Field Guide · Where to Start
There are dozens of tests in the PANS world, and no one hands you the order. So you run one, wait, run another, and two years later you still don’t have the picture. This is the map: three tiers, scaffolded, so you cast a wide net once — then follow only the branches your results actually light up. The goal isn’t every test. It’s the right first round, so you stop starting and stopping.
If you’ve been told to “just watch and wait,” or you’ve been at this for years and still feel like you’re guessing — start here. You don’t have to find the way out alone.
If you’re new — OR two years in and have never done a comprehensive methylation panel or an organic-acids (mitochondrial) test — start here. Most families never get the full workup, and these two are the most-missed. Here’s what’s essential first, and how to scaffold out.
Almost every stalled family we meet is missing the same two pieces. Not because they’re exotic — because no single specialist orders them. The neurologist runs strep titers. The GI doctor runs a stool test. Nobody runs the cleanup engine (methylation) or the energy engine (mitochondria / organic acids) — the two layers that decide whether anything else even works. So we put them in the very first round, on purpose.
The Plan B frame, in one breath: test first (don’t guess from genetics or symptoms), food-first while you test (the anti-inflammatory foundation runs the whole time), no supplement doses on a webpage (that’s your clinician’s job, anchored to your child’s results), and confirm every order with a clinician — many of these functional panels need a functional or integrative doctor, or to be requested by name.
Tier 1 is the hub — a wide net you cast once. Tier 2 are the branches, and you only walk the ones Tier 1 flags. Tier 3 is the deep, specialized work, reached only when the scaffold points there. Read it outward from the center.
One wide net at the center; branches you only follow when the center flags them; the deep work at the rim.
Tier 1
Run these together, not one at a time. The point is to stop the start-and-stop. Five groups — and two of them are the pieces almost everyone skips.
CBC, CMP, full thyroid (TSH, free T4, free T3, TPO antibodies), ferritin + a full iron panel + CRP, 25-OH vitamin D, B12, folate, zinc, copper, ceruloplasmin, and RBC magnesium. This rules out the common, fixable causes first — low iron, low D, thyroid, a simple deficiency — before you go hunting for anything exotic. Cheap, standard, and the floor under everything else.
Homocysteine, whole-blood histamine, MMA (methylmalonic acid), RBC folate, and B6 as P5P. This reads the body’s cleanup-and-detox engine — whether your child can clear toxins and the die-off any treatment produces. When this is blocked, kill protocols backfire and treatments “stop working.” Almost no one orders it. It belongs in the first round. Why methylation gates everything →
Strep titers (ASO + anti-DNase B), Mycoplasma (IgG / IgM / PCR), an EBV panel, and HHV-6. PANS is, at its core, an immune reaction to a trigger — so you look for the triggers up front. A negative throat swab doesn’t clear strep; titers and PCR catch what a single swab misses.
23andMe Ancestry raw data → Plan B’s read. The cheap Ancestry test covers every major methylation and detox SNP. It’s the blueprint — it predicts which cycles tend to run weak — but a blueprint is not a diagnosis (that’s the overlay rule, below). How to get your child’s SNPs →
An OAT (Organic Acids Test, urine) OR a Genova NutrEval. This single panel reads mitochondria / energy + methylation markers + neurotransmitter breakdown + gut/yeast markers + nutrient status all at once — the widest, highest-yield test on the map, and the second thing families never get. The OAT is the mitochondrial / energy window in particular. The engine & the OAT →
Why these five, together: the bloods catch the simple stuff, the infection panel finds the trigger, and the methylation panel + the OAT/NutrEval read the two engines — cleanup and energy — that decide whether treating the trigger will actually hold. Genetics tells you where to look. One round, the whole picture.
Tier 2
These are branches. You don’t run them up front — you follow only the ones Tier 1 actually flags. That’s the whole point of casting the wide net first: it tells you which of these to walk.
| If Tier 1 shows… | Follow this branch |
|---|---|
| Methylation off (high homocysteine / histamine) | Urine amino acids (transsulfuration / CBS), the SAMe:SAH ratio. |
| Mito / energy off (OAT markers, fatigue) | CoQ10, carnitine + an acylcarnitine profile, lactate / pyruvate. |
| Infection signal | Tick-borne work-up (IGeneX / Galaxy), Coxsackie / enterovirus, deeper viral panels. |
| Gut signal | A comprehensive stool test (GI-MAP / GI Effects). |
| Mold / water-damage exposure or CIRS signs | Mycotoxin urine + the CIRS panel (MSH, TGF-β1, C4a, MMP-9, VEGF). |
| Minerals / copper off | 24-hour urine copper. |
| Mood / neuro | Urinary neurotransmitters. |
This is the discipline that saves money and stress: you don’t run a $400 mycotoxin panel unless mold is on the table, and you don’t chase tick-borne testing unless there’s a signal. Let Tier 1 point.
Tier 3
Only if the scaffold points here. These are the targeted, expensive, or invasive tests you reach for when a Tier 2 branch is clearly lit and you need to go further.
This is the single most important habit on the whole map, and the one that prevents the most harm. A gene is a tendency, not a verdict. You hold the blueprint (genetics) next to the live readout (the functional panel) and you act only where they agree.
We learned this the expensive way more than once: a scary-looking SNP that, on the functional panel, was running perfectly fine. Treating the gene instead of the child is how families end up over-supplementing a kid who didn’t need it. The map is built to stop that: the functional panel is the tie-breaker, every time.
The whole reason Tier 1 elevates the methylation panel and the OAT/NutrEval is that this engine — cleanup and energy — gates everything else. Here’s the deep read:
You don’t need every test — you need the right first round. Cast the wide net once (Tier 1), and make sure it includes the two pieces families almost never get: a comprehensive methylation panel and an organic-acids (mitochondrial) test. Then follow only the branches your results light up (Tier 2), and save the deep, specialized work (Tier 3) for when the scaffold clearly points there. Read function against genetics the whole way, so you treat the child and not the blueprint. Food-first while you test; confirm every order with a clinician. This is parent education, not medical advice — bring it to your team as questions.
Tier 1 is a lot to order, and the results are a lot to read. Upload them and Minta reads the methylation panel, the OAT/NutrEval, the bloods, and the genetics together — flags what’s actually off, applies the overlay rule for you, and turns it into the specific Tier-2 branches to bring to your practitioner. Let Minta do this for you →