspart of my evaluation, screen
for nutritional deficiencieslike vitamin D, b12, folate,
ferritin, iron, and treat thoseif vindicated.
And yes, it's because I thinkthat their child's
neuropsychiatric symptoms aredue to these vitamin
(19:11):
deficiencies.
But if these nutritionaldeficiencies are low, then first
of all, it's going to worseninflammation and it's going to
affect cognitive health andtheir brain health.
And, for example, iron Ironcarries oxygen to the brain.
If their ferritin or iron islow, then of course they're
going to have worsening of theirneuropsychiatric symptoms,
(19:31):
because it's kind of like whenwe go at altitude, right, and
we're all grumpy and you can'tsleep because our brain isn't
getting enough oxygen.
So that's what happens when wehave low ferritin and iron.
So I screen and treatnutritional deficiencies.
I also screen for otherconditions that might be either
causing and mimicking pandasymptoms or exacerbating them
(19:51):
lead toxicity, metabolicconditions, rheumatological,
tick-borne illness and I lookfor potential infectious
triggers.
You know, like the ASO and theanti-DNA speed, which screen for
strep, but also like an EBVpanel or looking for other
conditions.
I tailor the laboratory work,the diagnostic evaluation and
the treatment for the uniqueneeds, the history, the response
(20:14):
and the progress of each child.
And one big thing is the keyfeature in pandas is
inflammation.
Right, that brain under attack,it is inflamed, it is an
inflamed brain.
So, yeah, I, I one little boydescribed this is he felt like
(20:36):
his brain was on fire.
So the first thing is to putout the fire with the algorithm,
which is a non-steroidalanti-inflammatories like
ibuprofen.
Again, these are simpleinterventions antibiotics,
steroids and then IVIG.
And I do think IVIG isintravenous immunoglobulin G.
(20:56):
It is a highly highly, highlyhighly purified blood product,
this concentrated, and it isadministered intravenously IV,
you know, intravenously at anoutpatient infusion center over
two days.
And I think that this is wherea lot of the physicians get
stuck and a little intimidatedby IVIG and so a lot of them
(21:21):
will start like a lot of times,by the time the patient comes to
me, somebody has started themon antibiotics, but they come to
me because they say I can'tfind anyone who's going to order
the IVIG, which of course we do.
So that's how we put out thefire.
But then we need to protect thebrain long-term and this is
where the integrative managementcomes in.
I guide families throughfeasible mind, body, spirit,
(21:44):
holistic interventions thatreduce inflammation, beginning
with a high-protein, high-fiber,anti-inflammatory nourishment,
lifestyle, physical activity,restorative sleep,
mindfulness-based stressreduction, avoiding toxins,
earthing like engaging withnature and touching the ground
All of that helps to modulate amisbehaving immune system.
(22:05):
Natural sunlight that is thebest source of vitamin D, it is
an anti.
The sun has anti-inflammatoryeffects on our bodies.
And then, of course, socialconnections, because that helps
not just the child tore-socialize but also families.
I do have my own little braincocktail with supplements,
including magnesium, for brainhealth, for sleep.
(22:27):
A lot of these kids with pantsand pandas have disordered sleep
.
So magnesium I'm a big fan ofand that's part of my little
cocktail, Vegan omega-3sOmega-3s are essential in brain
function.
And then vitamin D.
I start everybody on vitamin D,regardless of whether they're
low or deficient or not as ananti-inflammatory and as a brain
(22:47):
protectant.
If they are deficient, then Istart them on a higher dose.
If they have a normal vitamin Dlevel, which honestly it is
very rare to have here in theMidwest, I'm shocked if I find
someone with a normal vitamin Dlevel.
I've never seen one, especiallyif I'm checking, like in the
middle of winter.
They're going to have a lowvitamin D.
But the dose will depend onwhat the level is.
(23:11):
And I do not shame familiesabout their nourishment it's
such a personal thing.
But I do encourage any degreeof progression towards a
high-protein, high-fiber,anti-inflammatory nourishment to
reduce inflammation, to protectthe brain long-term and, most
importantly, to improve thatgut-brain connection.
And I think you've spoken aboutthis before in your social
(23:34):
media and in your podcast.
And what we do is we offertools to guide families with
this intervention.
We don't just tell families, oh, eat more vegetables.
We really do provide veryhands-on guidance for this and
we understand that this is veryit's a very personal thing,
right?
You know, it's a very personalthing.
(23:55):
It's economical, it's cultural,it's lifestyle, it's just so
many factors.
And so we and we also do thisonce their child is ready.
A lot of kids with PANDAS dohave self-imposed eating
restrictions, restrictive eating.
So initially I've had familiestell me I'm fighting for every
calorie.
Right now, you know I amfighting, all they're eating is,
(24:15):
you know, chicken nuggets andmac and cheese.
And I'm like you know what,when you're fighting for every
calorie.
When their brain is inflamed,when their brain is on fire, yes
, yeah, just get food in there,that's fine.
But then once they're ready andwe go into remission and the
encephalopathy and theinflammation it gets better,
then we start hitting this morehardcore.
Dr. Hokehe Eko (24:34):
Yes, definitely there is a process to it, and
we're not here to overwhelm you.
We're here to walk beside youand know it is possible.
Just step by step, by step bystep, you get there.
So that's what the parent,feeling overwhelmed with
everything we say.
That is hope and it's astep-by-step process.
Dr. Noemi Adame (24:53):
Right, absolutely, and so
individualized, initially, withmy PANS and PANDAS families.
I meet with them every week,you know, every week.
So, okay, they did IDIG lastweek.
Okay, they did antibiotics,they started antibiotics last
week, how's it going?
And I do have some families whoget discouraged because we'll do
the entire algorithm, we'll dothe brain cocktail, and they
(25:16):
still feel like, okay, they've,in every intervention.
Part of the intervention alsoincludes surgical removal of the
tonsils.
So you know so, and mostfamilies, by the time they come
to me, their child has alreadyhad their tonsils removed, like
somebody has said okay, you know, because again everybody wants
to reaper out, go to ENT and getyour tonsils removed, right,
you know, and it is part of thepandasphysiciannetworkorgcom
algorithm.
So, like, if we do all themedical interventions and
(25:37):
they're still having somesymptoms, you know, and again,
each intervention will lead toimprovement, but families want
the child that they had beforethey got sick with PANS or
PANDAS.
So if we do all the algorithmand we do all these things and
they're still having symptoms,then I will, with shared
decision making, start toexplore other options like that
are brain protected,anti-inflammatory and immune
(25:58):
modulating, such as low-dosenaltrexone, and I use a
compounding pharmacy for this.
But yeah, I will explore andI'll prescribe this.
I always recommend therapy andcounseling with a
PANDAS-informed therapist and,when indicated.
Yes, I am veggies over pills,but there are times that we do
need pharmaceuticals to reducesymptoms until the
(26:18):
anti-inflammatory effects of thePANDAS-specific treatment and
the holistic interventions takeeffect.
Dr. Hokehe Eko (26:25):
Yep, absolutely right.
So yes, because yes, it's abalance, it's a combination of
both.
We're not ditching conventionalmedicine, we're saying there is
a place for it, but there'salso a big place for what can we
do to decrease things naturallyas well?
So thank you for that.
Yeah, very well thought outexplanation of treatment
(26:48):
integratively.
So parents I'm sure parents arelike, okay, okay, so where can
we find Dr Adame?
Dr. Noemi Adame (26:55):
So we are a very, very digital practice.
The best way to reach us is ourwebsite, wwwculverpediatricscom
.
We have a webpage on our mainwebsite specifically for PANS
pandas.
That explains our approach.
(27:15):
I also host a groupinformational session on Mondays
at 5 pm Eastern.
So if a family's like, okay,I'm thinking of joining her
practice, but I want to learn alittle bit more about her, I
want to learn a little bit moreabout her approach, then they
can register for one of thesegroup it's their virtual group
sessions or you can call us, youcan email us, you can book a
(27:38):
one-on-one complimentary consultthose book out a little further
ahead.
I'm also available for speakingengagements.
All that is on our website.
We're also active on socialmedia.
We have a Facebook andInstagram.
Culver Peds is our handle andplease, yes, contact us and I
(27:59):
always tell families, especiallyfrom out of state, I will try
and help find someone closer toyou if we can.
But if you just and we but,like I said, we have had some
families from out of state thatcome to us we are more than
happy to welcome you and andguide you, no matter how far
away you come from, to see us.
Dr. Hokehe Eko (28:16):
Yay, wonderful, yes, that's great.
So what's one last brain healthtip you're going to leave for?
Dr. Noemi Adame (28:24):
parents.
Okay, how about this one?
A handful of spinach makes theinflammation go down.
Dr. Hokehe Eko (28:30):
Okay, I love it yeah.
Dr. Noemi Adame (28:33):
Yeah, and it just yeah.
You know, I was in academicsfor a long time before I went
into this world of privateoutpatient and I would love to
one day do a study on PANS andPANDAS, the experimental group
being Hope Woods, Plant-Based,and the control group, you know,
just following the traditionalalgorithm.
(28:55):
I really would, because mostpandas physicians feel like
that's the key is starting with.
Nourishment is essential.
Dr. Hokehe Eko (29:01):
Yeah, no, that would be an interesting study.
Call me when you're about tostart.
That would be a groundbreakingstudy.
Yeah, that's wonderful.
So, yes, we'll have all theinformation for Dr Adame in the
show notes.
Thank you again.
I hope you learned from DrAdame's beautiful presentation
(29:23):
of PANS and PANDAS and howintegratively we can help your
entire family glow with healthfrom the inside out, which is
Glow Pediatrics motto, becausewe're here for the whole family,
which is GoPediatricsMotobecause we're here for the whole
family.
So, please share this againwith someone in your world that
you feel needs to hear this.
And until next episode, have awonderful day and remember
(29:44):
you're the best parents for yourchildren.
Okay, have a wonderful day,thank you.
Hello parents, welcome to another episode of
Brain Power with Dr Eko.
I have an amazing guest.
I know I say that every week,but really I mean it.
All my guests are amazing in mybook.
So I have the amazing Dr Adamehere.
She's a pediatrician, but notjust a pediatrician, she's an
integrated pediatrician, justlike I am, and she focuses on
(00:20):
treating the entire familythrough.
I mean leading them to holistichealth, and it's the entire
family that counts.
So, without further ado,welcome to the show, Dr.
Adame.
Dr. Noemi Adame (00:32):
Oh well, I'm so excited to be here.
I'm Dr Adame.
I'm also known as the VeggiesOver Pills.
Doctor, that's our tagline theVeggies Over P pills doctor.
I am a board certifiedpediatrician, but I'm also a
Whole Foods, plant-based homecook and baker.
I'm a writer, I'm a publicspeaker.
(00:52):
I'm a holistic wellness expert.
I own a small clinic calledCulver Pediatric Center and it's
a pediatric clinic that helpstransform the mind, body, spirit
, health of children byempowering and educating their
families, communities andschools in holistic nutritional
wellness.
So in addition to my generalpediatrics residency training,
I've also completed additionaleducation on nutritional
(01:14):
wellness through the AmericanCollege of Lifestyle Medicine
and on the integrativemanagement of ADHD and autism
through the Andrew WeilInstitute for Integrative
Medicine.
I write a regular column forour local newspaper called the
Culver Citizen that's titled GetHealthy with Dr Adame.
I host a monthly radio showcalled the Veggies Over Pills
Radio Show with Dr Adame at alocal radio station and I wrote
(01:38):
a journal to help guide adultsor parents in holistic wellness
called the MetamorphosisHolistic Wellness Journal.
Dr. Hokehe Eko (01:45):
I holistic wellness called the
metamorphosis holistic wellnessjournal I like that word
metamorphosis, because isn'tthat what we're all trying to?
Butterfly behind us, yeah yeah,chain into the best version of
ourselves.
Wow.
So typically that whole biomeans that she's extremely well
educatededucated, and you shouldgo see her.
Dr. Noemi Adame (02:06):
That's what all I'm saying.
Dr. Hokehe Eko (02:08):
Yeah, because she has great tools in her
toolbox to help your entirefamily reach holistic wellness.
So let's dive into what we'regoing to talk about today.
We're going to talk about pansand pandas in children, and the
very first question is what'spans and pandas?
Because we need to break thatdown, of course.
So that's all about it.
Dr. Noemi Adame (02:30):
And it's going to be interesting.
So if a family has already donea deep dive into PANS and
PANDAS, they will know so muchmore than anything I'm going to
talk about here.
But for someone who isunfamiliar with the term, pandas
is an acronym for PediatricAutoimmune Neuropsychiatric
(02:53):
Disorder Associated withStreptococcal Infections.
That's what PANDAS is.
It is an autoimmuneencephalitis, which is a fancy
way of saying that after a childhas a strep infection, they
develop antibodies or thosesoldiers to fight the strep.
(03:15):
Then, the way I explained it tothe families, you have these
soldiers right, these antibodiesin their blood and they're
attacking the strep to fight it,just like it's supposed to do,
just like the immune system issupposed to do.
But then the immune systemstarts to misbehave and those
antibodies turn on the brain, onthe child's brain, and they
start to attack the brain,specifically a part of the brain
(03:39):
called the basal ganglia.
And PANDAS is a subset of alarger umbrella term called
pediatric autoimmuneneuropsychiatric syndrome or
PANS.
So all PANDAS is PANS, but notall PANS is PANDAS.
(04:02):
So the main difference is whenthe symptoms are due to strep.
When the autoimmuneencephalitis or the autoimmune
psychiatric neuropsychiatricsymptoms are due to strep, we
call it PANDAS when it is due toanything else and triggers
include COVID.
I've had patients that COVIDwas the trigger.
It could be EBV, it could bemycoplasma, it could be herpes,
(04:30):
coxsackie, all these otherviruses.
If it's all these other thingsother than stress that caused
the initial presentation, thenwe call it PANS and a lot of
people use the terminterchangeably.
I usually, when I write aboutit, I use PANS and PANDAS to be
inclusive of families.
Dr. Hokehe Eko (04:41):
Right, so important.
I'm glad that you broke downthe differences between them,
and that's why we always sayit's so important.
If your child is havingpersistent sore throats, you
want to make sure you're gettingthem chets, because untreated
stress can lead to what she'stalking about today, right.
Dr. Noemi Adame (04:58):
Right, exactly, exactly.
And you know it's interestingbecause the symptoms I remember.
When I was in medical schoolthis is over 20 years ago we got
one slide about pandas.
I remember this was whenPowerPoint was new and it was
this blue slide.
All the slides were blue backthen, they weren't fancy and
just the white lettering and itsaid you know, pandas, molecular
(05:23):
mimicry, all these symptomsafter a strep infection, and I
thought it sounds fake.
It sounds fake.
But then when in the samelecture they discussed other
types of molecular mimicry andautoimmune conditions due to
strep-like rheumatic fever, life, iga, nephropathy, I didn't
think, oh, that sounds fake.
And so it really shows that,even as a medical student, you
(05:46):
know, we just have thatautomatic bias against anything
that is psychiatric and mentalhealth.
And I am, you know, and I saythat transparently and with the
shame that I felt about feelingthat way because it and this is
exactly why the traditionalmedical system has failed these
families, because these familiesare, are ignored or are just
(06:09):
not not given the treatment thatthey need onset in pre-puberty,
before puberty, of changes inmood, including obsessive
compulsive disorder, moodlability, anxiety, separation
(06:30):
anxiety, very debilitatingseparation anxiety like these
kids can't go to school, someprocedural learning, changes
like handwriting changes,changes in school performance,
changes in school attendance.
The other is tics, like asudden and dramatic onset of
vocal and motor tics, attentionissues, sensory issues.
(06:50):
Parents have sent me videos oftheir children that are
encephalopathic, screaming andbeing aggressive.
It is a very, very debilitatingand distressing condition,
especially because a lot of likemy families will tell you and
this is this is one of thecriteria that it's sudden and
(07:12):
immediate Like I have had familytell me on this day is when we
were sitting on the couchwatching TV when, all of a
sudden, he started perseveratingthat you know, someone was
going to come in the house andkill us and saying that they
didn't want to sleep bythemselves, they wanted to sleep
with us because they did, orthat they did not want to go to
school.
Like very sudden and dramatic.
(07:33):
If I ask a family, have theyalways been this way?
They say yeah, yeah.
So then probably not pandas,right, that doesn't mean I can't
help you, but it's not pandas.
So we have to go anotherdifferent route.
Pandas, and PANS is usuallyvery, very sudden presentation.
Dr. Hokehe Eko (07:47):
Right, and how soon after the infection like
strep, untreated strep has itshown up?
I mean, I know it's not settime, but what has the research
shown.
Dr. Noemi Adame (07:58):
So it can happen like very, very quickly
after the strep infection, likewithin a week.
But I have had families thatsay within about six weeks after
the strep infection.
The other problem is a lot oftimes it's a little hard to
(08:19):
pinpoint because I just had afamily that joined that the
rapid strep was always negative.
It was always negative.
But they present it with verysimilar with diagnostic criteria
that was said okay, no, this isPANDAS.
And then when we check theblood work, the ASO and the
(08:41):
anti-DNHB are elevated,indicating at some point this
child had strep, even though alltheir rapid streps were
negative.
In some of these families eventhe culture was negative.
So it is very nuanced and that'swhy, you know, I always tell
families PANDAS is a clinicaldiagnosis.
It is not a laboratorydiagnosis.
But some of these labs, likethe AS, which is an anti-DNA SV,
(09:05):
which basically just showrecent or past strep infection,
they can give us a clue as towhat the molecular or what the
infectious trigger was.
But yeah, it's anywhere from aweek to several weeks.
I've even had families wherethey get it.
They have like their firstpresentation and it's not too
(09:28):
bad, they can handle it, butthen they get another infection
with either strep or somethingelse and like one family
described it, and they fell offa cliff, and they fell off a
cliff, just, and so it's not.
It's every child is differentand we have to treat each child
individually.
But yeah, that's a very longanswer to your question that it
(09:49):
can be anywhere from a week toseveral weeks.
Dr. Hokehe Eko (09:51):
No, I like long answers to the questions because
it gets.
You asked me the exact samething.
You asked me one question andI'm like no, no no, no, no.
Dr. Noemi Adame (09:59):
I'll answer 10 questions.
Dr. Hokehe Eko (10:02):
But then for anyone listening, that's where
the wealth of information,life-changing information,
because they're like holy wings.
So then you know what to do andwho to reach out to, and so
thank you for that answer, forsure.
And so parents are saying, okay, so maybe this sounds like my
kid, so now what do I do?
Dr. Noemi Adame (10:23):
Right, so if the first thing to do I am a
pediatrician, generalpediatrician, primary care
doctor at heart so the firstthing that anyone should do if
they suspect that their childhas PANS or PANDAS is go to
their pediatrician first or goto their family doctor, go to
(10:44):
the primary care doctor thatknows their child, knows, their
family knows and they have atrusting relationship with and I
say that with some sadnessbecause we don't see that as
much anymore because thecorporate medical system and the
insurances have gotten inbetween and eroded that
relationship.
(11:04):
But the closest thing that afamily has to a regular
physician, a primary care doctor, that's who they should go to,
because that doctor's going toknow wait a minute, this is not
the same child that I saw attheir last wellness six months
ago or a year ago or even twomonths ago.
So that's why it is soimportant to first make a
(11:26):
connection with their primarycare doctor and then that doctor
can then say you know what?
Hey, I am familiar with PANDAS,I'm familiar with the PANDAS
Physicians Network treatmentalgorithm.
Let's do treatment and takecare of your child.
And if that happens, great.
(11:46):
If their doctor says okay, Iremember, I know that we have to
start antibiotics for PANDASand we can do that, but then
beyond that I'm just not thatcomfortable.
Then I suggest for families togo to the pandasppn.
org website and there is aphysician directory so they can
look within their state orwithin their zip code for a list
(12:10):
of doctors that are PANDASliterate and PANDAS and PANS
informed.
Dr. Hokehe Eko (12:16):
Okay, wonderful, and we'll have that in the show
notes.
That's really important.
Dr. Noemi Adame (12:24):
You know I don't know if you have
physicians listening.
My guess is I'm a physician andI listen to your podcast, so
you probably do.
And so physicians specificallyspeaking to primary care
physicians, family doctors andpediatricians you can treat
PANDAS.
There is no secret.
The treatment is no secret.
There is literally a beautifulalgorithm with articles backing
(12:49):
the evidence and thepandaspositionnetworkcom website
.
No reason why pans and pandasshould not be something that
primary care doctors who takecare of children take full
ownership of this.
Families are suffering.
They do not have time to waitsix months to see a neurologist.
(13:12):
They do not have time, oh, tosee a rheumatologist, for
example, which is the othersubspecialty that sometimes
treats pandas here in Indiana.
It's six months to a year andin the meantime, families are
suffering, children aresuffering.
So this needs to be owned byprimary care and I will say that
(13:33):
if you do have a physician,that is like okay, but I need a
little guidance.
I'm happy to guide them throughtheir first patient, because
you know what?
Someone guided me.
Someone guided me through myfirst patient and it made a
world of difference.
And so there's this, drCourtney West, I think she's out
in Pennsylvania.
I met her at a conference andshe guided me through my first
patient and I will pay itforward also.
Dr. Hokehe Eko (13:54):
Yes, thank you.
So my fellow physicians who arelistening to this, thank you.
So my fellow physicians who arelistening to this, reach out
and ask for help.
We all are learning.
Dr Adame and I had no ideaabout integrative medicine until
we went and got extra training,so there is no shame in not
knowing.
We're lifelong learners and sowe're here to help you.
(14:15):
If you need help, if you needpointers on where to go to learn
how to take care of yourpatients holistically, we will
be happy to point you in theright direction.
And actually I'll just put someresources in the show notes so
that anyone listening can gothere and seek help.
Yes and yes.
It's so important, even whenparents come and they ask for
(14:39):
help, help that we don't justsay, even if it's something
you're not familiar with, let'ssay, okay, let me go search for
stuff and then I will get backto you, than dismissing the the
concern, because I remember ourparents know those children more
than anybody else.
so it's so important for us tobe the first to be advocates for
(15:02):
our patients.
I know that's part of the issueis that we're rushing and we
don't have that much time, butplease, Right.
Dr. Noemi Adame (15:11):
No, I agree, and I do think you know, because
I think if I was back in theworld of corporate medicine, I
do wonder did I encounterchildren with pandas?
Yeah, but because I had 10minutes with him, I said, okay,
I'm going to send you to psychor I'm going to send you here
and just funnel them furtheraway, because and that does
(15:35):
haunt me, that does haunt me Nowthat I have my own concierge
direct primary care practice, Ican spend the time I can spend.
I can block two hours for afamily for their initial visit,
and that's after having met witha family for another hour just
gathering information, so thatwhen they do bring the child to
the clinic, we're not spendingan hour gathering information.
(15:57):
I, you're right, you know so,we've already.
So it just yes, there's thisbeautiful act to treat pandas,
but beyond the algorithm, whatfamilies need is time,
compassion and someone to listento their story and their
journey.
That's the main thing thatfamilies affected by Pants and
(16:18):
Pandas need.
Dr. Hokehe Eko (16:20):
Yes, because it definitely upends their world as
they know it and, like youpointed out, it's sudden.
So definitely we need lots ofcompassion and just holding
their hand and walking themthrough it and letting them know
there is hope.
You know it's not hopeless.
Your child can get better.
We just need to get started onthe right things to do for your
(16:41):
child.
I'm going to say something hereIf anyone is listening and
knows a family that isstruggling, please send this
episode to them so that they canlisten to it and reach out and
figure out who can take care ofthem, reach out to their doctors
and all of that, so that we'reall.
Let's pass this on as kindness.
Let everybody share thisepisode and share some kindness
(17:05):
today, because there aremillions of families struggling
and have no idea what to do.
Dr. Noemi Adame (17:10):
Right, Exactly, exactly, and they just need to
find the right resources.
There's several active Facebookpandas, parents groups and
really parents are turning to,but they're not feeling heard by
the traditional medical systemor they already have a great
pediatrician.
I have several families,especially the ones that live
(17:43):
further away.
They're like you know, can youjust be my PANDAS doctor?
And I said, yeah, absolutely.
Third type of family that joinsour practice is they've already
received the traditional, thealgorithm treatment, but they
(18:04):
want to see can I unmedicate mychild?
So they're looking for anintegrative approach to see if
it is possible to unmedicate andand go into remission without
needing any more antibiotics orsteroids and and and and.
So we've had families that that.
That's that's why they lookinto our practice and we're here
regardless of where they are ontheir journey.
Dr. Hokehe Eko (18:22):
We are here to help yes, wonderful.
So let's talk about theintegrative approach to pandas.
Dr. Noemi Adame (18:28):
Yes, yes, so you know, like I said, I always
tell families I am a Westerntrained, board certified,
science-based physician, so Iwill follow the diagnostic and
treatment algorithm from thePandas Physician Network, but I
also integrate what I havelearned about integrative
medicine on ADHD and autism,because there's a lot of overlap
(18:49):
.
It's all about protecting thebrain, right?
It's all about reducinginflammation and protecting the
brain.
About protecting the brain,right.
It's all about reducinginflammation and protecting the
brain.
So I will also, for example, aspart of my evaluation, screen
for nutritional deficiencieslike vitamin D, b12, folate,
ferritin, iron, and treat thoseif vindicated.
And yes, it's because I thinkthat their child's
neuropsychiatric symptoms aredue to these vitamin
(19:11):
deficiencies.
But if these nutritionaldeficiencies are low, then first
of all, it's going to worseninflammation and it's going to
affect cognitive health andtheir brain health.
And, for example, iron Ironcarries oxygen to the brain.
If their ferritin or iron islow, then of course they're
going to have worsening of theirneuropsychiatric symptoms,
(19:31):
because it's kind of like whenwe go at altitude, right, and
we're all grumpy and you can'tsleep because our brain isn't
getting enough oxygen.
So that's what happens when wehave low ferritin and iron.
So I screen and treatnutritional deficiencies.
I also screen for otherconditions that might be either
causing and mimicking pandasymptoms or exacerbating them
(19:51):
lead toxicity, metabolicconditions, rheumatological,
tick-borne illness and I lookfor potential infectious
triggers.
You know, like the ASO and theanti-DNA speed, which screen for
strep, but also like an EBVpanel or looking for other
conditions.
I tailor the laboratory work,the diagnostic evaluation and
the treatment for the uniqueneeds, the history, the response
(20:14):
and the progress of each child.
And one big thing is the keyfeature in pandas is
inflammation.
Right, that brain under attack,it is inflamed, it is an
inflamed brain.
So, yeah, I, I one little boydescribed this is he felt like
(20:36):
his brain was on fire.
So the first thing is to putout the fire with the algorithm,
which is a non-steroidalanti-inflammatories like
ibuprofen.
Again, these are simpleinterventions antibiotics,
steroids and then IVIG.
And I do think IVIG isintravenous immunoglobulin G.
(20:56):
It is a highly highly, highlyhighly purified blood product,
this concentrated, and it isadministered intravenously IV,
you know, intravenously at anoutpatient infusion center over
two days.
And I think that this is wherea lot of the physicians get
stuck and a little intimidatedby IVIG and so a lot of them
(21:21):
will start like a lot of times,by the time the patient comes to
me, somebody has started themon antibiotics, but they come to
me because they say I can'tfind anyone who's going to order
the IVIG, which of course we do.
So that's how we put out thefire.
But then we need to protect thebrain long-term and this is
where the integrative managementcomes in.
I guide families throughfeasible mind, body, spirit,
(21:44):
holistic interventions thatreduce inflammation, beginning
with a high-protein, high-fiber,anti-inflammatory nourishment,
lifestyle, physical activity,restorative sleep,
mindfulness-based stressreduction, avoiding toxins,
earthing like engaging withnature and touching the ground
All of that helps to modulate amisbehaving immune system.
(22:05):
Natural sunlight that is thebest source of vitamin D, it is
an anti.
The sun has anti-inflammatoryeffects on our bodies.
And then, of course, socialconnections, because that helps
not just the child tore-socialize but also families.
I do have my own little braincocktail with supplements,
including magnesium, for brainhealth, for sleep.
(22:27):
A lot of these kids with pantsand pandas have disordered sleep
.
So magnesium I'm a big fan ofand that's part of my little
cocktail, Vegan omega-3sOmega-3s are essential in brain
function.
And then vitamin D.
I start everybody on vitamin D,regardless of whether they're
low or deficient or not as ananti-inflammatory and as a brain
(22:47):
protectant.
If they are deficient, then Istart them on a higher dose.
If they have a normal vitamin Dlevel, which honestly it is
very rare to have here in theMidwest, I'm shocked if I find
someone with a normal vitamin Dlevel.
I've never seen one, especiallyif I'm checking, like in the
middle of winter.
They're going to have a lowvitamin D.
But the dose will depend onwhat the level is.
(23:11):
And I do not shame familiesabout their nourishment it's
such a personal thing.
But I do encourage any degreeof progression towards a
high-protein, high-fiber,anti-inflammatory nourishment to
reduce inflammation, to protectthe brain long-term and, most
importantly, to improve thatgut-brain connection.
And I think you've spoken aboutthis before in your social
(23:34):
media and in your podcast.
And what we do is we offertools to guide families with
this intervention.
We don't just tell families, oh, eat more vegetables.
We really do provide veryhands-on guidance for this and
we understand that this is veryit's a very personal thing,
right?
You know, it's a very personalthing.
(23:55):
It's economical, it's cultural,it's lifestyle, it's just so
many factors.
And so we and we also do thisonce their child is ready.
A lot of kids with PANDAS dohave self-imposed eating
restrictions, restrictive eating.
So initially I've had familiestell me I'm fighting for every
calorie.
Right now, you know I amfighting, all they're eating is,
(24:15):
you know, chicken nuggets andmac and cheese.
And I'm like you know what,when you're fighting for every
calorie.
When their brain is inflamed,when their brain is on fire, yes
, yeah, just get food in there,that's fine.
But then once they're ready andwe go into remission and the
encephalopathy and theinflammation it gets better,
then we start hitting this morehardcore.
Dr. Hokehe Eko (24:34):
Yes, definitely there is a process to it, and
we're not here to overwhelm you.
We're here to walk beside youand know it is possible.
Just step by step, by step bystep, you get there.
So that's what the parent,feeling overwhelmed with
everything we say.
That is hope and it's astep-by-step process.
Dr. Noemi Adame (24:53):
Right, absolutely, and so
individualized, initially, withmy PANS and PANDAS families.
I meet with them every week,you know, every week.
So, okay, they did IDIG lastweek.
Okay, they did antibiotics,they started antibiotics last
week, how's it going?
And I do have some families whoget discouraged because we'll do
the entire algorithm, we'll dothe brain cocktail, and they
(25:16):
still feel like, okay, they've,in every intervention.
Part of the intervention alsoincludes surgical removal of the
tonsils.
So you know so, and mostfamilies, by the time they come
to me, their child has alreadyhad their tonsils removed, like
somebody has said okay, you know, because again everybody wants
to reaper out, go to ENT and getyour tonsils removed, right,
you know, and it is part of thepandasphysiciannetworkorgcom
algorithm.
So, like, if we do all themedical interventions and
(25:37):
they're still having somesymptoms, you know, and again,
each intervention will lead toimprovement, but families want
the child that they had beforethey got sick with PANS or
PANDAS.
So if we do all the algorithmand we do all these things and
they're still having symptoms,then I will, with shared
decision making, start toexplore other options like that
are brain protected,anti-inflammatory and immune
(25:58):
modulating, such as low-dosenaltrexone, and I use a
compounding pharmacy for this.
But yeah, I will explore andI'll prescribe this.
I always recommend therapy andcounseling with a
PANDAS-informed therapist and,when indicated.
Yes, I am veggies over pills,but there are times that we do
need pharmaceuticals to reducesymptoms until the
(26:18):
anti-inflammatory effects of thePANDAS-specific treatment and
the holistic interventions takeeffect.
Dr. Hokehe Eko (26:25):
Yep, absolutely right.
So yes, because yes, it's abalance, it's a combination of
both.
We're not ditching conventionalmedicine, we're saying there is
a place for it, but there'salso a big place for what can we
do to decrease things naturallyas well?
So thank you for that.
Yeah, very well thought outexplanation of treatment
(26:48):
integratively.
So parents I'm sure parents arelike, okay, okay, so where can
we find Dr Adame?
Dr. Noemi Adame (26:55):
So we are a very, very digital practice.
The best way to reach us is ourwebsite, wwwculverpediatricscom
.
We have a webpage on our mainwebsite specifically for PANS
pandas.
That explains our approach.
(27:15):
I also host a groupinformational session on Mondays
at 5 pm Eastern.
So if a family's like, okay,I'm thinking of joining her
practice, but I want to learn alittle bit more about her, I
want to learn a little bit moreabout her approach, then they
can register for one of thesegroup it's their virtual group
sessions or you can call us, youcan email us, you can book a
(27:38):
one-on-one complimentary consultthose book out a little further
ahead.
I'm also available for speakingengagements.
All that is on our website.
We're also active on socialmedia.
We have a Facebook andInstagram.
Culver Peds is our handle andplease, yes, contact us and I
(27:59):
always tell families, especiallyfrom out of state, I will try
and help find someone closer toyou if we can.
But if you just and we but,like I said, we have had some
families from out of state thatcome to us we are more than
happy to welcome you and andguide you, no matter how far
away you come from, to see us.
Dr. Hokehe Eko (28:16):
Yay, wonderful, yes, that's great.
So what's one last brain healthtip you're going to leave for?
Dr. Noemi Adame (28:24):
parents.
Okay, how about this one?
A handful of spinach makes theinflammation go down.
Dr. Hokehe Eko (28:30):
Okay, I love it yeah.
Dr. Noemi Adame (28:33):
Yeah, and it just yeah.
You know, I was in academicsfor a long time before I went
into this world of privateoutpatient and I would love to
one day do a study on PANS andPANDAS, the experimental group
being Hope Woods, Plant-Based,and the control group, you know,
just following the traditionalalgorithm.
(28:55):
I really would, because mostpandas physicians feel like
that's the key is starting with.
Nourishment is essential.
Dr. Hokehe Eko (29:01):
Yeah, no, that would be an interesting study.
Call me when you're about tostart.
That would be a groundbreakingstudy.
Yeah, that's wonderful.
So, yes, we'll have all theinformation for Dr Adame in the
show notes.
Thank you again.
I hope you learned from DrAdame's beautiful presentation
(29:23):
of PANS and PANDAS and howintegratively we can help your
entire family glow with healthfrom the inside out, which is
Glow Pediatrics motto, becausewe're here for the whole family,
which is GoPediatricsMotobecause we're here for the whole
family.
So, please share this againwith someone in your world that
you feel needs to hear this.
And until next episode, have awonderful day and remember
(29:44):
you're the best parents for yourchildren.
Okay, have a wonderful day,thank you.
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