PANDAS & Lyme: My Recovery and 8 Years of Misdiagnoses

Posts tagged ‘Narcolepsy’

My Narcolepsy Diagnosis Almost Killed Me

What happens when you’re diagnosed with narcolepsy, and every treatment fails?

Three years ago, I wanted nothing more than to be awake.

After a sore throat on my first day of college, I’d become increasingly incapacitated with sleepiness that nothing could relieve. I spent the majority of freshman year asleep, existing in a dream-like state where I never seemed to attain full consciousness. I hoped for a solution to my problem that worked as quickly as it had begun, but nothing prepared me for what my sleep neurologist said instead, on that fateful May afternoon:

“You have narcolepsy.”

My whole world shattered.

Narcolepsy is a serious autoimmune disorder in which the body destroys the brain chemical hypocretin—the neuropeptide responsible for regulating wakefulness. There is no cure.

Normally, there’s a clear line between the sleep and wakefulness cycles, but in narcolepsy, it’s as if they’re blurred together.  People can experience sleep paralysis with strong emotions while awake, known as cataplexy, and carry out routine activities while asleep (automatic behaviors). They may see terrifying hallucinations while waking up or falling asleep, and they might wake up and not be able to move. Worst of all, you can’t stay awake during the day (though you might not be able to sleep at night). Untreated, it’s utterly debilitating.

I would have narcolepsy for the rest of my life, my doctor explained, but with medication, it shouldn’t stop me from living.

On the surface, I fit the bill for narcolepsy perfectly. I had daytime sleepiness so severe that I could fall asleep standing up, in the middle of a conversation, or after sitting down for five minutes, regardless of how much I slept at night. I had the cataplexy; whenever I laughed hard, my knees buckled in a paralysis attack. I had the hallucinations and the automatic behavior. And I had Periodic Limb Movement Disorder—my legs would move hundreds of times while I slept, resulting in awakening over two-hundred times during my overnight sleep study; people with narcolepsy often have PLMD.

But there was one problem with the diagnosis: my sleep studies didn’t look like narcolepsy.  In my daytime sleep study called the Multiple Sleep Latency Test, where I took five twenty-minute naps over the course of the day, I never once entered REM sleep—and entering REM in at least two naps characterizes a narcolepsy diagnosis. So I was a “narcoleptic…” Who didn’t really have narcolepsy.

My neurologist wasn’t confident in my diagnosis, so he sent me away from the appointment with medicines to treat the PLMD, just in case it was the sole cause for my extreme sleepiness. If the medicines worked, I didn’t have narcolepsy. But the medications I tried—Neurontin, Neupro, and Requip—didn’t make me any less sleepy, and instead, I deteriorated further. Requip even landed me in the ER, with violent involuntary movements, and I lost the ability to walk.

So apparently I did have narcolepsy—and now a movement disorder and increasingly severe psychiatric problems that five other neurologists couldn’t explain or relieve.

After the Requip nightmare, I started a $5000 narcolepsy medication called Xyrem, but it too failed miserably at controlling my symptoms; before long, I reached the brink of insanity as I fell into delirium, became terrified of vomiting, and stopped eating.

“We’re so sorry, but we don’t know how to help you.”

My doctors were running out of treatment options… Or so they thought.

In a last-ditch effort to save me, my parents begged for a five-day steroid burst. If it worked, then perhaps I had that “controversial” autoimmune disorder called PANDAS/PANS.

And then I woke up.

After three days of Prednisone, I was in my right mind and awake without stimulants for the first time in months. Even after the burst ended, my “narcolepsy” was still gone. The transformation was so shocking and dramatic that my formerly PANS-skeptic doctors became PANS advocates.

A couple weeks later, a specialist confirmed my PANS diagnosis, and I received IVIG to more permanently stop my symptoms. A case of mono and a Strep infection had tricked my immune system into attacking my brain, which manifested as sleep issues and psychiatric/cognitive problems.  Although the sleepiness returned to a more mild extent two months post-IVIG, it never reached the severity of before, and after a second IVIG, it disappeared for good.

Today, three years after my narcolepsy diagnosis, though I’m still fighting PANS to a far milder extent (and now Lyme), I live a fulfilling life.  So I can’t help but think, what if I’d never found out I had PANS? If PANS hadn’t killed me through starvation or suicide, then it would’ve been a living death sentence to survive with treatment-resistant “narcolepsy” and PANS’ other torturous, disabling symptoms.

10% of those diagnosed with narcolepsy have normal levels of the brain chemical hypocretin, meaning the cause of their symptoms isn’t understood. And doctors still don’t know the cause of narcolepsy’s cousin, idiopathic hypersomnia. How many other people are out there diagnosed with hypersomnia, narcolepsy, or PLMD who, like me, actually have PANDAS/PANS?

Until more patients and doctors are aware of PANS, we’ll never know. Although I’m no longer the “Dreaming” Panda in the same sense as when I came up with the blog name in 2014, now I dream of the day when no one has to endure what I did to awaken from their nightmare. I hope people will share my story, and their stories, with the world, to turn this dream into reality.

I Officially Have PANDAS!

So I went to see a PANDAS specialist this week, and I’ve finally been diagnosed with PANDAS.  My doctor was wonderful and finally took my symptoms seriously.  She even said my mysterious illness from 2006-2007 may have been Rheumatic Fever. And unfortunately, she told me I’m not just having tics, but also chorea, which could explain my strange falls when I walk.  The best words my doctor said were, “You’re going to get better.”

She has put me back on Prednisone for six weeks along with a different antibiotic called Cefdinir.  I am in such a bad flare right now that she wants me to do IVIG as soon as possible. She was very troubled by everything I had been through and decided that eight years was long enough and we should just knock out the disease with the stronger method of IVIG treatment.  Plus, my movements have not improved at all with antibiotics.

I don’t even know what I feel right now.  I’ve waited so long for someone to tell me for sure what my illness was, and now someone did.  I still can’t believe it.  I’m ecstatic and terrified all at the same time…

I’m grateful, because most people with this condition never get a proper diagnosis. They estimate 160,000 people in America have my disorder, but it was only discovered in the late ’90’s, and only several thousand people have received a diagnosis. Many people suffer through years of treating the symptoms, only to have treatments fail. Now, I don’t have to do that for another single day.

I’m shocked, because having a diagnosis means there’s no way for me to deny to myself that things aren’t as bad as they really are. For months, I’ve coped by trying to tell myself that I don’t feel “that bad,” and I still haven’t fully processed what has happened to me. I’m still surprised every time I wake up in the morning, fall down, and realize again that I can’t fully control my movements. When a neurologist gives you a name for your condition, it’s like a Mack truck running you over with shock, because you realize that this is your reality right now.

I’m so, so happy, because I’ve been told I’m going to get better. For eight years, I thought I was stuck with all these crazy symptoms. I believed it was all just going to always be part of my existence. But now, I’ve been told it doesn’t have to be, and it’s an incredible feeling.

I’m worried, because I have to have IVIG in another week, and for 10-15%, it doesn’t work.

I’m scared, because they still know so little about this disorder. How do we really know I won’t relapse in a decade or so? Or even in another few months?

I’m sad, because now that someone has told me what has been wrong with me, I know that I’ve lost eight years of my life to a disease that could have been treated if it had been diagnosed sooner. Even after I’m better, I think I’m going to have to go to counseling to avoid PTSD…

I’m angry, because I can’t understand why any of it had to happen to me. Seriously, why me? And why does this happen to anyone? I am filled with grief when I consider how much pain it has caused me and when I realize there are thousands of others like me. It’s just too much. This has been a major struggle in my Christian faith lately. I’ve read the book of Job a lot, and I’ve just decided that there is no answer for now—there’s only trust in spite of my lack of understanding. That’s why it’s faith—because you don’t see signs or answers—not because you do perceive it with your eyes.

Most of all, I’m relieved, because I finally have an answer and a productive way forward. I’m in good hands with this new doctor, and even though it could take up to a year for me to recover completely, I truly believe that I will get better. Oh, and my doctor said that, given my response to steroids and antibiotics, there’s no way I have narcolepsy.  Phew.  Yes, my PANDAS diagnosis is wonderful news!

Is Looking at My Medical Records Really Too Much to Ask?

This week, I’m going to be seeing three neurologists including one PANDAS specialist. As you can imagine, I’m very nervous but also excited about the possibility of figuring out what has gone on with me for the past eight years. In order to prepare for the appointments, I’ve been trying to get my hands on my own medical records for awhile—with little success.  Forgive me, because I need to vent…

I don’t understand why it has to be so hard for me to look at some pieces of paper—pieces of paper with my personal information on them. The laws say that I have a right to do so. And as far as I’m concerned, they belong to me. Unfortunately, the administrators I’ve had to get in contact with have disagreed. One even had the nerve to tell me after I had explained my situation: “The records belong to us.”

These people were horrible. They hardly wanted to lift a finger to help me. All they cared about was how long they could get away with taking—as if what they’re dealing with was just another office job—nevermind that a person’s health is at stake.

I was eventually able to get the records from two of the three practices. Unfortunately, the third one has fourteen years of my records that include the time of my symptom onset, and they have been the worst to deal with by far. I’m considering taking an attorney with me when I go back, because some of what they told me sounds illegal. To give you an idea of how little they care, this is how the conversation went:

“I’ve been trying for awhile to get my medical records which were transferred to another practice a few years ago. They were very unhelpful and didn’t tell me they couldn’t release the ones from your practice along with theirs. I’m in a predicament because I have a specialist appointment out-of-town next week, and I need my records by Wednesday…”

“Legally, we have two weeks to get them to you.”

Are you kidding me? This is your response to someone who has just explained the nightmare they’ve been through at another practice? This is what you say to someone who’s just told you that they’re sick enough to need to go out-of-town for a specialist?

That’s wrong and unacceptable,” I said, trying to stay calm. “I’m sick, and I need them next week. Look, you have them sitting right there. Can I not copy them for you and take the copy?”

“No, we can’t do that.”

“I’m very ill, and I need my charts to get a proper diagnosis. Is there any way to expedite the process? I’ll pay extra.”

“No, by law we have up to two weeks to get you your records.”

“I don’t have two weeks. You have two weeks by law, but morally, why won’t you even try to help me get them sooner? Is there nothing you can do?”

“We have up to two weeks to get them to you.”

In a perfect world, I know there wouldn’t be such a rush to get my records, but that’s not how life worked out.  It would be one thing if that administrator had shown even a little bit of concern for my situation and told me she couldn’t do anything, but instead, she was a total jerk.  And I’m sure I’m not the only one who has been dealt with in this way. I pity every soul that’s stuck dealing with that woman on a regular basis because they see one of the doctors at that practice.  Who knows?  Maybe she’s crazy enough to surprise me by getting me my records before my appointment on Friday…

Takin’ Roids

I’m no doctor, but recent developments have shown I almost certainly have PANDAS or PANS.

A standard way to see if symptoms are autoimmune-related is to do a steroid burst for five days. The theory is that if inflammation is the culprit, the symptoms will improve with the steroids. It doesn’t work for some true PANDAS/PANS patients if there is still an active infection like Lyme or mycoplasma causing an exacerbation.

But it worked for me. I just finished a five-day burst of Prednisone with incredible results. By the third day, I did not need any Nuvigil to stay awake, and my concentration was so good that I was able to sit down and write a paper and take a test in a timely fashion with no brain fog. My tics and walking problems also significantly lessened, though didn’t completely go away. My depression vanished. It was amazing to feel normal again!

Dare I hope that I’m not actually narcoleptic? I don’t think people with narcolepsy can suddenly stop feeling sleepy during the day. Narcolepsy is an autoimmune condition caused by the destruction of a brain chemical called hypocretin. Once the chemical is destroyed, it can’t be regenerated. Hypocretin regulates wakefulness, so if the loss of it (narcolepsy) was what was causing my sleepiness, I should not suddenly feel this awake with no stimulants. I’ll see my sleep doctor next week, and he’s going to be shocked. I wonder what he’ll say about this…

The next step is treatment with an antibiotic called Augmentin. My doctor prescribed a high dose of it for thirty days, but I’m curious to see what the PANDAS specialists will say. In the next couple weeks, I’ll be seeing an immunologist and a neurologist that specialize in treating it. I should have seen them eight years ago, but how could we have known? I’m hoping and praying that I do not have permanent brain damage from unknowingly delaying treatment for so long. But these last five days of steroids give me hope that I will soon feel normal again….

“You’re Just Tired”

So I tried Xyrem for a week, and I did sleep like a baby. It was actually wonderful—I would wake up in the morning feeling completely rested and not feeling like I needed twenty more hours of sleep. I hadn’t felt that way for eight years. But it upset my stomach so badly that I lost even more weight because I was unable to eat anything. I’m down to a hundred pounds. I was around 111 before this summer…

My doctor is just plain flummoxed by my strange reactions to meds, so he made me stop everything over the weekend—even my anti-depressant. As would be expected, I felt horrible in every way. But one of the worst parts was what someone said to me about how I would be off my meds:

“You’re just going to feel tired…”

I know that she meant no harm by what she said, and for most people, those words may have sounded like a nice sentiment. But for someone who is sick, it was a slap in the face.  I wish I knew what it felt like to get tired. Shoot, I wish I could feel tired in the sense that you think of being tired, because your definition of tired is probably my idea of a good day.  When I say I’m tired, it’s worse than if a normal person went three days without sleep.  My tired is not your tired. Your tired is as similar to mine as being able to swim one lap is to being Michael Phelps.

I’ve been sick for awhile, and often, when I’ve told people I’m tired and sleepy and how hard it is, I get a cold, “Yeah, I’m tired, too.”  Usually, people mean well and might even think they’re being sympathetic by saying they relate.  But that’s the problem—there’s no way you can even imagine my tiredness unless you’ve lived with a chronic illness.

By saying you’re also tired and sleepy like I am, you’re telling me what I’m dealing with is normal and trivial—that it’s just what everyone goes through sometimes. You’re telling me I should just suck it up and deal with it and get some sleep, because that’s what you do when you’re “tired.”  But that’s the difference—your tiredness goes away, but mine does not.

So please, never even imply that a narcoleptic “just feels tired.” That’s like saying the Pacific Ocean contains “a few gallons of water.” No, the ocean is water, and in fact, it’s the most water you’ll ever see and is bigger than you could possibly imagine until you are thrown overboard and left bobbing around by yourself in the middle of it. When you are there, you can realize what an ocean really is. I have the privilege of being stuck swimming alone in an ocean of “tired.” Don’t tell me you know how it feels to be stranded here, because I don’t see you swimming around next to me.

It’s time for all of us to stop telling people that we know how they feel, because we don’t. It’s time to stop responding to others’ pain with insensitive comments. Why can’t we just believe people when they say they hurt? Why do we tell people how they should feel? It’s not that hard to just take a moment to sit down next to someone and acknowledge that what they’re telling you must be as hard as they say it is. That’s all I’m asking—to just listen and not try to tell me what I’m facing isn’t that bad.

De(pressed)ad Again…

I don’t even know where to start since I last wrote.  I seriously think I’m going crazy.

The other night, I got in a really bad way.  During the day, I would just sit down and stare into space, because that was all I could do. I had no concentration whatsoever. Whenever I tried to do homework, I found myself just staring, thinking about nothing. I tried to make myself focus, but then I’d just start staring again before I realized I was doing it.

(more…)

Why I Can’t Stand All These Meds

So, my Xyrem finally came.

For my non-narcoleptic readers, Xyrem is one of the meds used to treat narcolepsy and cataplexy, but it’s a controlled substance with only one pharmacy in the US that makes it. After getting a prescription from the doctor, I had to go through two weeks of phone calls from nurses and pharmacists at that pharmacy. The best part of one conversation went like this:

Nurse: Do you have cataplexy in addition to narcolepsy?
Me: *falls to the ground…*

(more…)

My 8 Year Journey Into the Wormhole of Rare Diseases

Hello world!  Welcome to my recovery blog.

I’m a teenager that has Narcolepsy with Cataplexy, OCD, and another undiagnosed illness that is suspected to be PANS (Pediatric Acute Neuropsychiatric Syndrome) or PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus).

I’m writing this blog to raise awareness for my conditions and hopefully, to inspire others to not give up.  There may or may not be a cure for my illness, but I’m on a journey to take back my life, and this blog is for recording that journey.

Once upon a time, I was completely healthy and fit.  But in the summer of 2006, I came down with a mystery illness that tore apart everything I knew.  (more…)

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