Hashimoto’s and PANS/PANDAS: The autoimmune connection every parent needs to know with Dr. Nancy O’Hara

Subtract approx. 2:30 from these times:
00:04

Dr. O’Hara, I am so excited to finally have you on the show. Welcome, welcome to Thyroid Mystery Solved. Thank you so much. And I’m really excited to be here. Yeah. So  today we are kind of shifting the conversation a little bit  to something that I think is not talked about nearly enough.  And  that is how our kids  are more prone to having certain…

00:30

health issues when we are moms or even dads with Hashimoto’s  or hypothyroidism or both.  And there’s so much talk about fertility and miscarriages when it comes to Hashimoto’s.  And I talk a lot about that on the show,  but the talk of having kids that may have certain special needs or things like ASD or ADHD or even pandas  related to Hashimoto’s I think is less talked about, but it needs to be.

00:56

Dr. Herr, I’m so excited to get into all of this. So can you first tell us,  are moms who have Hashimoto’s or the thyroid issues a higher chance of having kids that may have certain types of special needs? Absolutely. ah There’s no question about it. And I think that  the statistics  are  just the tip of the iceberg, ah but they’re real. mean, so my area of expertise is now pans and pandas.

01:25

And we know that at least 63, 64 % of those children have a family history and a first degree relative of autoimmune disease. And the most common autoimmune disease  is thyroiditis, autoimmune thyroiditis, Hashimoto’s thyroiditis. That’s most common  and most common in the moms. We also know that

01:51

that autoimmune disease and specifically thyroiditis is much more statistically um positive to have a mom uh with that and have a child with neurodevelopmental issues. Now, why is that? Yeah.  So go ahead.  I was just going to ask real quick because just to make sure we’re all on the same page.

02:13

And we’re going to get into that more, but for someone who may not have heard the term before, can you just briefly explain what is PANS and PANDAS? Yep. So PANDAS was first described by Sue Swedo and others in the 1990s, and it stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with STREP. So basically when a child is exposed to STREP, like from a sibling or a friend or a family member,  or gets STREP themselves,

02:41

rather than the immune system attacking the strep infection, like let’s say in the throat, those antibodies or immune system components instead attack the brain and specifically the basal ganglia and cause neuropsych symptoms like OCD, like restrictive eating disorders, like ticks and anxiety and  all types of things like that. And that’s strictly pandas. So pandas has to be a strep infection.

03:10

that then in a child that’s genetically susceptible, there’s an immune reaction that is abnormal and dysregulated,  and the immune system attacks the brain rather than attacking the strep. PANS was described in 2012 in a white paper when 30 clinicians and researchers got together to try to make pandas less controversial. And so they included

03:37

um, mycoplasma, viruses, tick-borne diseases, mold, anesthesia, and all of those things that could also trigger an abrupt onset neuropsychiatric syndrome. And all it did was make it more controversial. I have to say in deference to Sue, we have to remember two things.  One, the P is pediatrics.

04:01

We do know that these diseases, if either misdiagnosed or mistreated or undertreated or not diagnosed as children, can occur in adults.  And we also know that tick-borne diseases and mold can certainly occur in adults. And also those specifically can be more subacute. We just shouldn’t call them pans or pandas if it’s either not children or not acute. We can call it autoimmune encephalitis.

04:30

We can even call it basal ganglia encephalitis, but it’s  those actual acronyms that are being  overused and misused that in deference to Sue, have to at least say that. But  in general, in my opinion, all of those diseases, including autism and other neurodevelopmental and neuropsychiatric issues like ADHD, like schizophrenia,  all involve immune dysregulation.

04:58

And in fact, some form of autoimmune disease where the immune system is possibly attacking self and especially the brain. So that’s why it then follows that moms who have autoimmune disease, especially, and this is research from Judy Vanderwater and multiple other people show that those moms,  when they have children, are more at risk to have a child.

05:26

also who has immune dysregulation or some form of autoimmune disease. It is so, so interesting because, you know, even though there is this research, I think just generally speaking, people don’t know that. I mean, I know when I was going through my journey  and when I had my son Jake, who I talk about him a lot on the podcast, he’s nine now.  And obviously I’m at much different place now. I know so much more. And I did have my thyroid controlled much more then, um, then

05:54

earlier, though now nine years later, things have shifted even more.  But  I, once he was diagnosed, I remember thinking, how is that even possible?  Like how can  I,  okay, I have a child who has all of these things. And this is before even we found out about pandas. We’ll get into that.  Um, because I did all the things  I had the healthiest pregnancy. mean, every doctor’s appointment was like check mark on everything. And I mean,

06:21

I ate really well. did prenatal yoga. I took the best vitamins. I supported my thyroid. was on T4. was on T3. I was on everything. And it almost, I mean, obviously there’s so many emotions that go along with that because as women, think we feel so responsible for everything naturally. And so of course, right. You know, my first, when I first found out, was like, okay, what did I do wrong? And I went through everything. Like I did everything. I mean, I did above and beyond.

06:50

You know, and I think that it is in a way, um, you know, and the whole point, right, of us talking about this is not to scare anyone or tell people, Oh, if you have this, you’re going to have that. If someone is, you know, of childbearing age, it’s more kind of knowing this and knowing that like there’s certain things that happen. And of course all the things we can do about it, which we’ll get into. Yeah. And none of this, I always say it’s not shoulda, coulda, woulda, and it’s not to add to that mom guilt. Because like you said, we all have it.

07:18

when we’re all gonna have it the rest of our lives, matter how many paid friends and therapy  and running and everything else we do, that’s just the nature of us. And not to say that dads don’t feel it too,  but yeah,  I mean, it’s something that I don’t think  is talked about enough. And again, please moms out there, don’t add to your guilt. This isn’t about that. It’s just about looking at all the factors.

07:47

And I think also  with understanding this, right, if someone  is, let’s say, looking to get pregnant, right, there’s things that we could do to support our body and to balance things now beforehand in preconception care and pregnancy.  Um, and then for a lot of people who have kids with special needs,  right, for all of the different kinds of needs that there are, then understanding the autoimmune component, because again, I think with something like autism spectrum disorder,

08:16

in a very traditional sense, right? We know that there’s changes in the brain. And I think that,  you know, there’s a lot of therapies out there. There’s OT and then there’s, um you know, speech and there’s all of these things, but they’re not specifically looking at the immune portion of it. And I think understanding that can help us to  look at other avenues, right? Of what we can do. Yeah, absolutely. And I think  one other piece I want to mention is the genetic piece.

08:45

or the epigenetic piece  or the genomic piece. And again, that’s not you’re damned if you do, damned if you don’t, it’s just that  those pieces of the genes also play a factor both for our moms and for their children. um And we always use the phrase genetics loads the gun, environment pulls the trigger. although we can’t change our genetics, so

09:15

you know, the actual genes themselves, there’s a lot we can do  that changes how our body reacts to that underlying susceptibility. Yeah. And when you say genetics, are you talking specifically about genetics for autoimmunity or genetics for autism or genetics for say brain inflammation? Can you elaborate on that a little bit? Truthfully, all of it.  And the more I learn, the more I know, I don’t know. Truthfully, you know, and,

09:44

um Yes,  know,  our genetics as moms who have autoimmune, thyroiditis, Hashimoto’s, you know, are going to possibly show that we have more inflammatory triggers or genetics, epigenetics, genomics, and genomics just means little pieces of genes  that may be passed on.

10:08

um And it can be de novo, meaning it’s a mutation that happens. doesn’t have anything to do with what your genes are, but there can be little pieces of genes that are passed on that make the child also more susceptible to autoimmune disease or susceptible to environmental and dietary triggers that may set off an autoimmune disease.

10:33

Now in terms of autism spectrum disorder, one of the things that is often talked about is that boys are much more susceptible than girls. I mean, I think the last I checked it was like five to one, right? It might be more. So if auto-immunity plays a role and genetics play a role, how does this factor into it? Yeah. Well, well, we know the guys are the weaker gender. I just always have to say that. Um, you know, but.

11:00

I think we’re talking about the immune system, but we also have to talk about the metabolomics and the metabolic system.  And  often the hormonal changes um increase the risk  of inability to methylate, inability to detoxify, inability to handle um different hormonal, et cetera, changes.

11:25

And so you’re right, our boys are more susceptible. They’re more susceptible to pans and pandas too. And in autism, it’s one in 12.5 boys in the state of California, one in 20 overall, where it’s one in about 31 to 37, depending on who you talk to and which statistics you look at when you include boys and girls. But yeah, all of these, know, autoimmune disease is much more common in women as adults.

11:55

But in children, the autoimmune disease is more common in boys than girls. And all of the factors that affect that, you know, are at play.  And I think we still don’t have enough information to really definitively say why that is.  Is it the protective effects of estrogen?  Is it testosterone? Is it some other block because of those that’s not allowing them to detoxify as well?

12:25

I think that verdict is still out. Yeah, that’s really interesting. I just had Dr. Gersh on and we talked about hormones and autoimmunity and she was talking about the X chromosome and really explained in detail why women are more prone to autoimmune disease, but specifically she was speaking of adults, women are  post puberty. So this is so  interesting that it’s the boys that are  young that have that. um

12:50

And that makes sense also then with pandas because with pans and pandas, it’s an autoimmune reaction.  And I never realized boys are more prone, but yeah. Yeah.  It’s the same sort of almost four to one in some instances. However,  we also know that there,  and this is again, a big generalization that children  that get these diseases, um the girls often have a more severe form than the boys.

13:20

Um, and, and why is that? Does it take  more,  you know, genomic  total load? Does it take more immune or metabolic triggers to get a girl to show the symptoms? Maybe, you know, and, and therefore then they have more environmental dietary triggers to overcome, you know, still to be revealed. Yeah. And what do you think about

13:48

thyroid hormone in pregnancy because  the babies, their thyroid doesn’t develop until a certain, I think it’s eight weeks, right?  Um,  so if someone has,  you know, maybe not outright hypothyroidism, but  maybe they have subclinical hypothyroidism, maybe their TSH is a little bit high. And by the way, in pregnancy, I’m sure you see this all the time. I see this too. TSH will go up in people, even if nothing else shifts  and

14:17

Do you think  that very early, like first eight weeks  of conception can affect things for people? Absolutely.  I mean, we know that and  more and more we’re seeing research comes out that several things affect those babies.  Maybe the use of acetaminophen, more research is needed, but that’s research that’s just coming out. Maybe lack of folate, big deal. But in those first eight weeks,

14:47

The  multiple things, not just the thyroid hormone, but what about the minerals? We really need selenium. What’s the mom’s mineral levels  in those first eight weeks that have some  kind of subacute thyroid issue? What are their zinc levels? And that affects so many different things. But absolutely,  the ability of the thyroid to adapt.

15:16

as well as its ability to act correctly, especially in that first trimester, really affects our kids. And again, moms, not shoulda, coulda, woulda, um but. Yeah. And how important do you think um it is to test the kids  for  thyroid issues um if they have a mom with Hashimoto’s and hypothyroidism? Do you often see those thyroid issues translate? Right.

15:44

Now,  am  as somebody who has taken care of children with autism and now children with pans and pandas for decades, I very rarely see a child less than two or three years of age. So when I’m answering, I’m answering for that age group. I’m not seeing newborns. um Although I do think that’s important to check, I have no clinical experience in that.

16:09

But absolutely, if I have a child who comes to my practice with autism or pans and pandas, I am checking their thyroid levels, regardless of what the mom tells me, because just like in pregnancy,  many moms have subacute thyroid disease and don’t even know it. So I think it’s really important to check that. I had a child when I first started in practice 30 years ago,  one of the first children I had,

16:36

had autoimmune thyroiditis and their thyroid had never been checked. And he was a tween. He was 11 years old and he had  significant um autoimmune thyroiditis  and it had never been checked because he had autism. So every child that walks in my door gets their thyroid levels, their thyroid antibodies checked because it does need to be treated if that’s one of the issues in the children.

17:06

Yeah.  What I found so interesting because I’ve always checked Jake and even before we started seeing you,  I checked his antibodies, you know, since the first time we ever did a blood test, which I think he let me do that at like maybe four.  Um, it was not easy, but we got that. I think also then he actually didn’t really know what it was. So I think actually that very first one wasn’t so bad. And then after that it was worse cause he was like, Oh wait, I know what they’re going to do. I don’t think so.  Um,  but he did not have the antibodies.

17:35

thyroid antibodies, neither a TPO nor thyroid globulin. He still does not. However,  what we did find was that he had an elevated TSH,  but  with a completely normal T4 and even a slightly higher T3. And this was so interesting because again, as someone who works with adults,  that’s not a pattern we see. That’s not a thyroid type I ever talked about. We just don’t see that, but  kids are different. Can you talk a little bit about this  interesting kind of balance that is

18:03

apparently pretty common in kids from what you were telling me. Yeah, absolutely.  Often we will see an elevated TSH. And I want to be clear, our conventional labs,  I think, have  a much too wide,  normal,  you know, sort of  levels.

18:25

um And you’ll see that the, you know, our conventional labs will say a TSH of 4 or 4.5 is normal. You and I both agree that that’s nowhere near normal. So  some of your physicians may be calling a TSH in children normal because it’s in that range. And we really want it in the, in the two range if we can.

18:49

And I think even on labs, right, they say for children under a certain age, these higher levels are normal, but are they really? Right. I don’t think so because I think these children are showing that either they have some, you know, some lower level, but still abnormal level of immune dysregulation, some lower level, but still abnormal level of mineral deficiency.

19:15

um, some abnormal level and you know, we haven’t even started to talk about the gut. So I think the, the gut  and, the effect of diet on that, uh, affects things and,  all of that together with whatever genetics they have  makes that thyroid  less responsive. And that then sets them up as do many other things to the inability to handle our

19:41

toxic burden in our environment. So I am treating  mildly abnormal, high normal, and definitely abnormal TSHs in any of the kids I’m seeing. Naturally, uh not with medication,  but I am treating it.

20:01

Like in Jake’s case, he had a high TSH, but he also had a high T3. So thyroid medication wouldn’t be the right thing because it would just bring him up even more. And he’s already pretty hyper. We don’t need more of that.  yeah, what was interesting, you explained how  T3, you know, T4 converts into T3 normally, right? And the gut and the liver, but in kids, when there’s inflammation, it actually over converts, which I thought was fascinating.

20:26

Absolutely. And that over conversion then causes your body, your thyroid stimulating hormone coming out of your brain to say,  we need to do more. We need to build up even though those levels don’t necessarily seem um abnormal, particularly the um T4. But absolutely, inflammation affects that in our kids. And I think more in our boys, though there really isn’t a study in that. Yeah. uh

20:54

If we know that our kids are more inflamed because we have Hashimoto’s  and you know, they need more support, whether they already have a certain diagnosis or maybe they don’t, but we just want to make sure that we prevent it. So where do we start? Cause there’s so many different things and we, you know, we could do a hundred different things, but as moms also having Hashimoto’s our energy  is gone. We need to preserve it. Right. So we can’t do anything and everything. So where do we start? Well, as somebody with celiac,  um, I,

21:24

always have to start with the gut.  And um as we know,  in moms with thyroiditis, it would be in your best interest to be gluten-free. And I think especially if you’re doing that as a mom, or as a mom, have autoimmune Hashimoto’s thyroiditis and you’re thinking about getting pregnant,  being 100 % gluten-free  is in your best interest. And I think it is so much easier now.

21:53

And I always say I was very lucky to go through five years of infertility because it made me look at many things, including the fact that I needed to be a hundred percent gluten free at that time. um But, but I think diet in general, you know, the gut is not the second brain, it’s the first brain. So the more we can have an anti-inflammatory diet, a diet that at least is very low in gluten, low in dairy, low in sugars.

22:21

more proteins,  oils, veggies, fiber,  that will go such a long way.  And also I think so much of the time we say, well, I’ll put a supplement on, then I don’t have to do the diet. You can’t supplement your way out of a good diet.  You just can’t. And  if we can do it as a family, and if you have to have your donut,  go have it after you drop the kids off at school. But the more we can make  our home

22:51

as fresh  and  anti-processed and organic um and whole foods, the outsides of the grocery store aisles, so to speak, the better. So I think that’s number one.  Then I think um anti-inflammatories.  One of the biggest is essential fatty acids.  Now some of our kids and moms with mast cell activation  or  over histamine may not be able to tolerate that as well.

23:19

but we have very good evidence that essential fatty acids are just that essential. And what does our standard American diet, our sad diet not have enough of? Fatty acids,  oils. So coconut oil, olive oil,  adding krill oil,  DHA for babies, EPA and DHA for older kids can be a great anti-inflammatory and  great in general.

23:48

then I think turmeric is one of my favorite anti-inflammatories. It’s neuroprotective in a lot of cases. It also helps to decrease anxiety um in some of our kids, but is a very good anti-inflammatory. Phospholipids in general,  aloe.  know, aloe is a great anti-inflammatory that, you know, Jill Christa talks about it binding mold.

24:12

um We talk about it a lot as a cathartic, as an anti-constipation. And by the way, you know, if your child’s constipated or has diarrhea, there’s something going wrong in their gut. um And we need to treat that first. um So anti-inflammatory diet, anti-inflammatory supplements, and then in general, you know, what are we doing with our kids? Well, in our developed countries, we’re living a lot more inside.

24:41

more less vitamin D exposure, more EMF exposure, more antibacterial soaps and all of that. The more we can be outside playing in the dirt, getting sunshine, you know, the better it is for all of the systems of our body, but particularly our immune systems and our gut. Right. Right. And that’s so, so important.  Now, when we talk about pandas, but pans and pandas,  because I think

25:10

A lot of people don’t realize  that their children may even exhibit some of that, you know, because we think, oh, they’re just acting out because they’re tired or, oh, you know,  this happened, right? Can you talk a little bit about how  when someone has PANS or PANDAS, how the symptoms are different than just acting out, how people can know what it is and that we could get into some of the things we can look at? Because like you mentioned with PANDAS, it’s strep,  but

25:39

Oftentimes, unfortunately, once they have that and that inflammation has started, it doesn’t have to be strep, can be other things. Right, absolutely. And I think that with Panzer Pandas, the biggest thing I look for is the abrupt onset. The child that may have a low level of OCD or anxiety or something like that, that on February 12th was his regular self and on February  14th, he devolved into ticks.

26:06

or severe OCD or wouldn’t leave your side and go to school  or all of a sudden stopped eating. It’s that  abrupt onset that you really need to look for. Now, if it’s more subacute and you’re just seeing, you know, he’s more brain foggy or this OCD is just increasing overall, think back, was there an abrupt time at any point where things abruptly changes? Oftentimes when the terrible twos or

26:36

or the terrific threes or whatever we want to call them, there can be an abrupt change, but we don’t even notice it because we’re calling it the terrible twos. And, you know, we’re in the throes of potty training and dealing with everything else at that time in life. But, but really go back and look at that. And, and then I say, you know, look at what changed before that, you know, was there strep in the classroom you just got a note home about.

27:05

Was grandpa in the hospital with walking pneumonia and it could be mycoplasma? Were you just at Aunt Ethel’s house in the Poconos and your dogs had tons of ticks on them? Did you just have water damage in your house? know,  all of those things, I’m sort of, was there just COVID in the family?  know,  all of those things could be the triggers.  And then what I really ask is  if you go to your pediatrician,

27:35

talk to them about what that was. And if it was strep in the classroom,  even if the child’s throat looks pristine, do a throat culture,  do a test to see, because  going back to what I said originally, that immune system is dysregulated. So if your immune system is not attacking the strep in the throat, but attacking the brain, you’re not going to see the pus and the redness and the swelling in your child’s throat.

28:03

that you may usually see in your child that doesn’t have pandas. So that throat can look pristine and there still be strep there. And this is antibody response.  Yeah, this is so big. And this is what I  really want people to understand and take away, especially, you know, this episode is airing in the fall as we head into,  you know, fall, winter, or a lot of these things, because that’s exactly what happened with Jake  and.

28:30

What was interesting in our case is that it was fairly abrupt, you know, he, he was never an easy kid. Let’s put it that way.  So sometimes you just think, oh, it’s another phase, right? But how we figured this out and it took us six months, and this is when we ended up finding you after  is  that my husband got strapped out of nowhere  and we were like,  what do you even do? Like,  you know, I’m an adult, so I get strapped that much. And he was very ill  except.

28:58

We didn’t know it was strep. He went to urgent care and they said, your throat looks really bad. Here’s an antibiotic. Right. He came home and he said, Oh, they gave me an antibiotic. And then he felt better in two days. I didn’t think to ask, well, did they do a coat? Normally I do, but I think it was a busy time. I forget exactly what was happening, but I just, I didn’t ask. Right. And then it’s your husband, not your kid. yeah, exactly. Usually I’m on top of all of this stuff, but, but then what was interesting was.

29:28

At that point, this was the summer. This is when we noticed a lot more tantruming in Jake, but listen, he’s had periods of this through his whole life. He was five at the time, right? So  it was worse, but I didn’t think about it. And by the way, also, I think  then, I mean, we’re going back five years. I don’t think Panos was talked about as much as it is now, at least not in my world. And I was still under the thought, like learning about it in school. It was like, oh yeah, well, you know, kids over there get that, but like.

29:57

Yeah. My child would never, I mean, like, do you know who I am kind of thing? Like my child can never have this, right?  So  I didn’t even like,  like it wasn’t even like something that I could even conceptualize that could happen.  But what was interesting was about  maybe  four months later, Scott was sick again, like  fever, terrible.  And so he went to the doctor and then this time, like the doctor didn’t call back.

30:24

So I called and I’m like, listen, my husband was here two days ago. Like, did you run a culture and they’re like, oh yeah, yeah. We heard his culture just came back. It’s positive for strep. And I’m like, okay. Then I’m like, Scott, what are you doing? Like, where are you going? And where are you picking up strep? Right. We all felt fine, but I smartened up and I said, wait a minute, let us all get tested for strep. We all had it. I had very mild symptoms just because I’m always taking oregano and things like that. My daughter didn’t really have symptoms and Jake.

30:54

did not have any, his throat was pristine. And actually when the doctor looked at all of our throat, she said, you know, your throat’s a little pink, like it could be maybe the start of something.  And for him, she’s like, no, he’s fine. And I’m like, test everybody. yeah.  Yeah. And that is so common, so common. And I would bet you that maybe even earlier than this,

31:16

somebody in the family  or somebody exposed Jake earlier. Yeah. So  when  it may have been more acute, but you weren’t seeing it exactly. So seeing it as an autism symptom. you know, what’s interesting is I know exactly when this was when he was one years old, we had a live in Nanny  and she had strap and she got  so ill. had to take her to the hospital because we didn’t know what was wrong.

31:43

And I don’t even think her throat hurt the bat. She was just extremely sick. And so in the hospital,  um, they said it was strep and I had called  our family pediatrician, right? Jake was one. I said, listen,  um, you know, the nanny has strep. She’s extremely sick. We’re all fine, but like, should we touch Jake? And the pediatrician said, no,  she said, he’s very young. The,  the, the stress of the test is going to be too much for him, right? Cause no kid wants that.  And she said, you know, but what is the nanny doing? And I’m like,

32:13

Well, everything she’s like, does she feed him? And I said, yes. I’m like, she cooks the food. feeds him. She’s like, well, does she put his food in her mouth? And I’m like, well, no,  she doesn’t. like she cooks the food. She feeds him. Like when I’m at work, like she’s with, she lives here, you know, with us.  And she was like, well, as long as she’s not putting the food from her mouth to his mouth, then like the chances are small  and  you know, don’t worry about it. And you know, back then I didn’t think of it, but that  probably was. oh

32:42

I do want to say children are very resilient. Do I want to draw their blood or do their strep throat cultures every day of the week? No. But,  but the,  the counter to that is if we miss it, it is so much worse. And I think we can help our children to be able to accept these things.  Um,  I,  and I think it’s important not that you should have done it or anything, but

33:10

You know, there are so many ways that that nanny just by breathing and wiping her nose and then doing the food without washing her hands, you know, may well have transmitted the strep at that time. And remember, again, genetically speaking, our kids are more susceptible.  No, am I saying to put them in a bubble? Absolutely not. But am  I saying to do good hand washing and fix that diet a little bit more? Yeah, sure.  Again.

33:38

That’s such a typical scenario, but the AAP, the American Academy of Pediatrics came out in December of 2024 and basically said, yes, pandas exist, yay, but there’s nothing you can do about it. And it hurt the diagnosis of this disease so much because all we are asking is that to do that strep throat culture, not a quick strep. A quick strep is looking for the antibodies. The antibodies aren’t there.

34:07

do the throat culture to see if that’s a possibility. Now again, if it’s pans,  know, mycoplasma, viruses, tick-borne diseases, mold,  that strep culture is gonna be negative. But at least you can rule out that strep piece.  And it is so important. you know,  he was probably, your husband was probably getting it from your son. Oh, 100%. Over and over again. Yeah, exactly. And then you and your daughter, you know, of course, again, the strong.

34:37

We’re stronger.  We’re fighting it. Right, right. Exactly. Yeah. Well, that’s the thing. Like I’m so, I mean, it’s such a blessing in disguise that Scott got sick twice that that’s how we figured out that it was Jake all along. Otherwise we would never know he had no symptoms.  And, know, I tell  everyone, you know, that I talk to, whether they’re clients and minor people in my program, and we talk about this a lot,  that like, just if someone has struck around you, get tested. Like it does not  really…

35:06

or to do that, it takes a couple of extra minutes, go to urgent care, just do it. Because the thing is in this situation, if it is strep, you can do something about it, right? But if you don’t, that is when it perpetuates and gets worse and worse. And then from there is where you can get pans, right? That when this is inflamed, then it becomes this multi-scenario situation with pans where anything can react. And two things I also wanted to say is,

35:31

First of all, you know, in a child with autism or other neurodevelopmental issues or even a neurotypical  kid where it’s not abrupt onset and technically you shouldn’t have the diagnosis of pandas or pans, it still can affect your gut. That, you know,  our gut starts in our nose and mouth and that  seeding of germs from our mouth, from our throat into the gut.

35:58

changes the gut milieu, changes our immune system, may change our metabolic system, changes so many things that even though it may not be that abrupt, there’s still an effect on our kids. um And treating that, the second thing I wanted to say is treating that fully is really important. I don’t wanna use any more antibiotics than  the  next person. I really don’t. And…

36:24

And, but when we talk about strep throat specifically, we need to treat it fully. Can herbs treat it?  Absolutely. But it’s not a couple of days. It’s more like at least a couple of weeks. And we need to treat that and not shortchange it just because the child feels better.  We need to do the complete course, whatever your, your practitioner is recommending in those cases.

36:51

Now, one thing that we’ve noticed this year, and I a lot of other people are noticing,  is  that people are not getting better on the first try with antibiotics with strep. And this has been over the last couple of years. Can you talk more to that and what you’re seeing? Because you see so much of this in your practice and you’ve been  such help to us with really educating us and explaining about this.

37:17

Well, I think it’s again, everything is multifactorial, sorry.  But one of the reasons is that with antibiotic use, particularly for ear infections that may not need it, um we’ve overused amoxicillin. And if a child has been on amoxicillin multiple times in the past, it is less likely that amoxicillin will, um that the germ will be sensitive  to amoxicillin. It’s much more likely for the germ to be resistant.

37:46

So I really, and in this area, meaning our Northeast corridor.

37:53

particularly in Connecticut where we are, don’t use amoxicillin.  Don’t use it for stress.  It’s  too resistant. So I would say if you shouldn’t prescribe anything in the penicillin family, amoxicillin, penicillin,  I would recommend  asking for a different antibiotic, particularly something like septanir, for example. I also know from my colleagues in Boston,

38:21

that they’re seeing azithromycin resistance. Now here we are not. Strep is still sensitive to macrolides like azithromycin, chlorithromycin, but you  have to know your area. It’s possible that strep in your area is resistant to azithromycin, then that category is out. So again,  if either of those are the case, amoxicillin or azithromycin resistance,

38:47

Cephthoneer is one of my favorites and been very well researched in uh pandas um and pans by people like Tanya Murphy, et cetera. So I think both of those are really important. And then with herbals,  know,  just like with the antibiotics, if you use the same herb over and over again and don’t rotate it, you’re gonna develop resistance.

39:12

So when I use herbals, I like to use one that I know has good sensitivity, like oregano, like golden seal,  like silver,  colloidal or uh ionic silver. But I like to use them in rotation as much as possible so we don’t get that resistance buildup. Yeah, yeah. I love oregano.

39:36

Yeah, we use that. I rotate that and garlic and silver.  And I think you actually had mentioned this to us before, where if you use silver together with the antibiotic, that  can help it work even better. Absolutely. It increases the potency of the antibiotic. So  I’m big into, especially when parents have to use an antibiotic, to add the herb. Because the other thing that happens is

40:04

Again, pediatricians don’t want to overuse antibiotics, but if your child  is worse and maybe it’s pandas, that usual five to 10 day course isn’t going to be enough and you’re not going to be able to get your pediatrician to order more. So do that five to 10 day course, but then add the herbs in there and continue the herbs longer.  That can really be helpful because  as  many of your listeners know,

40:30

Herbs are very powerful. They’re not just antimicrobial. They’re, they’re not just antibacterial. They’re anti  fungal, which can be great for our dysbiosis and our abnormal gut milieu. They’re anti-viral, but they’re also anti-inflammatory. They have immune modulating properties that make them very helpful where antibiotics for the most part don’t have that ability.

41:00

Now you mentioned that the typical five to 10 day course may not work if someone has pandas  and you know, usually doctors say finish, you know, the whole bottle and typically they give you seven to 10 days. Um, usually 10 days, but I know some practices are like, Oh, less is better. You know, if they’re  feeling better.  So in an ideal situation, if someone does have pandas and they do get strapped, how long would they be on the antibiotic? Three to four weeks. Wow. Yeah.

41:28

And that’s why I try to switch it to herbs. mean, often what I’m doing is I’m ordering the antibiotic for a month and I’m saying, you know,  if your child is better, two days after they’re better, which may be at a week, maybe at two weeks,  repeat that strep culture if it were positive, because you want to make sure that they’re now negative. So you want to stop the antibiotic, go ahead and stop it. But if that strep culture is positive, restart it.

41:56

or maybe you need to a different antibiotic. um But also in that first week to two weeks, add the herbs because if you’re feeling uncomfortable continuing the antibiotic that long, you want to make sure they’re tolerating the herbs and the herbs at full dose.  Often, as you know, what I do is I’m starting at a very low dose to avoid any Herxheimer or die off reactions and it takes time to build up.

42:25

So I’m adding that antibiotic, telling them to add the herb and build up on the herb, then stop the antibiotic. You know, if they feel comfortable doing it for three to four weeks, that is probably ideal. And if you’re doing a probiotic or fiber  or modified Citrus pectin, you know,  you’re building up your good flora, your commensal bacteria. So you’re balancing that act for the gut.

42:52

But I do think adding those herbs and prolonging that, because the other thing  really is that they’re gonna get exposed to something else. They are in cesspools in school. And so  also having the herbs, having the immune modulators in for most of the winter will be protective,  usually for strep, but also for all the viruses that are coming down the pike that they may get and maybe for the mycoplasma too.

43:22

So  one of the things that we noticed, and I’m sharing this only because I know  people listening, they may not realize some of these things. And I think if they hear  some of the stories, they might be able to see themselves in their CEO. Wait a minute, that happened to me. didn’t realize it was something,  but  once we treated Jake for strep, once we found out he had it,  um, you know, six months later from the original episode, right.  Um,

43:47

Two doses of, and this was a while ago where Moxicillin was working, um, two doses of Moxicillin and he was a different child.  Um, we of course continued for the 10 days and he was really good for about three months. And then things shifted again, not  so  harshly.  but it was definitely like, oh now we’re acting out more, we’re more defiant, you know, things  like that were happening. And so.

44:16

Again, no one had anything. No one was sick. He had a runny nose, but like no throat stuff. We tested him strep again. So then we used a different antibiotic  that you had prescribed for us.  Uh, and what was interesting is we didn’t see such a big down regulation at that time. And that’s what I found interesting because that first time it was literally magical. Like, Oh my God, my child is back. Like I haven’t had this in so long.  And then the second time when we tested him and that the throat culture wasn’t, it turned negative.

44:44

from when it was positive again.  And you know, he was  bad, but it wasn’t this,  Oh, my child is back.  And then this went on for probably the next year where he had strep a total of five times. We’ve used different antibiotics each time. And  you know, it was a little better, but not much. And that’s when we started talking about pan. So I’d love for you to talk about that because you mentioned it briefly before, but just to get into a little bit.

45:11

more about that and some of the other triggers that it can have. And this is not uncommon because  the big thing to remember with Panzo-Ware Pandas is its immune system reaction. It’s not about the underlying trigger. Yes, it’s good to find it and treat it appropriately, but the problem is with the immune system. So the immune system is not acting correctly. So  our children are getting exposed to a lot more than strep. It can be other bacteria. And by the way,

45:40

You know, it’s why I always say if a child is going to get an adenoid and tonsillectomy, make sure you culture the tonsils or adenoids because the germs inside there can be other bacteria  or yeast besides strep. Yeast is a big one.  And this is not one that’s really recognized in the conventional model of PANS, but one I see all the time. And is it because all the antibiotics we’ve been giving for pandas?

46:07

Maybe if we’re not balancing that act with a diet, probiotic, fiber, et cetera. So  those other germs we have to start thinking about if we didn’t initially. So could it be yeast? Could it be mycoplasma? Especially since COVID, we’ve had much worse mycoplasma infections in our winters, especially the last two years. So mycoplasma is an atypical bacteria.

46:33

that can cause sinus infections, bronchitis, pneumonia. But again, our kids may just have the exposure and only show the neuropsychiatric changes, the anxiety, the OCD, and never show any bronchitis or pneumonia symptoms. It’s just grandpa has it  or dad has it. um Then it’s also viruses,  not just COVID, although that has been uh a big

47:02

factor for a lot of kids because it acts in many ways the same, but in many ways differently than other viruses. All viruses,  know,  COVID has reactivated a lot of chronic viruses, herpes viruses, EBV, CMV, but any virus that comes down the pipe can cause pants. You know, any of your rhino viruses, your cold viruses, your flu viruses, any of them. And those can be much more insidious.

47:31

You know, yes, there can be  the line in the sand where they have the remarkable  and abrupt change in behavior. But if you’re getting exposed to them all the time, there can also be this little drip, drip, dip in the total body load. And then  the others that again, COVID  reactivated in a lot of our kids is tick-borne diseases.

47:58

Borrelia, which is typically called Lyme disease. And then the other two, are much more common in this area of the country now,  and  much more significant when it comes to neuropsychiatric symptoms are Bartonella and Babesia.  So if  I have a kid that’s getting that kind of history, I’m going to be looking for all of those and mold, you know. And by the way, anesthesia, that kid that goes and has the TNA, uh

48:26

because they keep getting strep,  but  they don’t protect them, so to speak, when they’re getting the anesthesia and going through the trauma of the surgery.  They get worse afterwards and the parents are like, wait, I got the tonsils out. I thought they were supposed to get better. Again, so many factors go into that. One, that the tonsils and adenoids are part of your immune system and may be necessary. Two, that you just had a big metabolic and mitochondrial hit.

48:56

and you may be needing to support that child more. So the thing I love about this disease is I used to read Nancy Drew mysteries as a kid, you know, it went with my name, but I love that sort of detective thing, um but I’m definitely afraid of the  dark, so I can never be a detective.  But looking for these things  is part of that detective work that I love to do and try to figure out.

49:25

what the trigger or triggers may be. And most of the kids, even those that have pandas, it becomes pants. Yeah. And I think that is really, really, really important for people to, and again,  not because, oh no, now you’re going to have this, but it’s like,  we just need to be aware, right? Because so many people didn’t, don’t know. I didn’t know.  Right. And so I think this is so important for people to hear and to understand  and to know that

49:52

there is a lot of different things that we can do because we can support all of these different triggers, the mold, the tick-borne illness, the viruses, right? There’s protocols for that. And you mentioned a lot of things already. You know, and there’s a lot more people who do that’s customized to them.  And also going back to our moms, you know, in that scenario,  if you have thyroiditis or you have an autoimmune disease, did you go back and look to see if you had a tick-borne disease? You know, maybe even had it and didn’t know it when you were pregnant.

50:22

were you exposed to mold and water damage and you were dealing with mycotoxins, your thyroid disease may not be getting better because you don’t know that these were in you.  And again, that susceptibility or even that infection could have been passed on. So  looking for it in yourself is also important. Yeah,  that’s all the triggers that we talk about a lot that is really important.  Dr. O’Hara, this is so insightful.

50:51

And I know that this is going to really open eyes  for a lot of people. And I want this to be out there because so many people just don’t know, like I didn’t know.  And  there’s so much, you know, that could be done. So for people who want to learn more about what you do, how can they connect with you, contact you, see more, us. Yep. So my website is D  R O Hara.com D R O H A R A.com. And everything is there.

51:19

I’m not accepting new patients, but I do now do a lot of mentoring where I’m training other practitioners to look at things. know,  often our kids need a village. You know, this is a village of problems. We need a village of caretakers. So  even if you have a wonderful caretaker sometimes or practitioner of any sort, sometimes just a new set of  eyes. And I say this for myself can be really helpful. So I do a lot of mentoring.

51:46

I have a membership program that’s open to parents as well as professionals of  all ilks where I have monthly teachings  and tons of resources on all of these different things that you could read for hours and hours and hours.  And then I also started a podcast of which you have been a guest uh and it’ll be airing soon. The  podcast, Like My Book,

52:13

um and everything that I do is demystifying Pans Pandas. It’s everywhere your podcasts  are. um You can get that. And my book is still there. And I also  last year did a new audio book, which has five new chapters because I wrote this book, it was my COVID baby, much harder than my regular baby did deliver, but delivered it. But  I’ve learned so much even since then.

52:40

You know, and so I put five new chapters in on Bartonella, Babesia, mold, COVID, and  one we barely touched on, which is cerebral folate deficiency.  And so  there’s lots of information out there. And  one last thing  I leave everybody with is one of my favorite quotes, which is, follow those who seek the truth, but flee from those who have found it. All of us are still learning, me included.  And the more we’re willing to be curious,

53:10

and keep trying to figure things out for ourselves and our kids,  the more likely they are to get better. Yeah, I love that. I love that so much. Thank you, Dr. O’Hara. So appreciate you being here, and we’ll chat really soon. Absolutely. Great to be here, and thank you.