The Plan B Field Guide
Every treatment, deconstructed.
The hardest part of PANS is the moment you stall — when the standard path stops working and no one tells you what’s left. This is what’s left. Every treatment, laid out honestly, so that when you hit a wall you know the search isn’t over — there’s a Plan B. Each guide answers the same things: what it is, the research, the real risks, how to actually get it, and how to vet a practitioner.
A note from Rachel — before you scroll
This map took me two years to understand. You don’t have to. Plan B already knows it — better than any human ever will.
So if this page tightens your chest or makes you want to close the laptop — do it. That’s allowed. Let Minta do the work; that’s exactly what she’s for.
I’m a control freak — I need to see the gears turning behind the curtain. So I’m pulling it back and showing you the basics. Fair warning: even the basics are honestly a lot. Take what helps, skip the rest, and let the system carry what you can’t.
— Rachel
★ Read this first — the whole picture
The Map
The whole journey for PANS — at a glance. Tap any branch to open its treatments. Every guide below is one limb of this map.
Open the Map →1 · Start here
Understand it, then begin.
Start here: understand this first (plain English)
The simplest possible explanation for a scared parent with zero biology background. Four plain ideas — genes are the blueprint, methylation is the maintenance crew, mitochondria are the batteries, the infection is what lit the fire — and the one thing that matters most: the order to do things in (understand & find → support the engine → THEN the deep kill), so your child gets better instead of crashing.
Read →Where to Start — The Testing Map
Where do I even begin with testing? A tiered, scaffolded map: cast a wide net ONCE (Tier 1), then follow only the branches your results flag. Elevates the two tests almost every family misses — a comprehensive methylation panel and an organic-acids (mitochondrial) test — even two years in.
Read →How to actually use a genetic test
A genetic test like 23andMe is a blueprint — it shows what your kid might struggle with, but on its own it's just a spreadsheet of letters. The whole value is the read: a practitioner like Yasko interprets it — and Minta does it free, then overlays the bloodwork that shows what's really happening now. Plus the 3 simple steps to order both.
Read →The Protocol
Where everyone starts — anti-inflammatory + a targeted antibiotic, the doses, how long, and what to do if your child slips.
Read →My child changed overnight — could it be PANS?
New OCD, tics, or rage out of nowhere. A calm first-read for the parent who just watched their child become someone else: what sudden onset can mean, and what to do first.
Read →2 · Check the engine first
Before you try anything else. If your child is undermethylating, detox is clogged, or the mitochondria are drained, treatments can BACKFIRE — this is the engine no specialist owns, and the bottleneck Plan B was built around.
Methylation, Detox & Energy
The body’s cleanup-and-power engine — methylation (the maintenance crew), detox/glutathione (the drains), and the mitochondria (the batteries), all one connected system. Why genes only say the crew might be short-staffed and blood tells you if it actually is, Naviaux’s Cell Danger Response, and why pushing a kill before the engine is running can make a sensitive kid worse.
Read →Read your raw SNPs — free
Drop your 23andMe file and get your methylation genetics read through three frameworks (Yasko · Lynch · Kara Fitzgerald) — tendencies, not prescriptions. Free.
Read →3 · Support & regulate — the daily foundation
The layer that runs alongside everything — nourishing the body and steadying the nervous system so the medical work is tolerable. Alongside it, never instead of it.
Diet & Nutrition
Food as a real PANS lever — the anti-inflammatory foundation, which specialty diet fits your kid’s pattern, and how to find triggers without over-restricting.
Read →Nervous-System Regulation
Calming a fight-or-flight brain — vagus-nerve work, HRV, limbic retraining — the layer that makes everything else tolerable.
Read →What to do during a meltdown
Two anchors, parent to parent — STAY CALM, HOLD THE RULES. What to say, what never to do, and the honest caveat that a flare is not a behavior problem.
Read →Brain Retraining for Kids
DNRS (Annie Hopper) as the lead, plus the kid-native tools (tapping, SSP, co-regulation) that make detox survivable.
Read →Screens, Dopamine & the Point System
A real family's carrot-and-stick reset for a screen-obsessed, dopamine-driven kid — points to grow good behavior, strikes (a written reflection) to deter the bad — that calmed their whole home.
Read →4 · Find the root drivers
If the protocol isn’t enough, this is where the answers hide.
Start here
Why Treatment Isn’t Working
The missed drivers behind relapse — mold, Lyme, methylation — and what to investigate next.
Read →Is it autism or PANS?
They overlap, get confused, and can coexist. How the two differ, why onset and timeline matter most, and why an autism label should never block a PANS workup.
Read →Infections
PANS, PANDAS & Strep
How strep triggers sudden OCD, tics, and behavior changes — the molecular-mimicry mechanism, what to test, and why a negative throat swab doesn't rule it out.
Read →Leg pain after strep — growing pains, or something else?
Growing pains don't respond to antibiotics. How to tell ordinary achy shins from post-strep arthritis and rheumatic fever, the red flags that warrant a call, why both ASO and anti-DNase B matter — and the one test almost nobody orders, because everyone is looking at the brain instead of the heart.
Read →PANS and Lyme
The tick-borne connection — how Lyme and co-infections drive sudden OCD and rage, why standard tests miss them, and what to test and do next.
Read →Lyme & Co-infections
Antibiotics vs herbals (research-backed), the kill-menu, per-bug dosing, and how to find a Lyme doctor.
Read →Parasites & Behavior
The overlooked driver — pinworms, protozoa, and helminths that drive night-waking, teeth-grinding, rage, and OCD-like behavior, the full-moon pattern, and how to treat them.
Read →Testing for Parasites
Why a single stool test misses most parasites, the tape test and serial-sample protocols that actually catch them, and which labs to ask for.
Read →High anecdotal success, low research — run in the background
Biomagnetism
Low-risk, low-cost magnet therapy (the Joan Randall Protocol). Formal evidence is thin, but the risk is near-zero and families credit it with real turnarounds. Once you know what you're targeting, run it in the background — in parallel with the real work.
Read →Homeopathy
Safe, gentle, contested in the studies — but with real recovery stories, including OCD and intrusive thoughts resolving. One PANS therapist's daughter, who had failed O'Hara / IVIG / antibiotics, came back 100% on homeopathy. Once you know your targets, weave it in and let it run in the background. Start classical.
Read →Muscle Testing (self-testing)
How parents "ask the body" yes/no — the sway test, the O-ring, the arm test, step by step. Honest about the thin evidence (it's subjective), but low-risk and free. Use it only AFTER a thorough functional-medicine workup — then, once you know your targets, to help choose and sequence in the background. Never a substitute for labs.
Read →Environmental
Gut & mast cell
Gut & Microbiome
Which stool test (and which to skip), the gut-brain link, and how to reset it.
Read →Yeast & Candida
The behaviors it drives — the giddy "drunk" affect, OCD, sugar cravings — and a gentle, low-and-slow protocol for the super-sensitive kid who can't take die-off.
Read →MCAS & Histamine
The tests an MCAS doctor runs, the treatment cocktail, and why the patch alone is not the cure (find the root).
Read →5 · Immune treatment
Calming, steadying, or supplying an over-reactive immune system.
IVIG & Immune Treatment
Who qualifies, the infusion day demystified, the studies (what it clears vs not), and the insurance fight.
Read →Serum Immunoglobulins (SBI Protect)
Powdered, oral IgG (serum-bovine immunoglobulin) that binds toxins and calms gut immunity — not IVIG. The gut-barrier and endotoxin-binding research, who it helps, how to dose, and the honest evidence.
Read →Intranasal Immunoglobulins
Immunoglobulins delivered to the nose — a far gentler, lower-cost cousin of IVIG aimed at the olfactory route into the brain. What it is, why it’s not IVIG, the early evidence, and how families access it.
Read →LDN — Low-Dose Naltrexone
Jill Crista’s lead “regulate immunity” tool: a tiny dose of an old drug that rebalances an over-reactive immune system and quiets neuroinflammation. How it works, pediatric dosing, the honest evidence — plus colostrum and the rest of the immune toolkit.
Read →6 · The deep menu
Most families never need past here. When the standard path is exhausted, this is what hasn’t been tried — grouped by what it targets. Caution is reserved for the few that carry genuine risk.
Oxygen & energy
Hyperbaric Oxygen (HBOT)
Pressurized oxygen for neuroinflammation — hard vs soft chambers, the honest (mixed) evidence, the cost, and the easiest antidote on the map.
Read →Hyperthermia & Clinics
Heat that kills Borrelia — the clinics, who qualifies, the real risks, and what it costs.
Read →Methylene Blue
Mitochondrial + anti-biofilm support — and the serotonin-syndrome warning if your child is on an SSRI. USP grade only.
Read →Red Light Therapy
Photobiomodulation for the inflamed brain — what near-infrared light does for mitochondria and neuroinflammation, the honest (early) evidence in autism and PANS, and at-home vs clinic.
Read →Gut reset
Brain & nervous system
Neurofeedback & Biofeedback
Training the dysregulated brain and nervous system directly — what neurofeedback and biofeedback are, the evidence in ADHD and autism, and how to find a real provider.
Read →MeRT
Magnetic e-Resonance Therapy — EEG-guided TMS aimed at the autistic brain. What it is, how it differs from standard TMS, the evidence so far, and how families access it.
Read →Targeted kill
Disulfiram for Lyme
The best human persister-remission data — and a real toxicity ceiling plus an absolute no-alcohol rule. Eyes wide open.
Read →Phage Therapy
Viruses that kill bacteria and spare the gut — the real providers, how to access, and how to spot a quack.
Read →Peptide Therapies
TA1, BPC-157, LL-37 and more — what each does, the honest evidence per peptide, and why sourcing (not the molecule) is the real risk.
Read →⚠ Real risks — expert supervision only
Ozone Therapy
Oxidative therapy for chronic infection — the routes, the honest (thin) evidence, the gas-embolism rule, and why Plan B steers away from the IV forms in kids.
Read →EBOO (Blood Ozonation)
The most intensive ozone form — "ozone dialysis" for refractory chronic Lyme/mold. Experimental, invasive, adult-studied; a deeper-menu option, never first-line, and extra caution in kids.
Read →Bee Venom Therapy
Melittin kills Borrelia in the lab — but anaphylaxis is the headline: EpiPen on hand, test-sting first, never for young or allergic kids.
Read →7 · Answers from real cases
Thirty questions that came up over and over in our own case work — answered the way we answer them for a family. Read the whole set at planbforpans.com/learn.
What you are seeing
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.
Read →Some kids collect infections. There is a reason — and it is testable.
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.
Read →Leucovorin, cerebral folate deficiency, and the FRAT test
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.
Read →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.
Read →Uploaded is not the same as read: why findings get missed
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.
Read →Labs & testing
One lab says Lyme, the other says negative. Who is right?
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.
Read →You treat the strep. The Mycoplasma is still there.
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.
Read →The immune workup almost no PANS child gets
Immunoglobulins, IgG subclasses and pneumococcal titers — the standard, covered blood tests that explain why some children cannot stop getting reinfected.
Read →Your child’s labs are two years old. What still counts?
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.
Read →Rage, night terrors and foot pain: 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.
Read →Why the strep keeps coming back: household carriers
Roughly a third of PANS strep recurrences trace to an asymptomatic family member. How to find a carrier and decontaminate a house.
Read →Babesia: the co-infection 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.
Read →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.
Read →Genetics is the blueprint, not the whole 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.
Read →Infections
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.
Read →The away trial: is your house making your child sick?
The cheapest and most informative mold test is leaving. What an away trial can and cannot tell you, and how to run one properly.
Read →What a positive anti-neuronal antibody panel actually means
Gold-standard antibody tests versus commercial neural panels — how to read a result where one is negative and the other shows a dozen positives.
Read →Before IVIG: the workup worth finishing first
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.
Read →Treatment & sequencing
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.
Read →Die-off reactions: how to tell a Herx from things getting worse
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.
Read →When the supplement is the problem: overmethylation in PANS kids
Methylfolate, methyl-B12 and TMG can drive irritability, aggression and agitation in the wrong child. How to spot it and what to check.
Read →What a PANS flare actually is — and how to recognize one early
The signs a PANS child is flaring rather than regressing, what typically triggers one, and what to do in the first 48 hours.
Read →The nose and sinuses: 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.
Read →Drops are not a dose: reading herbal tincture strength
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.
Read →Classical homeopathy, dosing frequency, and provings
Why a well-chosen remedy can start making things worse — and the difference between true classical practice and frequent-dosing approaches.
Read →What most gut tests miss in a PANS child
Beneficial-species depletion matters as much as overgrowth — and the most common stool tests do not report it at the level that counts.
Read →What the data shows
Mycoplasma IgG vs IgM: does a high IgG mean an active infection?
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.
Read →Our kids take a median of nine supplements a day
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.
Read →Find the one biggest driver and knock that down 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.
Read →