Demystifying PANS/PANDAS Podcast

Families tell me the same thing all the time. “I thought it was just strep.” Dr. Richard Horowitz arrived at the same place from the other direction, over 41 years in medicine and more than 13,000 tick-borne disease patients. His 16-point MSIDS model maps what he calls six rivers of inflammation running into one ocean, and he describes the way most medicine handles it as a patient walking in with sixteen nails in their foot while the doctor pulls out one and sends them home. On Demystifying PANS/PANDAS we walk through all sixteen, and through the free Lyme questionnaire I use in my own practice almost every day. Then he tells me about the Alzheimer's biomarker case study he has just had accepted for publication. Whatever you name the illness, it is inflammation in the brain, and the work is finding out where it is coming from.

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About the Guest:

Dr. Richard Horowitz, MD is a board-certified internist and medical director of the Hudson Valley Healing Arts Center. Over more than thirty years he has treated more than 13,000 tick-borne disease patients from around the world. He is a founding member and past president of ILADS and ILADEF, has trained hundreds of healthcare practitioners, has consulted for government agencies, and has published on both classical and integrative approaches to vector-borne disease and COVID.

He developed the term multiple systemic infectious disease syndrome, or MSIDS, for the symptom complex arising from infections, inflammation and immune dysfunction. He is the author of Why Can't I Get Better? and How Can I Get Better?, and of Ending Chronic Illness, released October 13. He no longer prescribes directly, and now consults with and trains other physicians on complex cases.

Read more about Ending Chronic Illness, released October 13, at cangetbetter.com.

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Nancy O’Hara, MD, MPH, FAAP, FMAPS

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Michelle Pinto is a nurse, and when her two children were diagnosed almost ten years ago her first reaction was a professional one: how is this not covered by insurance. That question took her to the Massachusetts State House in 2019 to testify, then into a coalition of parents, an advisory council, and a PhD.

Her research is why I wanted her here. Most of what we know about these disorders follows the child. Michelle surveyed parents and caregivers, scoring family burden — a wider concept than caregiver burden: the parent who stopped working, the changed income, sibling fallout, stigma, and sheer uncertainty. Her survey filled faster than expected, and the open-ended questions surprised her. Every response had a real answer in it. She is planning a second paper on what families wrote when finally asked what they wished a provider knew.

We talked about the Look. Foundation, where she serves as a board member and where her family received a healing grant before she ever volunteered. Michelle says the foundation has given more than five hundred thousand dollars in healing grants to date, close to one hundred thousand last year, covering what insurance does not: testing, supplements, appointments, sometimes parking. There are also village hours: open support calls where a parent can simply listen without speaking, and where, Michelle says, the most useful information passes along. Then, the advocacy. Massachusetts has had an insurance mandate since early 2021, and a Department of Public Health advisory council in its third year. Two further bills are pending: a prevalence study to count affected children statewide, and a screening bill, so a sudden change triggers a look for infection at the point of care. Michelle's argument there is the one I want providers to hear. You do not need to be an infectious disease specialist to recognize this, and the evidence favors catching it early, not years later.

Her closing words are for the parents. If you feel a tug, follow it. Make the call that is hard to make. As she puts it, this illness makes you feel like you are not a good parent, and that is not true. I would add what I always say: it is treatable, it does exist, and it takes a village.

This conversation is educational and is not medical advice. If you are worried about your child, talk to a clinician who can see them.

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About the Guest:

Michelle Pinto, PhD, MSN, RN, is a registered nurse, nurse researcher and clinical assistant professor at the University of Massachusetts Dartmouth. She recently defended her PhD dissertation, Perceived Family Burden in PANS/PANDAS: A Descriptive Correlational Study, which makes her one of very few researchers examining what these disorders do to families rather than to patients alone.

She serves on the Board of Directors of the Look. Foundation, on the Massachusetts Department of Public Health PANS/PANDAS Advisory Council, and as a member of the Massachusetts Coalition for PANS/PANDAS Legislation, where she helped pass the state insurance mandate that took effect on January 1, 2021. Michelle is also the mother of two children who have lived with PANS/PANDAS, which is where all of this work started.

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Social Handles:

Look Foundation: lookfoundation.org

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Nancy O’Hara, MD, MPH, FAAP, FMAPS

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I always say it takes a village, and this conversation is a good example of what that village sounds like. I sat down with my dear friend and colleague Dr. Christine Saba at MAPS, and we ranged across a lot of ground, starting with the talk she gave on refined sugar as a genuine burden on children's health. Chris is a pharmacist and a pediatrician, so she sees the biology and the whole child at the same time, and she is wonderful at making the science practical, from choosing whole foods over refined ones to something as simple as slowing down and eating together instead of on the run.

From there we went where this show always goes, to the children in front of us. Chris shared how she first came to understand that infections can sit underneath neuropsychiatric symptoms, and how her work with ILADS and MAPS has deepened her understanding of vector-borne illness and co-infections in kids. The theme we kept returning to is that it is never one single thing—it is the whole child and the whole system, and our job is to be detectives who look at all of it. If you are a parent in the thick of this, please hear the part that matters most: it is treatable, you are not alone, and we do not give up hope. We keep knocking until the right door opens.

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About the Guest:

Dr. Christine Saba, PharmD, MD, is both a pharmacist and a pediatrician, a combination that shapes how she thinks about children's health from the inside out. She serves on the boards of the International Lyme and Associated Diseases Society (ILADS), where she has worked to bring a pediatric lens to vector-borne illness, and she is a clinician within the MAPS community. Through her practice, Saba Integrative Medicine, she cares for complex children by looking at the whole picture: diet, environment, infection, and immune function, rather than any single trigger.

Learn more about Dr. Christine Saba and her practice at sabaintegrativemedicine.com

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Nancy O’Hara, MD, MPH, FAAP, FMAPS

Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drohara.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

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Scott Antoine and I have been telling each other for years that we are brother and sister from another mother, because when it comes to anxiety and OCD in our children we tend to see the same thing. What he brought to the Medical Academy of Pediatrics and Special Needs this year was a framework I had not heard put quite this way. He trained in toxicology. In the emergency department, a poisoning gets three responses: get the patient away from the substance, support while it clears, and where one exists, give the antidote. He applies all three to anxiety, and adds a fourth, which is preventing the next exposure.

Most of this conversation is about reframing, which is not the same as talking a child out of a feeling. Scott is not trying to remove anxiety. He is changing what it means. There is the woman who could not tolerate a mask and reworked it into a scuba regulator. There is the eighth grader whose bullying registered as more damaging than a later assault, because, as he puts it, the brain decides for us what counts. And there is the moment he tells a child with OCD that neither three washes nor a thousand is the right answer, so the child gets to choose. Scott had OCD himself at sixteen, and he says the thing every child in that room needs to hear: your brain is not broken.

Then it gets personal for both of us. He goes to the basement when it rains to check for mold. I spent four sleepless nights running through infections when my son told me something was not right, and it turned out to be a girl. We name it as what it is, and we talk about the work of not putting our own fear onto our children. If you are in a support group that has told you every sniffle means the wall is coming down, that has not been our experience. It is treatable. It does exist. And it takes a village.

This conversation is for education only and is not medical advice. Any supplement, device or technique discussed should be reviewed with your child's own clinician before you try it.

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About the Guest:

Dr. Scott Antoine, DO, FACEP, ABOIM, IFMCP, is triple board certified in emergency medicine, integrative holistic medicine, and metabolic nutritional medicine. He trained in toxicology during his emergency medicine residency and spent years in the emergency department before moving into integrative practice. He now practices at the Center for Fully Functional Health in Carmel, Indiana, and is one half of The PANDAS Docs. He is the author of The Comprehensive Physicians' Guide to the Management of PANS and PANDAS and co-created an online course for parents who cannot get to him in person. He is also a PANS/PANDAS parent himself.

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Social Handles:

Website: thepandasdocs.com

Instagram: @thepandasdocs

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Nancy O’Hara, MD, MPH, FAAP, FMAPS

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In this episode, I wanted to demystify something that gets missed far too often: the role that tick-borne and vector-borne infections can play in a child's PANS or PANDAS. Dr. Casey Kelley and I talk through why most families never remember a tick bite, and how other carriers like fleas, lice, mosquitoes, and pets mean a clean history does not rule infection out.

We walk through the symptom patterns that may raise a flag, the honest limits of testing (antibody tests can read falsely negative in the sickest kids), and why she sometimes weighs empiric, clinician-guided treatment by asking a simple question: what would we do differently with the result? She shares how she treats children like small adults with kid-sized doses, opens detox pathways before antimicrobials to ease reactions, and leans on foundations most parents can start with: sleep, anti-inflammatory food, nervous-system and vagal support, Epsom baths, and time.

This is not a quick fix, and I never want a parent to leave feeling more afraid. Dr. Kelley's own reminder stayed with me: create joy, even if it's just being silly and dancing in the kitchen. That counts. It is treatable. It does exist. And it takes a village.

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About the Guest:

Dr. Casey Kelley is the founder and medical director of Case Integrative Health in Chicago, where she practices integrative and functional medicine with a focus on complex chronic illness, including tick-borne and vector-borne disease. She earned her medical degree at The Ohio State University College of Medicine, has been a member of the Institute for Functional Medicine for more than 15 years, and is a former board member of ILADS. She also teaches clinicians and patients through her Groundwork for Healing course.

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Social Handles:

Website: https://caseintegrativehealth.com

Groundwork for Healing: https://healwithcase.com

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Nancy O’Hara, MD, MPH, FAAP, FMAPS

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I recorded this one with Dr. Eric Gordon and Dr. Nafysa Parpia at the MAPS conference, right after the two of them gave an incredible lecture on the toxic world we live in, and it is exactly the kind of conversation I wish more families could hear when they feel stuck. So often the search is for the single toxin, the one test, the one thing to remove, and together they gently take that apart. Their view is that it is the total load that matters: a child’s genes, their gut, their nutrient status, and their environment, all interacting. I learn in pictures, and the one that stayed with me is the reminder to go back through the door, not the window, meaning support the body before you try to pull anything out of it.

Dr. Gordon takes us through some of the toxicants that get overlooked, aluminum in particular, and why inflammation, the cell danger response, and “root compensations” mean removing a root cause is rarely the whole story. Dr. Parpia walks us through testing wisely, screening before provoking, reading blood versus urine, and checking methylation and minerals before any detox, and both of them keep coming back to why complex chronic illness is an “N of one,” different in every child. None of this is a quick fix, and they are honest that it takes time and does not help everyone. But there is real hope in treating the whole child instead of chasing one number, and that is the note I want families to leave on. It is treatable, it does exist, and it takes a village. Be present, be hopeful.

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About the Guest:

Dr. Eric Gordon is the founder and medical director of Gordon Medical, where he focuses on complex chronic illness, patients dealing with persistent infections, toxic exposures, and the kind of layered, hard-to-untangle presentations that other clinics often cannot place. Patients come to him from across the country and beyond. His work centers on treating the whole person rather than a single lab value, supporting the body’s own capacity to detox and heal rather than forcing it.

Dr. Nafysa Parpia is the Director of Naturopathic Medicine at Gordon Medical, where she specializes in tick-borne illness, ME/CFS, mold and mycotoxin illness, mast cell activation, environmental toxicity, and the complex chronic conditions rooted in immune dysregulation and persistent infection that often don’t respond to standard protocols. A graduate of Bastyr University and a board member of the International Society for Environmentally Acquired Illness (ISEAI), she is known for a careful, sequenced approach to detoxification, testing thoughtfully and supporting the body’s foundations, nutrients, gut, and detox pathways, before trying to clear anything. Together, she and Dr. Gordon treat each patient as an “N of one.”

Websites: https://gordonmedical.com; https://www.gordonmedicalforum.com

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Nancy O’Hara, MD, MPH, FAAP, FMAPS

Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drohara.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

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In this episode, I talk with my longtime friend and colleague Dr. Julie Buckley about something she has been refining for years: a dairy-free ketogenic diet for children with autism, PANS/PANDAS, and seizures. Julie explains why dropping dairy matters so much. Because plant-based, medium-chain fats are far more ketogenic than animal fat, she can keep the ratio low enough that her daughter still enjoys nectarines, tomatoes, and cucumbers at nearly every meal. We talk about how those medium-chain fats feed the mitochondria directly, why that matters for the brain, and how a food-first approach may ease the need for supplements or medications that sometimes leave our children more anxious or agitated.

We also open up a newer conversation about peptides, and Julie shares the early, carefully tracked observations from her practice. Woven through all of it is a theme I care about deeply: food as nourishment and connection, not restriction. Julie's stories about getting children into the kitchen, and about her own daughter's wisdom and humor, are a reminder that this work is about supporting the whole child and the whole family. It is treatable, it does exist, and it takes a village.

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About the Guest:

Dr. Julie Buckley is a pediatrician and functional medicine physician in Ponte Vedra Beach, Florida, where her practice, Pediatric Partners of Ponte Vedra, cares for children of all ages. A graduate of the University of Miami School of Medicine and the Jackson Memorial Hospital pediatric residency, she became one of the first pediatricians in the world to complete the Institute for Functional Medicine's certification in 2016.

Her work grew out of her own family. She turned to functional, root-cause medicine after her daughter regressed into autism at age four, and deepened it after her own breast cancer diagnosis in 2009. She is the author of Healing Our Autistic Children, an international speaker on autism and related disorders, and the founder of the HealthyUNow Foundation, a nonprofit building educational, therapeutic, and residential support for individuals and families affected by autism.

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Social Handles:

Website: https://pppvonline.com
Foundation: https://healthyunow.org
LinkedIn: https://linkedin.com/in/julie-buckley-b24944102

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Nancy O’Hara, MD, MPH, FAAP, FMAPS

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What if the most important vaccine question is not yes or no—but which child, which timing, and under what conditions? In this episode of Demystifying PANS/PANDAS, Dr. Nancy O'Hara speaks with Dr. Ari Calhoun about immune activation, genetic susceptibility, microglial signaling, and why some children may be more vulnerable to neuroimmune responses when vaccines are given during sensitive developmental windows or periods of higher inflammatory load.

They explore how vaccine reactions may be shaped by immune pathway differences, maternal and early life antecedents, microbiome health, family history, and total immune burden. Dr. Calhoun also explains practical ways to reduce risk through informed consent, schedule adjustments, spacing, brand selection, and targeted nutritional and anti-inflammatory support—offering families a more individualized path that moves beyond fear and toward thoughtful, child-centered care.

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About the Guest:

Dr. Ari Calhoun, FMAPS is a naturopathic doctor and the founder of Wholesome Brain Medicine, where she specializes in the treatment and prevention of neurodevelopmental and pediatric neuropsychiatric conditions. Her work spans autism, ADHD, PANS/PANDAS, anxiety, OCD, tics, mood disorders, and other brain-based conditions, with a focus on how the immune system, metabolism, genetics, and the environment shape neurodevelopment and long-term mental health.

She is widely known for her thoughtful, science-based work in vaccine risk assessment and individualized immune support, helping families navigate complex vaccination decisions while protecting neurodevelopment and supporting resilience. Her clinical approach begins as early as preconception and extends through pregnancy, childhood, and adolescence.

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Social Handles:

Website: https://wholesomebrainmedicine.com/
Instagram: https://www.instagram.com/dr.aricalhoun/
LinkTree: https://linktr.ee/dr.aricalhoun

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Nancy O’Hara, MD, MPH, FAAP, FMAPS

Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drohara.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

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What if the real problem is not just screen time, but what constant digital stimulation is doing to a child's brain, mood, and ability to cope? In this episode of Demystifying PANS/PANDAS, We speak with Dr. Koichi Tanji about the sharp rise in recreational screen use, how to tell the difference between overuse and addiction, and why chronic gaming, social media, and online stimulation can impair attention, increase anxiety, and erode real-world connection.

We explore how screen dependence can show up as irritability, boredom intolerance, poor boundaries, social withdrawal, sleep disruption, and loss of motivation, along with why these patterns can be especially complicated in neurodivergent children or kids with deeper physiological stress. Koichi also explains how families can begin reducing screen dependence through awareness, structure, replacement activities, and individualized support rather than shame or oversimplified rules alone.

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About the Guest:

Dr. Koichi Tanji ND, LMHC, FMAPS is a clinician and counselor who works closely with children and families navigating screen dependence, behavioral dysregulation, anxiety, and neurodivergence. He is known for helping parents understand how chronic recreational screen use can affect the developing brain, emotional regulation, motivation, and social functioning in the digital era.

Drawing from both clinical experience and research, Koichi brings a practical and compassionate lens to the conversation around gaming, social media, and digital overstimulation. His work focuses on helping families build awareness, restore boundaries, and support children in reconnecting with healthier rhythms, relationships, and coping strategies.

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Social Handles:

Instagram: https://www.instagram.com/be_better_with_koichi/
Email: [email protected]

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Nancy O’Hara, MD, MPH, FAAP, FMAPS

Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drohara.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

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What if a child's neuroinflammation began long before the first symptoms appeared? In this episode of Demystifying PANS/PANDAS, Dr. Somer DelSignore joins us to speak about congenital vector-borne infections and how in utero exposure to pathogens and maternal immune activation may influence brain development, immune programming, and later neuropsychiatric or developmental challenges.

They explore why pregnancy timing matters, which early signs may raise suspicion, why negative testing does not always rule out transmission, and how hidden infectious burdens can sit beneath labels like PANS, autism, or autoimmune encephalopathy. Dr. DelSignore also shares the thinking behind her RESET Protocol and why lasting recovery often requires addressing inflammation, infections, gut health, toxins, detoxification, and nervous system support together.

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About the Guest:

Dr. Somer DelSignore, DNP, BC-PNP, FMAPS, ILADS, FAAOT is a board-certified child and adolescent provider known for her expertise in diagnosing and managing complex chronic illness in children. She is the CEO and founder of Hudson Valley Integrative Health and has developed the RESET Protocol, a root-cause framework designed to address immune dysfunction systematically.

She is a fellow at MAPS and AAOT, a member of ILADS, and has deep experience in autoimmune and neuroimmune conditions, along with the psychiatric manifestations of infectious disease, especially tick-borne infections. Dr. DelSignore earned her Master of Nursing Practice from the University of Pennsylvania and her Doctor of Nursing Practice from SUNY Upstate Medical University, and completed residencies at CHOP, Penn State, and Children's Health in Dallas.

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Hopewell is a family-owned pharmacy which has been in existence since 1987. You can call them at
800-792-6670, email them at [email protected] or visit them online at www.hopewellrx.com.
Hopewell Pharmacy: Your partner in integrative wellness.

Other Links for the Guest:

Website: https://hudsonvalleyintegrativehealth.com/
LinkedIn: https://www.linkedin.com/in/somerdelsignorekidslyme/

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Nancy O’Hara, MD, MPH, FAAP, FMAPS

Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.drohara.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

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