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Question 63: Our daughter Lil T. had a winter
season in 2001 plagued with numerous head colds, and sinus infections.
She also came down with 2 bouts of strep throat....In January of this
year (2002) Lil T. started to sniff excessively! Her dad and I would
remind her to use a tissue if her nose was running. She would answer
that her nose felt like there was something in it. Then in May of
this year we noticed the sniff being replaced with the constant eye
blinking and nose twitching. So we took Lil T. to an allergist and
had her tested for allergies. (She said her eyes itched and they were
blood shot!) They were negative according to the doctor. He suggested
that we have a cat scan of her sinus cavity to check for polyps. Once
again nothing showed up. From there we went to the family physician
and he checked up her nose and said it all looked fine, but to have
Lil T.'s eye checked by an eye specialist. The eye specialist said
her eyes are fine and gave us some saline drops to put in her eyes....Lil
T. is still blinking her eyes and twitching her nose, (at times excessively).
When her dad and I correct this tic/twitch she says that her nose
itches up inside and sometimes her eyes burn. The weird part is that
she doesn't take her hand and rub either. My husband and I are having
arguments between us about this being a "tic" or if we should
have her looked at by an ears, nose, throat specialist. Lil T. is
upset because we are constantly reminding her to stop the twitching!!!!!!!!!!
People around us have commented on Lil T.'s eye blinking, nose twitching.
A friend asked me if she has TS. I thought TS was the verbal , very
noticeable body jerking. I am not expecting a miracle, just some help
in diagnosing what is going on with our beautiful 8 year old daughter.
I want the constant nagging to stop if our Lil T. can't help this!
Sorry for the long letter, but I have had this pent up inside for
quite awhile. God Bless, from Lil T.'s mom!
Good morning
"Lil T.'s mom":
Please don't apologize for needing to vent -- you ARE allowed to be
human, you know!! :) Also, such thoroughness in your report to me allows
me to better answer your question.....................
Something that I should perhaps make more clear in my media exposures,
and which I'll clarify right now, is that the symptoms I present with
are an extreme version -- the vast majority of TS cases have much milder
(often hardly noticeable) symptoms such as excessive eye-blinking. I
am further up the spectrum of severity than most, plus I make no effort
to suppress in most situations anymore. To be diagnosed with TS, though,
one only needs to have one "noisy" or "phonic" tic
in addition to multiple movements -- and nose-sniffing DOES qualify.
Use of
the vocal cords in a tic is not required by the standard criteria. I
recall Dr. Mort Doran (the plane-flying surgeon with TS) once saying
that the differentiation between movement tics and noise tics is purely
semantic. In other words, it just so happens that once in a while the
"rut" you find yourself stuck in involves an area of the body
that is DESIGNED to make noise. There is nothing qualitatively different
in these tics.
I had to smile as I read through your email, only because the course
you describe is virtually text-book: for this reason I left most of
your text above for others to read and learn from/commissurate with..
Symptoms starting after a bout of strep-throat (I have an article about
this at www.lifesatwitch.com/pandas.html that
you will find interesting). Eye-blinking being the first symptom. Her
8-year old way of trying to describe that she feels "compelled"
somehow to do these things, and in a stereotyped way (always blinking
and not rubbing). The 'front-line' medical community missing the boat
(they are not trained in disorders such as these) and instead suggesting
allergies, eye doctors, and ear/nose/throat specialists (in fact I KNOW
an ear/nose/throat specialist that sees so many cases of undiagnosed
TS that he has written an article about it -- you can see this article
at www.lifesatwitch.com/msn_health.html).
In short, while I obviously can't be making online diagnoses for ethical
and legal reasons, I would urge you to get an appointment with a TS
specialist (psychiatrist, neurologist, or psychologist). Psychiatrists
and neurologists often have longer waiting lists, and require a medical
referral, but if you are in Ontario they are also covered by OHIP. Psychologists
aren't covered by OHIP, but are often covered by employment insurance,
have shorter wait-times, and do not require a medical referral (this
is important since I've heard many stories about parents being obstructed
by their family doctor who, unfamiliar with when the diagnosis of TS
should be explored, dismisses the symptoms and refuses to make a referral).
One final thing: please look at the "Diagnosis"
archives of my "Ask Dr. Dunc" archives, and in particular
read http://www.lifesatwitch.com/response41.html
-- this is the response to another question I was once sent. In this
response I talk about how to ensure that the appointment you DO set
up with the psychiatrist/neurologist/psychologist is a successful one
(i.e. sometimes the child doesn't tic when you WANT him/her too -- namely
at the appointment! What do you do?).
I hope all this helps -- good luck, and take good care! Remember, putting
a name to something is an enormous part of the battle: it opens many,
many doors to education, understanding, coping, and acceptance. Life
gets better from here -- good luck!
Dr. Dunc.
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