Nicolette Peterson, COL ’23, Granby, MA
I am so grateful to have had the opportunity to work one-on-one with Dr. Patrick Whelan for my second summer at UCLA Health. Dr. Whelan is a pediatric rheumatologist, and he is thought to have treated more patients with a diagnosis of PANDAS/PANS than any other physician in Southern California. Outside of his various endeavors at UCLA Health, Dr. Whelan is also a professor for a graduate course at Harvard University, investigating the link between music, neuroscience, and neurodegenerative disease.
This summer, I worked alongside Dr. Whelan to conduct research on his patients with a diagnosis of PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) or PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus). Children diagnosed with PANS/PANDAS experience a sudden onset of OCD symptoms, tics, and/or emotional lability, which typically manifest shortly after their exposure to infection. The preceding infection is thought to induce neurological inflammation within PANS/PANDAS patients, accounting for their abrupt change in behavior. Many parents recall observing a seemingly “overnight” psychological shift in their children.
PANS/PANDAS patients often fall between the cracks of neurology, infectious disease, and psychiatry during their initial medical consultations. Neurologists and infectious disease doctors are willing to provide treatment for unresolved infection-related symptoms, but they are oftentimes not fully equipped to manage the care of patients’ psychological features. Conversely, psychiatrists are willing to treat patients’ behavioral symptoms, but their evaluations may be taken out of context of these patients’ infectious disease histories. As a result, many PANS/PANDAS patients meet with multiple medical teams before they are referred to rheumatology, a department that attempts to create a cohesive workup tying together these patients’ seemingly unrelated — but temporally connected — behavioral, neurological, and infectious disease symptoms. The challenge that many PANS and PANDAS patients face in acquiring well-rounded care testifies to the need for further research and understanding of these diagnoses within the medical field.
Dr. Whelan has observed that many of his PANS/PANDAS patients seem to exhibit some degree of immunodeficiency, leading to their repeated (and often more acute) experiences with community-acquired infections. Over the past eight weeks, I have reviewed all of Dr. Whelan’s medical records from the past year, and I was able to pinpoint 160 patients who were determined to have a differential diagnosis that included PANDAS or PANS. I evaluated 48 distinct criteria for each patient, filling in a total of 7680 data fields, from which I derived my statistical findings. In line with Dr. Whelan’s observations, a substantial proportion of these patients had serological results which revealed some degree of immunodeficiency. Approximately 47% of Dr. Whelan’s PANS patients experienced frequent infections, and 28% had an immunoglobulin deficiency, signifying an impairment of their immunological defense systems.
In addition to my research, I had the opportunity to shadow Dr. Whelan within UCLA Health’s Westwood and Santa Monica Hospitals. I observed his treatment approach for a long-term pediatric PANS patient, as well as his initial workup for a patient with potential PANS. During these consultations, I observed Dr. Whelan’s process of constructing the case reports that I reviewed within my research. I was also able to observe a variety of Dr. Whelan’s patients within the Pediatric Inpatient and Intensive Care Units, whose symptom presentations included Covid-induced stroke, coma, peripheral gangrene, and cardiac arrest.
Each Thursday, I shadowed Registered Nurse Stacey Zedeck within UCLA’s Pediatric Allergy and Immunology Department. Stacey’s team aims to bolster the immune responses of pediatric patients with severe nut allergies. Following immunotherapy, each patient is spoon-fed minute doses of their allergen to determine their tolerance, as their physiological reactions are closely monitored by the Allergy and Immunology team. I observed two children experience extreme allergic reactions during this procedure, requiring epinephrine, and I was able to provide hands-on support to patients and their families.
Overall, my experiences at UCLA have definitely affirmed my desire to pursue a career in the medical field! I am incredibly appreciative of Career Services for providing the financial support that made my summer opportunities possible.
This is part of a series of posts by recipients of the 2022 Career Services Summer Funding Grant. We’ve asked funding recipients to reflect on their summer experiences and talk about the industries in which they spent their summer. You can read the entire series here
