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A real Plan B synthesis, fictionalized. Based on a real child’s case. Every name, place, date, clinician and identifying detail has been changed so no family can be recognized. The clinical story, the reasoning and the plan are exactly what Plan B produced.

Sample synthesis · “Owen”

Owen’s synthesis

Built from his parent's birth-to-now story and 200 lab results read together — including why every treatment seemed to make him worse.

Owen fits the pattern Plan B is studying. Mold before birth and in early childhood, the same cluster of behaviors, and a crash on every kill step. Our first case study, the Mold-First Study, is testing whether early mold is what ties these kids together. It’s a hypothesis, not a finding yet. See “Where Minta’s thinking is going” below. About the study →

The story in one sentence

Here's what no one has connected for Owen. His rage on B vitamins and on each new kill herb fits his own labs, which show a backed-up clearance step (cystathionine 773 high, cysteine 249 low). Meanwhile the one infection his labs actually show, all six Coxsackie B strains, was never rechecked.

Minta reviewed your 200 uploaded lab results and your intake before writing this.

Dear Mom, I've read all of it. The deep puncture wound from his fall onto a broken fence post when he was 9, and the six weeks of strong antibiotics. The stitches he felt. The buried wood fragment that drained for four months. The manic-looking episode that winter. COVID the following summer. How much better he got after you left that house the spring after that. His gut is better and he falls asleep more easily. That progress is yours.

Right now he's flaring: rage, nightmares, 'I'm bad,' and fixation at 7/10, since the one drop of cryptolepis. His routine labs are thorough. What's missing is the immune and tick-borne testing that would tell us what is actually driving him.

Owen's behaviors, read as a whole

These are the patterns you've described. There are no daily logs yet, so the tracker will sharpen them.

His behaviors fall into four clusters:
- Rage plus aversion to one family member
- Scrupulosity, existential worry and 'I'm bad' thinking
- Nightmares and broken sleep
- Fixation plus school regression

Rage with vivid nightmares often points to Bartonella. That is a pattern Plan B is testing across families, not a proven link, and Owen has never been tested for it. Scrupulosity is classically strep-linked (published PANS framework). The strep antibodies on file weren't raised, but they can't be trusted until his immune panel is known. The clearest signal is timing: he flares when something new pushes his immune system, such as an illness, a kill herb or B vitamins. (Hypothesis, needs data.)

Behaviors tracked

  • Restricted / fixated interests (7/10)
  • Vivid nightmares (5/10)
  • Free-floating anxiety (5/10)
  • Religious / existential (5/10)
  • Rage / explosive aggression (5/10)
  • Aversion to a specific family member (5/10)
  • Apologizing / scrupulosity / 'I'm bad' (5/10)
  • Academic regression (5/10)
  • Sleep disruption (5/10)

What would clarify it

Three things: start the nightly tracker (including daily bowel movements and any illness), the immune panel, and Bartonella testing through IGeneX plus TLab.

Where Minta's thinking is going

Our best theory right now

Here is our best current theory, and it is an early hypothesis Plan B is studying, not a diagnosis. You lived with mold while pregnant with Owen, and his symptoms began in a moldy house. That early mold may have weakened his clearance and his immune defenses. So infections like his Coxsackie linger, and kill steps backfire. It fits his story well. But no test has confirmed it, and the results could point somewhere else. We don't know yet.

Early mold weakened his clearance and immune defenses, so infections linger and kill steps backfire (Mold-First Study, early hypothesis) leading
Why we think so: He had mold exposure in the womb, and his symptoms began in a moldy house. His gut and sleep got better after you moved. He has the cluster Plan B is studying: rage, nightmares, 'I'm bad,' fixation, and aversion to one family member. He crashes on kill steps, including this flare after one drop of cryptolepis. His labs show a backed-up sulfur step (cystathionine 773 high, cysteine 249 low). He has six high Coxsackie B titers that were never rechecked.
The test: Urinary mycotoxins (MycoTOX). There is no mold-toxin test on file at all.
If positive: Mold moves from history to a measured part of his picture. The plan stays load before kill. First comes support for clearance, with bowels open every day and the tank full. Only then would any kill step come, one at a time. It would also make Owen part of what Plan B is learning.
If normal: A normal result can't erase what happened early on. It would mean mold is less likely to still be driving him today. The Coxsackie recheck and the immune panel move to the front.
His Coxsackie infection is still active possible
Why we think so: Two years ago, all six Coxsackie B strains were high: B1-B4 at 1:500 and B5-B6 at 1:1000. Negative is under 1:100. These were never rechecked. It is the only infection his labs actually show. He flares when something pushes his immune system.
The test: Repeat Coxsackie B1-B6 titers plus enterovirus PCR (blood).
If positive: Titers that are flat or rising, or a positive PCR, would mean the virus is likely still active. Then questions for his practitioner come into play, such as immune-directed care if he qualifies.
If normal: Falling titers and a negative PCR would point to an old infection. The immune panel and the clearance step become the bigger questions.
A hidden antibody gap is letting infections hang on possible
Why we think so: No immune panel has ever been run. His negatives can't be trusted yet. That includes EBV, CMV, HSV, Mycoplasma and strep. He makes some antibodies, to Coxsackie and COVID. A subclass gap could still hide under that.
The test: Immunoglobulins IgG/IgA/IgM/IgE plus IgG subclasses 1-4 (with pneumococcal and tetanus/diphtheria antibodies).
If positive: Low results would change the whole plan. They would open the door to a conversation about IVIG with an immunologist. They would also mean his old negatives need a second look.
If normal: A normal panel means his negatives can be believed. Then attention shifts to the untested drivers: Coxsackie activity and Bartonella.
The stalled B6 clearance step is the main problem on its own possible
Why we think so: Last month's panel showed SAH 43 high, cystathionine 773 high and cysteine 249 low. Homocysteine 5.0 and serine 164 were also off. Read together, sulfur metabolism looks stuck at a step that needs active B6. He rages on B vitamins.
The test: Plasma vitamin B6 (P5P, light-protected), then a repeat methylation panel.
If positive: This would explain his reaction to B vitamins. His practitioner could decide on the right B6 form and dose. That would be P5P, not pyridoxine, added one change at a time.
If normal: A normal P5P means the stall needs another explanation. Mold and the immune questions carry more weight.

What we don’t know yet

No mold-toxin test, no immune panel, no Bartonella test and no daily logs exist yet. So this is still a theory. We also don't know what happened in the months before that first winter episode, or whether his wound was ever cultured.

Framework: Mold-First Study (early Plan B hypothesis). Load before kill. One variable at a time.

What his own labs show

  • Coxsackie B (about two years ago, at 10). B1-B4 were 1:500 and B5-B6 were 1:1000 (negative is under 1:100). These were never rechecked. One draw can't tell old infection from active, so a repeat is needed.
  • Clearance engine (Genova, last month). - SAH 43 (high; range 16-41) - Homocysteine 5.0 (low; range 5.2-11.4) - Cystathionine 773 (high; range 74-369) - Cysteine 249 (low; range 271-392) - Serine 164 (high; range 91-161) - Taurine, betaine and methionine yellow-flagged as borderline low Read together, sulfur metabolism looks stalled at cystathionine. That step needs active B6 (P5P). This is a hypothesis; plasma P5P confirms or rules it out. You also told me his genomics show COMT and detox trouble. I don't have those genotypes in the file.
  • Sarcosine 4,566 (last month's Genova panel) and OAT phosphoric 2,646 (about two years ago) were flagged during extraction. Both need a human re-read against the original reports before anyone interprets them either way.
  • COVID spike antibody 95.2 U/mL (reference under 0.8) is positive. It shows infection or vaccination but can't separate the two. A nucleocapsid antibody would.
  • CMP (undated). Glucose 61 is low (65-99 fasting reference; this sample was non-fasting) and CO2 16 is low (range 20-32). Both should be rechecked. The BUN/creatinine ratio was ordered, but no result value is on the report, so ask the lab for it.
  • CBC (undated). MPV 10.1, eosinophils 153 and basophils 32 were flagged, but the reference ranges are cut off in the screenshot. You'll need the full report to read them.
  • Negatives can't be read yet. EBV, CMV, HSV, Mycoplasma IgG and strep are all negative, but no immune panel has ever been run. He clearly makes some antibodies (to Coxsackie and COVID), but a subclass gap would still hide.
  • Never tested: Bartonella (even though he's being treated for it), Lyme, Babesia, immunoglobulins, ferritin, zinc and copper, vitamin D (which he takes), thyroid, histamine.
  • Name check. The Genova and older reports carry his full legal name, and the screenshots carry no name. Please confirm they are all Owen's.

Open findings: each needs a disposition

  • Coxsackie B1-B6, 1:500-1:1000 (two years ago): REPEAT. Run paired titers plus enterovirus PCR. Only a repeat closes this.
  • SAH high, cystathionine high, cysteine low, homocysteine low, serine high (last month): REPEAT. Recheck after one change. Any treatment waits on plasma P5P. Closed by plasma P5P plus a repeat methylation panel.
  • Taurine, betaine, methionine borderline (last month): REPEAT on the next methylation panel.
  • Glucose 61 and CO2 16: REPEAT as a fasting BMP plus insulin.
  • CBC flags (MPV, eosinophils, basophils): REPEAT the CBC with the full ranges visible.
  • COVID spike 95.2: add a nucleocapsid antibody to separate infection from vaccination.
  • BUN/creatinine ratio: ordered, but no result reported. Request it from the lab.
  • Sarcosine and phosphoric flags: re-read against the original reports.

Working theory and where to start

No kill protocol yet.

  • Cryptolepis: ask his practitioner about holding it, since it was the one change before this flare.
  • Keep steady, don't raise: Avea (you said it helped) and Houttuynia.
  • Keep as is: vitamin C 1000 mg, vitamin D, aloe, Pectasol, melatonin 3 mg. Please tell me which nasal spray he uses.
  • B vitamins: none until plasma P5P is back. If B6 is added later, use P5P, not pyridoxine, and hold methyl donors for now.
  • Bowels: confirm one bowel movement every day. Pectasol and aloe only clear what actually leaves.
  • Past treatments: LDN (one year) and itraconazole (helped) are on the record.

Why

Working theory (hypothesis to confirm). Owen flares whenever his immune system is pushed, whether by an illness, a kill herb or B vitamins, because his clearance engine has a stalled sulfur step.

The drivers that fit are still untested: Bartonella, and whatever sits behind six high Coxsackie titers.

Why kill steps flare him. Immune activation switches on an enzyme (IDO). It pushes tryptophan toward quinolinic acid and away from serotonin. That can bring rage and dark or 'I'm bad' thoughts within 1-3 weeks. OAT quinolinic acid and 5-HIAA are the gauges for this.

How you’ll know

Log nightly in the tracker.

Put these gauges on every future draw: SAH, homocysteine, cystathionine and cysteine, Coxsackie B, and fasting glucose.

Slow down if rage rises 2 or more points within 3 weeks of any change.

When to shift

Work in this order:
1. Bowels open.
2. Tank full: P5P, ferritin, zinc, vitamin D known and replete.
3. Only then, one antimicrobial step at a time, never within 3 weeks of an illness.

The move, Avea and other changes overlapped, so his improvement can't be credited to any one of them.

Safety

Ask him directly whether he has had thoughts of hurting himself. If the answer is yes or you're unsure, call 988 or go to the ER. During a flare, avoid 5-HTP and tryptophan.

Framework: INTERIM PATCH. Load before kill. One variable at a time.

Tests to order: the coded master workup

You are not asking for too much. Getting all of this ordered may be hard. Unfamiliar doesn't mean unnecessary. PANS crosses immune, infectious, metabolic and gut medicine, and most doctors stay in one lane. That's why you end up holding the whole picture. Order in batches if you need to; a partial order is still progress.

Owen's needle fear is real and documented. Ask for:
- Numbing cream (LMX-4)
- A pediatric phlebotomist
- Everything in one stick

Every order opens with: 'Draw one extra SST and one extra lavender; hold for add-on testing, 7 days.'

Confirm results: check that every ordered test resulted within 10 days. Call the lab with the specimen ID for any that did not.

How to get them

1. Bloodwork, coded to insurance. Book a visit with a telehealth service such as Sesame Care (https://sesamecare.com) or with your own PCP or an in-network urgent care. Bring this sheet; the clinician places the order and the draw happens at Labcorp or Quest. If a provider is unsure about coding, tell them: 'Just order them; I'll handle coding.'

2. Specialty tests insurance won't cover:
- MycoTOX urine and OAT: walkinlab.com
- GI-MAP: gimaptest.com
- Pyrroles: DHA Lab (dhalab.com)
- Hair minerals: holisticheal.com (~$125)
- FRAT: through a practitioner
- IGeneX and TLab: through a Lyme-literate practitioner

3. Have Plan B do it. Plan B's ordering clinician can place this whole panel for you through the Labs tab for a small intake fee. Tell us your state.

If you can only do a few

Immunoglobulins plus subclasses, CRP and ESR, ferritin, vitamin D, zinc/copper/ceruloplasmin, plasma P5P, and the repeat Coxsackie B panel.

Tubes

About 9-10 small tubes in one stick (gold SST for chemistry, serology, immune and thyroid; lavender for CBC, ESR and histamine; royal blue for zinc; light-protected for P5P), plus 2 hold tubes. Ask the lab for pediatric minimum volumes.

Cost

  • Routine blood: about $100-200 cash, or a copay
  • Methylation and mineral set: about $220-400 cash
  • IGeneX/TLab tick-borne: several hundred dollars to about $1,000
  • MycoTOX and OAT: about $300 each
  • GI-MAP: about $400

Try insurance first and self-pay only what is denied.

Immunoglobulins IgG/IgA/IgM/IgE ESSENTIAL
CPT 82784 x3, 82785 · ICD-10 D89.9 · Sesame/PCP, insurance
Decides whether any negative in his file can be believed. Low totals change the whole plan.
IgG subclasses 1-4 ESSENTIAL
CPT 82787 x4 · ICD-10 D89.9 · Sesame/PCP, insurance
Subclass deficiency hides under a normal total IgG. A low result opens the replacement-IVIG door.
Pneumococcal 23-serotype IgG (baseline) plus tetanus/diphtheria antibodies ESSENTIAL
CPT 86317 · ICD-10 D89.9, Z01.84 · Sesame/PCP; immunologist to interpret
Tests for specific antibody deficiency using existing titers, no new shot needed. It is the paperwork for covered IVIG.
Complement C3, C4, CH50 ESSENTIAL
CPT 86160 x2, 86162 · ICD-10 D89.9 · Sesame/PCP, insurance
Checks the innate immune arm. Low values point to immune dysregulation.
CRP + ESR ESSENTIAL
CPT 86140, 85652 · ICD-10 R79.89, R70.0 · Sesame/PCP, insurance
Baseline inflammation during a flare. If raised, it supports an active driver.
ANA with reflex ESSENTIAL
CPT 86038 · ICD-10 R76.8 · Sesame/PCP, insurance
Autoimmune screen. A low-positive ANA with a negative reflex is common in PANS.
Anti-GAD65 antibody ESSENTIAL
CPT 86341 · ICD-10 F42.9, R45.4 · Sesame/PCP, insurance
Objective proof of brain autoimmunity if positive, which supports antibody-directed treatment. Also relevant to his low glucose.
Coxsackie B1-B6 antibodies (repeat) ESSENTIAL
CPT 86658 x6 · ICD-10 R76.8 · Sesame/PCP, insurance
Compare to the titers of 1:500-1:1000 from two years ago. Falling means old infection; flat or rising means still active.
Enterovirus PCR (blood) ESSENTIAL
CPT 87498 · ICD-10 R76.8 · Sesame/PCP, insurance
A positive confirms active enterovirus rather than leftover antibody.
Plasma vitamin B6 (P5P), light-protected ESSENTIAL
CPT 84207 · ICD-10 E53.8, E72.9 · Sesame/PCP, insurance
Tests the cystathionine stall and his rage on B vitamins. It decides the B6 form and dose.
Homocysteine ESSENTIAL
CPT 83090 · ICD-10 E72.9 · Sesame/PCP, insurance
A permanent gauge. Last value 5.0, low. — Methylation is the engine that makes brain chemicals, detoxes, and calms inflammation. High homocysteine = the engine is sluggish — common in PANS and fixable with the right B-vitamins.
RBC folate + serum folate ESSENTIAL
CPT 82747, 82746 · ICD-10 E53.8 · Sesame/PCP, insurance
Never done. Needed for any PANS child and read alongside FRAT.
B12 + methylmalonic acid ESSENTIAL
CPT 82607, 83921 · ICD-10 E53.8 · Sesame/PCP, insurance
Last checked about two years ago, now stale. Needed before any B vitamin decision.
Ferritin + iron + TIBC ESSENTIAL
CPT 82728, 83540, 83550 · ICD-10 E61.1 · Sesame/PCP, insurance
Never done. Low saturation with normal ferritin would point to infection holding iron back. No iron until this is known.
Zinc + copper + ceruloplasmin ESSENTIAL
CPT 84630, 82525, 82390 · ICD-10 E61.0, E60 · Sesame/PCP, insurance (zinc needs a royal blue tube)
The copper/zinc ratio, read as a balance. Indicated by his off engine markers.
Whole-blood histamine ESSENTIAL
CPT 83088 · ICD-10 R79.89 · Sesame/PCP; whole blood, special handling
Methylation clears histamine. A high value fits a slowed engine.
Vitamin D 25-OH ESSENTIAL
CPT 82306 · ICD-10 E55.9 · Sesame/PCP, insurance
He takes vitamin D but it has never been measured. — Vitamin D runs the immune system and mood. Most kids run low, and it's an easy, cheap fix that supports the whole picture. Aim well above "just normal."
TSH + free T4 + free T3 + TPO + thyroglobulin antibodies ESSENTIAL
CPT 84443, 84439, 84481, 86376, 86800 · ICD-10 E07.9 · Sesame/PCP, insurance
Never done. Thyroid can drive mood, cognition and school decline.
Bartonella: IGeneX ImmunoBlot + TLab ESSENTIAL
CPT 86611 · ICD-10 Z20.818 · Needs a practitioner; self-pay likely
He is being treated for Bartonella that has never been tested. Rage plus nightmares fits the pattern. Galaxy can miss it.
Lyme + Babesia (IGeneX ImmunoBlot, Babesia FISH) ESSENTIAL
CPT 86617, 86753 · ICD-10 Z11.8 · Needs a practitioner; self-pay likely
Never tested. Completes the tick-borne picture before any further kill decisions.
Fasting glucose + insulin + BMP RECOMMENDED
CPT 82947, 83525, 80048 · ICD-10 E16.2, R79.89 · Sesame/PCP, insurance
Rechecks glucose 61 and CO2 16 under proper fasting conditions.
CBC with differential (repeat) RECOMMENDED
CPT 85025 · ICD-10 R72.8 · Sesame/PCP, insurance
Reads MPV, eosinophils and basophils against the full ranges, which were cut off before.
SARS-CoV-2 nucleocapsid antibody RECOMMENDED
CPT 86769 · ICD-10 Z86.16 · Sesame/PCP, insurance
Separates natural infection from vaccination. You noted he worsens with each COVID.
ASO + anti-DNase B (paired) RECOMMENDED
CPT 86060, 86215 · ICD-10 Z20.818, F42.9 · Sesame/PCP, insurance
Starts a serial trend. Read only once the immune panel is known.
Throat + perianal strep cultures RECOMMENDED
CPT 87081 x2 · ICD-10 Z20.818 · Sesame/PCP, insurance
Throat culture never done. You reported gut strep, and the perianal area is the often-missed reservoir.
HHV-6 IgG/IgM + PCR RECOMMENDED
CPT 86790, 87532 · ICD-10 Z11.59 · Sesame/PCP, insurance
A reactivating herpesvirus that is never tested. — These viruses can reactivate and keep the brain inflamed, especially when methylation is blocked. Worth checking when infections keep flaring.
Ehrlichia / Anaplasma antibodies RECOMMENDED
CPT 86666 · ICD-10 Z11.8 · Sesame/PCP, insurance
Completes the tick-borne screen.
RBC magnesium RECOMMENDED
CPT 83735 · ICD-10 R79.89 · Sesame/PCP, insurance
Shows cellular magnesium before any magnesium is used for bowels.
Folate receptor antibodies (FRAT) RECOMMENDED
CPT 83516 x2 · ICD-10 R41.89, E53.8 · Needs a practitioner; cash
School regression with the brain starved of folate while blood folate looks normal. Treatable with leucovorin.
EBV quantitative PCR OPTIONAL
CPT 87799 · ICD-10 Z11.59 · Sesame/PCP, insurance
He is EBV-seronegative. PCR settles it if he can't make antibodies.
Autoimmune encephalitis antibody panel (Mayo/ARUP) OPTIONAL
CPT Mayo panel (multiple) · ICD-10 F42.9, R41.89 · Neurology
Only if refractory or GAD65 is positive.
Urinary mycotoxins (MycoTOX) RECOMMENDED
CPT self-pay · ICD-10 Z77.120 · Self-order, walkinlab.com, ~$300
No mold-toxin test is on file. This is the only way to know, given the house history.
GI-MAP stool RECOMMENDED
CPT self-pay · ICD-10 Z86.19, R19.8 · Self-order, gimaptest.com, ~$400
You reported C. diff, gut strep and gut staph, but no stool report is in the file.
Urinary pyrroles RECOMMENDED
CPT self-pay · ICD-10 R82.5 · Self-order, dhalab.com
Pyrroles dump zinc and B6, which fits the B6 question. — Classic in anxious, rigid kids who can't fall asleep. If high, it's very treatable (zinc + B6) and explains a lot of the mood picture. Cheap and often missed.
OAT (repeat) OPTIONAL
CPT self-pay · ICD-10 R79.89 · Self-order, walkinlab.com, ~$300
Quinolinic acid and 5-HIAA show kill-step mood risk. — A huge amount of information from one pee sample, no needle. Reveals gut yeast, the brain-chemical picture, and energy problems all at once — high value for a complex kid.
Hair mineral analysis OPTIONAL
CPT self-pay · Self-order, holisticheal.com, ~$125
Optional background only. It does not settle copper.
Genetic testing — STEP 2, not yet (Nebula Genomics or Yasko, only if the engine draw is off) STEP 2 — ONLY IF THE ENGINE DRAW IS OFF
Self-order — Nebula Genomics (nebula.org, ~$250) then upload the raw file to Plan B’s Blueprint reader for a free read; or order Yasko’s panel directly (holisticheal.com, ~$500 all-in, read included).
DO NOT ORDER THIS YET. Genetics is step 2: it is ordered only if the engine markers on the blood draw (homocysteine, B12/MMA/RBC folate, whole-blood histamine, zinc/copper/ceruloplasmin, pyrroles) come back off, or the child crashes on kill herbs or methylated supplements. The blood tells us what is driving the child; the genotype only tells us what to avoid and which cofactor goes first. When it is earned — two routes, pick by budget vs simplicity. (A) Nebula Genomics whole-genome (~$250): reads EVERY SNP with no chip gaps, so nothing on the Yasko methylation panel comes back missing; download the raw file and upload it to Plan B’s genetics reader (Blueprint) at app.planbforpans.com/genetics for a free Minta read. (B) Dr. Amy Yasko’s own panel (~$500, or bundled with her hair test): turnkey — one order, her curated methylation-cycle read included, nothing to download. Plan B does NOT use 23andMe: the current chip drops roughly half of a methylation panel, including many of Yasko’s core SNPs.
Organic Acids Test (OAT) — yeast / gut / mitochondria / oxalates / neurotransmitters RECOMMENDED
CPT send-out · ICD-10 E88.9 · Self-order (urine) — Walk-In Lab: walkinlab.com
Whole-metabolism urine screen: yeast + Clostridia overgrowth, mitochondrial + oxalate markers, neurotransmitter breakdown. The smoke-detector for the gut + methylation engine.

What hasn't been tried, worth asking about

Questions for his practitioner, not directives.

Immune-directed care (IVIG if the immune panel qualifies him)
Evidence-based · PANS Consortium 2017 / immunology
IVIG can replace missing antibodies, and it carries enterovirus antibodies. He isn't a candidate until the panel is back.
Oral vancomycin
Emerging, empiric · Practitioner-used for enterovirus-linked PANS
Some PANS doctors use it for Coxsackie-positive kids. It is an antibiotic, not an antiviral, and its benefit appears to come through the gut.
Trauma-informed therapy (EMDR or somatic)
Emerging · Autonomic / limbic
He felt the stitches and now fears any medical setting. That threat loop is real and treatable.
Photobiomodulation: Vielight Neuro Alpha ($1,750) or Vielight 810 ($300), vielight.com
Emerging · Neuromodulation
Gentle brain anti-inflammatory support with no kill pressure.
Classical homeopathy (Herscu-trained, single remedy)
Anecdotal · Bioregulatory
An option for the scrupulosity and rage picture once his tracker has two weeks of entries.

What I could not see

  • Not yet explained: school regression, the scrupulosity, and his low glucose. FRAT, anti-GAD65 and the fasting recheck test the most likely explanations.
  • Was the wound ever cultured? Four months of drainage with wood splinters and soil inside. The organism is not in the file.
  • The six-week antibiotic: its name and how long it ran, and the same for whatever cleared the C. diff.
  • The six to twelve months before that first winter episode: anything at all? An illness, a fever, a head knock, a death, puberty starting?
  • Every antibiotic you can remember, even roughly, and whether he got better, worse or stayed the same on each.
  • Pregnancy and birth: C-section? Antibiotics in labor? NICU? Breast or bottle?
  • Family history: anyone on either side with autoimmune disease, thyroid problems, OCD, tics, anxiety or depression?

What Owen should do

Owen worsens with every added push, so the hinge is finding the real driver before adding anything else.

  1. Ask his practitioner about holding cryptolepis. Add nothing new. Ask Owen directly about thoughts of self-harm.
    Cryptolepis was the one change before this flare.
  2. Log the nine behaviors, daily bowel movements and any illness.
    This is how every future change gets a clear cause.
  3. Book a telehealth visit or your PCP with the coded sheet, or use the Plan B Labs tab. Ask for numbing cream and the immune panel first.
    It decides whether his negatives mean anything.
  4. Repeat the Coxsackie B1-B6 titers (1:500-1:1000 two years ago) plus enterovirus PCR, and run IGeneX plus TLab.
    Treat what is confirmed, not what is assumed.
  5. Get plasma P5P before any B vitamin.
    Cystathionine 773 with cysteine 249 suggests the B6 step is stuck.
  6. Only after bowels are daily and the tank is full, and never within 3 weeks of an illness.
    This is load before kill.

Bottom line

Owen isn't failing treatment. He has been treated for an infection no test has confirmed while the one his labs show sat unchecked. Test first, then add one thing at a time.

If you get stuck

Rachel can help you hold all of this. She can organize Owen's whole story, get this one-stick panel ordered through Plan B's clinician, read each result as it lands, and build the next step with you. There is a small fee. With his needle fear, getting the draw right the first time matters, and that is exactly what she does. Rachel is not a doctor. She is a mom who has walked this road and solves problems. The tracker and Minta are here every day in the meantime.

How Plan B sees this

Mom, Owen has already shown he can heal. His gut and sleep are proof. The next gains come from testing, not from pushing harder.

Only if it feels right:
- Come join the Plan B for PANS parents group on Facebook. Post your questions, worries and wins. Someone there has stood where you are, and Rachel reads every one.
- If Plan B has helped and you're able, a small gift at planbforpans.com/donate keeps this free for the next family.

With love for you and Owen.

Your child’s first synthesis is free.

Tell your child’s story

Plan B for PANS is a 501(c)(3) nonprofit. A synthesis is education and organization to take to your child’s clinicians — not a diagnosis or treatment.