The New Patient Questionnaire Part 2

     Last week we covered Sections A, B and C of our New Patient Questionnaire covering Maternal Health, as well as the Pregnancy and Birth history of your child.  This week I will cover Section D, the Infancy/Toddler Years.  Our Questionnaire helps us identify and treat underlying medical conditions that may account for a number of "autistic behaviors" in your child!  It gives us and you invaluable insight into why your child behaves as he or she does.  Remember, our New Patient visit lasts about 2 hours.  We take the time to get to know and understand your child's problems!

     I start out by looking at the gastrointestinal tract and overall immune system status of your child's baby years as we go over questions about colic, reflux, ear infections, thrush, strep infections, asthma, allergies, rashes and that painful red ring around the anus.  A pattern of gastrointestinal problems usually stands out, as well as sickly children that had a lot of ear infections.  (About 30% of the time, this is not the case.)  The American Academy of Pediatrics acknowledges that about 70% of children with an autism spectrum disorder have more gastrointestinal problems than usual, and that is about the percentage that I see in my office as well. 

     How do problems like reflux, thrush, and ear infections affect my child with autism, you ask?  70% of our immune system is located in and around our gut, and if the gut is unbalanced early on, then the immune system seems to be as well.  It is very common for the infant history to have many GI symptoms, combined with reports of multiple ear infections, tubes in the ears, poor sleep patterns, thrush, eczema, and diaper rash.  Thrush is that white coating in their mouth that indicates a yeast overgrowth of the baby's GI tract.  Diaper rash is often the result of the yeast overgrowth at the other end!  (Think about it: the GI tract basically starts at your mouth and goes all the way through to your hind end!) Each time your child gets an ear infection, an antibiotic is usually prescribed.  The good bacteria that usually keep yeast at bay are wiped out each time your child gets an antibiotic.  The yeast says, "Thank you very much!" and begin to flourish and grow since all the competition for food and space have been cleared out of the GI tract.  So with each antibiotic that your child takes, the gut can get more and more yeasty.  Yeast cause rashes and eczema, tummy aches, make your child feel and act foggy and irritable, and can inflame the lining of the intestines.  Children with autism are prone to inflammation in the GI tract, which can lead to pain, which can lead to "bad" behavior and sleepless nights! 

        In the last 5 years or so, cutting edge research on the immune system and the gastrointestinal tract, published in mainstream journals, shows a relationship between yeast in the gut, and eczema and rashes on the skin.  By the way, so many parents tell us that their pediatrician gives them endless creams and ointments for these diaper rashes and eczema, which help a little but don't seem to wipe out the problem.  That's because if the rash and eczema are due to yeast problems in the GI tract, the creams and ointments do not treat it!  Parents are constantly pleased and amazed that a simple natural protocol we use for treating yeast in the gut clears up their baby's skin! The research also shows that using probiotics in the third trimester of pregnancy, and early on in the infant's life, can decrease eczema, asthma and allergies for that child!  Now that's exciting news!  But many pediatricians seem to be unaware this new research, and keep prescribing creams, ointments and even steroid creams.

     Next, I get into the "poopy" questions:  I ask about the frequency, texture and well, yes, the smell of your child's poop and gas!  Now, some parents look a bit baffled at this line of questioning; but many of you exclaim, "Finally, someone who's asking about all these weird things that we deal with every day!"  I mean we get into the poop!  Is it little hard "rabbit pellets", or enormous rock hard BM's, is it more diarrhea, or is it a really confusing mix of both diarrhea and constipation?  I know poop stinks, but was this "award-winning stench"?  Sometimes the infant history is clean, but GI problems develop later on.  I also ask about your child's sleep pattern as a baby.  If he or she had a lot of reflux, they were usually a poor sleeper, showing a pattern of frequent night awakenings and irritability. You may have been unaware of any reflux problems, but only knew that your baby was a poor sleeper! 

     Why am I asking so many questions about poop and gas?  I'm specifically looking for patterns of constipation and diarrhea.  Children on the autism spectrum tend to be more on the constipated side.  Yet they often have both diarrhea and constipation!  How does that happen?  Well, poop is mostly liquid stuff until it reaches the colon, towards the end of its journey through the body.  There in the colon, the body draws much of the liquid out of the poop, firming it up into that nice, normal, formed but soft shape that it should have.  When there is constipation, a hard clump of poop can block the colon and slow things down.  However, your child is still eating and making more poop.  So eventually the body forces the higher up, still liquid poop around the constipated clump, and voila, we see both hard, constipation poop and mushy, "mashed potatoes" poop alternating in the child with autism.  I cannot tell you how many parents in my office tell me that no one ever explained this pattern to them!

     Why am I asking about the smell?  Children with autism are prone to fungal and even bacterial overgrowth in the GI tract.  When a child is constipated, the poop is spending more time in the gut, hanging out and acting as a perfect growth medium for these yeast and bacteria.  Of course, occasional foul BM and gas odors may be due to something the child ate, but an overall pattern and history of room-clearing stench should create a healthy clinical suspicion of a yeast overgrowth.  I have some young patients who only have a bowel movement every 7-10 days or longer, and the parents vividly describe a stench that requires immediate bagging of diapers and removal from the house!  Now that's just not normal!

     Okay, so a picture is emerging here of a child with constipation, diarrhea, stinky gas, reflux, eczema, runny nose from allergies, restless or poor sleep, maybe has a lot of ear infections or colds, and they are irritable and fussy to say the least!  And you are exhausted! Sound familiar?  And why haven't your other doctors asked these questions?  Do they make you feel like you're a little crazy or bothersome?  Do they act like they wish you'd just shut up and take the prescription they are holding out to you?   I am not against prescriptions, but I think a lot of these children are being medicated until they just shut up, sleep, or both!

     You are not crazy!  These are real problems that children on the autism spectrum have!  And there are simple, natural protocols to correct these problems, calm your child down, get rid of the GI issues and let you and your child get some real sleep!  Now that sounds like just what you need! 

     Join me next week as I discuss "The Unholy Three"; the trio of medicines that new patients are usually on when they first arrive at my office.  I will explain why these prescriptions do not fix the underlying problems that can be responsible for a number of "autistic behaviors" in your child, and tell you about a sane, safe way to help your child feel better and have less "autistic" behaviors. 

Take care,

Dr. Jae

The New Patient Questionnaire

Part 1

     When you make your first appointment with us, we send a New Patient packet of forms, including our New Patient Questionnaire.  Wow, you say, it’s really long!

     Yes, it’s really long, but it is one of the most important tools we use in understanding what underlying medical conditions your child may have.  It also highlights several areas where a referral to another professional may be helpful to your child’s overall treatment approach.  It helps us clearly see what therapies and interventions will most likely be helpful. 

     The first series of questions gives us background information on your child, starting with the mother’s history during the pregnancy.  Although the causes of autism have not yet been clearly identified, there are several major theories, basically involving various toxic exposures. Since it is impossible to have an abrupt, world-wide epidemic of a purely genetic condition, a lot of research is looking for “triggers” that have caused so much autism.  We think there must be many triggers, especially since each person with autism presents so differently.  There must be an infinite variety of combinations of Triggers + Genetics causing such a spectrum of symptoms and severity. 

     So in our first series of questions, we ask about a variety of exposures to the mother, including work environment, medical and dental procedures, smoking, and prescription and recreational drug use.  We continue with the labor and birth, and include any antibiotics or vaccines given to your newborn during the hospital stay. 

     We are not against antibiotics or vaccines.  However, we do find the results of one research study troubling:  the hepatitis B vaccine given on the first day of birth is associated with a threefold higher rate of autism in boys.  We have not yet seen it refuted, so we encourage families to give this shot later, up to 2 years of age.  Most newborns are not at risk since we don’t have too many newborns trading sex for drugs! 

   Of maximum importance to us, early antibiotic use tends to set off a cascade of gastrointestinal problems in autistic children.  It’s like the good bacteria never get off to a good start, and we usually see colic, reflux, gassiness, sleep problems, ear infections (which lead to more antibiotics) and then tubes in the ears.  Antibiotics are not bad in themselves; its how we use them.  If everyone followed an antibiotic with a month or 2 of high-potency probiotics every time, I doubt we would see so many gut problems in our children.    That’s why we stock and recommend Therbiotic Complete probiotics, available in both infant and regular formulas, to most of our patients.  This is a physician-only probiotic, and we see amazing results with it.  When good normal bacteria are not well-established early, we see a lot of thrush, sometimes strep and sinus infections.  If your baby has thrush, this is an overgrowth of yeast in his gastrointestinal tract; it is not just in his mouth.  What you see in the mouth is just the tip of the iceberg! 

     Did you know that 70% of the immune system is in the gut?  If your baby’s gut is overrun with yeast, his gut lacks a healthy balance of good bacteria.  When the gut is unbalanced, so is the immune system!  These children tend to fall into 3 groups at our office.  Either they get sick frequently and catch every cold coming and going.  Or they may not get sick much at all, but seem to have a “hyper vigilant” immune system; they keep a runny nose, and seem to have more allergy and asthma symptoms.  The third group is the worst of both worlds: they get sick a lot AND have allergy/asthma inclinations!

     By this point, I already have an idea if your child had early gastrointestinal symptoms.  Next week’s blog will address the next section of the New Patient Questionnaire, and explain why early GI problems are associated with sleep and behavior problems.

     Take care, and love that child today!

Dr. Jae

     One of the most common questions we get is, “What happens at my first visit to your center?”  I’ll walk you through the initial process.

     To make an appointment, simply call us and Angela will get your basic contact information, and send you a New Patient packet with a number of forms in it.  One of these is our extensive 14-page New Patient Questionnaire, which you can also download from this website.  (See Downloads.)  Make sure this is filled out ahead of time, as it could add an additional hour to your first visit if you show up without it! Another form we use is the E2 Form from the Autism Research Institute.  This is scored and gives a fairly reliable probability of your child having a form of autism, or autistic traits.  This is just for your knowledge, so you will understand more about what is going on with your child.  It does not mean that you have to label your child.

      Because of our extremely low fee schedule, Angela will collect the fee for the visit at the time the appointment is made, or you may mail us the payment within the next week to 10 days.  We usually are scheduling 2 to 3 months out.  However, we can put you on the cancellation list if you need a quicker appointment. 

     I do not need for your child to already have a diagnosis, and he or she does not already have to be on any special diets or therapies before you come.  Some families are anxious for a diagnosis that will help them understand their child’s behaviors or problems, and many are just as anxious to avoid a diagnosis or label.  The good news is that we do not need to “label” your child  for him to receive help at our center!  Many of our patients do NOT have autism, but only have behavior and learning issues, gastrointestinal problems, an altered immune system, or just seem “different” from their peers and classmates.   We treat underlying medical problems that often cause difficult behavior and aggression, sleep problems, constipation, delayed language, poor social skills or “being in their own world”.   So don’t worry about labels, we are more focused on helping your son or daughter feel better and function better, than putting them into a slot! 

     Your first visit with us will take about 2 hours, so be sure to bring someone to help watch and entertain your child!  If you have more than one child that you would like us to see, we usually schedule separate appointments, although we can do them together if you are traveling from far away.  It is especially important to bring a helper if we are seeing multiple children in one visit! 

     I will go over the New Patient Questionnaire with you at this time, as this history will provide a rich source of insight into your child’s problems and treatment options.  This questionnaire not only reveals areas of concern that we can treat at our center, but I will also be on the lookout for when a referral is needed for psychological evaluation, vision therapy, sensory integration or a behavioral program.  If indicated, I may order a lab test.  LabCorp is conveniently located across the hall from us.   

     I will also observe and interact with your child in a low-key way, assessing his language and social awareness, behavior and communication skills while he or she is in the room with us.  This way I get a clinical impression of your child.  This is not the same as a detailed diagnostic assessment such as you might get in a full psychological evaluation.  I will be able to tell you if I feel your child is on the autism spectrum or if we are dealing with something else; again, this is a clinical impression using the diagnostic criteria of the DSM-IV for the various forms of autism.

     After going over your child’s history, plus observing and interacting with him, I will then explain what I feel is going on medically with your child.  About 3 out of 4 children will usually have some type of problem with their gastrointestinal system, and I will tie it all together for you at this point; the bizarre combination of behavior, sleep problems, constipation or diarrhea, unusual pain tolerance, why they only eat a few foods, the poor eye contact and why they may prefer to be alone.  Each child is unique, but the majority of the time there is a medical explanation for all of these things, and a very good chance they will respond to treatment at our center.  I cannot predict or promise a full recovery, but many children will calm down, sleep better, speak more, have better eye contact, as well as catch fewer colds and eat a more varied diet.

     I will then type up a simple treatment protocol for your child for the next 8 weeks or so, and schedule a return visit at that time.   You will usually start your child’s first therapy that evening!  How exciting!

     We keep it simple, especially in the beginning when most families are overwhelmed, tired, discouraged, or just sad.  We provide educational support and emotional support, and encourage you to call us with any questions after you get back home.  We can help you work with your school as well.  You may want to borrow some books at no charge from our Lending Library at this point. 

     Now your job will be to give this 2 month treatment plan your very best effort!  Consistency with the steps is very important, and gives the best results.  I do NOT want to see you 2 months later and hear things like, “Well, we tried it for a week or 2 and it wasn’t working, so we quit….”  You probably will not see such quick results.  Your child did not get this way overnight, and treating him or her is process, sometimes a journey, and will take some time.  We are correcting underlying medical problems, not treating symptoms, and it takes the gift of time and consistency.

     Next week, I will go over signs, symptoms and behaviors to look for if you are wondering if you should call for an appointment. 

     Take care, and love your child!

Dr. Jae