Plan B for PANS

The answers we wish someone
had given us

Written by a mother of three children with PANS, after years of appointments where every specialist saw one piece and nobody connected them. Plain English, no gatekeeping, and honest about what we do not know.

Symptoms & behavior
When your child fights every dose of medicine
Daily meltdowns over medication in a PANS child are usually OCD, not defiance. Why every trick stops working, and the approaches that actually help.
Is it OCD, or is my child being defiant?
How to tell PANS-driven OCD from oppositional behavior — and why the difference completely changes what you should do.
What a flare actually is
The signs a PANS child is flaring rather than regressing, what typically triggers one, and what to do in the first 48 hours.
When safe foods suddenly become inedible
ARFID in a PANS child is often the illness wearing a food costume. Why the food range collapses, and what actually helps.
Labs & testing
Mycoplasma IgG vs IgM — what actually counts as active?
High Mycoplasma IgG with a negative IgM confuses almost every PANS family. What each marker means, why doctors disagree, and the three tests that actually settle it.
Your Lyme tests disagree. Here is how to read that.
Specialty tick-borne panels and standard two-tier testing often disagree. Why a negative Quest or LabCorp result does not mean your child was never infected.
Normal folate, starving brain
Why serum folate can look perfectly normal while a child’s brain is starved of it — and the antibody test that tells you whether leucovorin is the right lever.
The immune workup almost nobody orders
Immunoglobulins, IgG subclasses and pneumococcal titers — the standard, covered blood tests that explain why some children cannot stop getting reinfected.
How old is too old for a lab?
How to tell which old results are still useful, which need rechecking, and why a stale abnormal result should never be treated as today’s emergency.
Uploaded is not the same as read
A positive result can sit in a chart for years without anyone acting on it. How to make sure every lab your child has had actually gets looked at.
When no doctor will order the labs
Practical routes to getting a full PANS workup ordered and covered — what to say, who to ask, and what to do when everyone says no.
Reading an anti-neuronal antibody panel
Gold-standard antibody tests versus commercial neural panels — how to read a result where one is negative and the other shows a dozen positives.
What most gut tests miss
Beneficial-species depletion matters as much as overgrowth — and the most common stool tests do not report it at the level that counts.
Genetics is the blueprint, not the picture
What a methylation panel can and cannot tell you about your child — and why the gene is the lock, not whether it is turned.
Infections
The Bartonella signature
The behavioral fingerprint that points toward Bartonella in a PANS child, why standard testing misses it, and what treatment realistically looks like.
Why the strep keeps coming back
Roughly a third of PANS strep recurrences trace to an asymptomatic family member. How to find a carrier and decontaminate a house.
Babesia — the one most often missed
Air hunger, night sweats and bone-deep fatigue that does not lift. Why Babesia is so often overlooked, and why it needs its own treatment.
The reservoir nobody checks
Chronic nasal and sinus colonization is a recognized PANS driver and one of the least-ordered parts of the workup. What to test and why.
Treatment & protocols
When to stop collecting opinions and get a Case Review
You have the labs, three specialists, and a kid who is not better. A Case Review is the one place someone reads all of it, in order, and tells you what has never been treated — and what to do first.
Find the one biggest driver first
Why treating a PANS child one symptom at a time keeps failing, and how to identify the single driver worth going after before anything else.
Open the exit before you increase the kill
Why starting antimicrobials in a constipated, under-hydrated child backfires — and the order that actually works: water, bowels, binders, then herbs.
Is this die-off, or is this bad?
What a Herxheimer reaction looks like in a PANS child, how to tell it from a treatment failure, and exactly what to do when it happens.
When the supplement is the problem
Methylfolate, methyl-B12 and TMG can drive irritability, aggression and agitation in the wrong child. How to spot it and what to check.
Constipation is stealing your child’s appetite
No lunch, then a huge dinner. Why a backed-up gut produces exactly that pattern, and why fixing it comes before everything else.
Before IVIG
IVIG can be transformative, and it can also fail for reasons that were knowable beforehand. What to rule out and treat before you get there.
Drops are not a unit of dose
Twelve drops of one brand is not twelve drops of another. How to compare tinctures properly and avoid accidentally under- or over-dosing your child.
When the remedy starts causing the symptoms
Why a well-chosen remedy can start making things worse — and the difference between true classical practice and frequent-dosing approaches.
Methylation, in plain English
What methylation actually is, why it matters in PANS, and what to do about it.
Environment
The away trial
The cheapest and most informative mold test is leaving. What an away trial can and cannot tell you, and how to run one properly.
Is mold making your kid sick? How to test.
The DIY ladder for finding mold in your home — moisture first, then the wall cavity, then the labs.
Research
Some kids collect infections
In our own cohort, children with abnormal immunoglobulins carried nearly twice the rate of stacked infection drivers. The standard blood test most PANS kids never get.
It is almost never one thing
In our cohort, 53% of children carried three or more infection or mold drivers at once. Why treating one thing at a time keeps failing.
Nine bottles. No map.
What we found when we counted: two-thirds of children on five or more supplements, half never tested for the drivers most likely causing their illness.
Get this for your own child

Upload whatever labs you already have — phone photos are fine — and Plan B reads all of them together: what is driving the picture, what has never been checked, and what to ask for next. The first synthesis is free.

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