Episode 101. PANS and PANDAS with Dr. Nancy O'hara

Adam Rinde, ND: [00:00:00] Dr. O'Hara, welcome to the One Thing Podcast. It's a delight to be here with you today.

Nancy O’Hara, MD: It's really delightful to be here with you, Adam, and thank you for inviting me.

Adam Rinde, ND: You're welcome. We were catching up on my first introduction to you in 2006 at a Defeat Autism Now conference in Seattle, Washington, and you were one of the featured speakers with Dr. Sydney Baker, and that was a big moment in my career, a big influence on the way I wanted to eventually practice medicine. And I would love to talk with you about what's changed in your practice and your life since the late 1990s and early 2000s. We were talking a little bit about that, and I'd love to go into that more.

Nancy O'hara, MD: Yeah, I started my career as an allopathic physician. I was a partner in a general practice. And then I went through five years of infertility in the 1990s [00:01:00] and nothing in Western medicine was helping me. And I met Dr. Baker as a patient. A patient of mine had gotten better with diet, which at the time as an allopathic physician, I thought was hooey, but because of the infertility and nothing was helping this go as a patient, see what happens.And I was pregnant three six months later and started my own practice a couple of years later. And the rest is history, and I started my practice in the late 1990s for children with autism and other neurodiverse neurodevelopmental issues. And then in and that's what I was doing when we met in 2006.

And then in 2009, my then nine-year-old son developed seizure like tics after getting strep throat, getting bit by a Lyme positive tic, and getting a viral infection all in the same week. And that's when I learned about PANS and PANDAS. And that changed the trajectory of my career to [00:02:00] now in 2022, I published a book and have several other projects along those lines.

For me though, the similarities are as important as the difference because it's always about the history and the physical exam. Whether it's Autism, or PANS or PANDAS. The top 10 biomarkers are history and physical exam. And I remember it wasn't probably much longer after 2006, a bunch of us got together and we were told to write down the top 10 biomarkers.

What tests should we be getting in all our kids with autism to, get in on this. And I just wrote over and over again, history and physical exam, history and physical exam, because we can learn so much from that. And that comes from Sid, and for your listeners who do not know Dr.Baker, he is the grandfather of functional medicine. And he taught both of us so much, and all of his citizens, if you listen, they will come. That's the history. Have we done enough for this [00:03:00] child? That's repeating that over and over again. That's not getting the next test. If you sit on two tacks, removing one tack doesn't make you 50 percent better.

You've got to look at the whole child. And that's what I do in PANS, PANDAS. And that's what I did and still do in autism. What's changed the most is COVID. And I think whether, you're talking about the disease or the injection it reactivated a lot of other infections, particularly dormant viral infections.

And dormant vector borne diseases, Borrelia, Babesia, Bartonella as well as others. And so, our kids now are sicker. They're a little bit more resistant to treatment. And I don't think it's just because I've been doing this for 30 years. I hear it from a lot of clinicians. And I also don't think it's just because of lockdown and masking and sheltering in [00:04:00] place and all of that, although that didn't help any of us.

It certainly is that, that our children, we're seeing certainly in the area of the country where I live, Connecticut, much more tick borne diseases as part of the abrupt onset of neuropsychiatric symptoms as we see in PANS. And I think. Maybe, I'm always looking for silver linings, maybe a few more people are coming to the table, maybe a few more people are seeing that infections and other triggers can be the beginning of a neuropsychiatric illness, and so if that's the case, yay, I'll take it.

: So those are the things, as a functional medicine physician now for the last 30 years with two naturopaths in my practice, a dietician, lots of therapists, it takes a village and unfortunately. And I apologize to any [00:05:00] allopathic physicians that may be listening, but unfortunately, most of us don't spend enough time doing history and physical exam, don't look outside the box and don't think of things outside of pharmaceuticals.

And we need to, because there is so much. Health and wellness that can come from herbals, botanicals, nutraceuticals, and just healthy lifestyle and diet.

Adam Rinde, ND: Sure. Yeah.. I want to circle back on the COVID comment and just go a little bit further into this clinical medicine and clinical diagnostic discussion.

It's. It's interesting with one of the things I remember from that conference was Dr. Baker had talked about approach to the patient and approach to working with a child in your clinic. And one of the things that really stood out to me is that he said to allow, [00:06:00] especially in neurodivergent children, to allow them to approach you and get on their level in the way that you communicate and allow them to initiate the eye contact. It was profound. I can't imagine AI being able to do that or any kind of tests to be able to establish a relationship.

Nancy O'hara, MD: Absolutely. And I say, one of the things that. I have kept all these 30 years is you have to come to the office once a year to be a patient of mine. And I've limited, I now only take new patients from Connecticut, New York, or New Jersey.

But even I think getting your hands on meeting people, making that connection. If you have to do it through telehealth and remotely, okay, but you need to meet them where they are. And, Sid always talked about our N of one, that's our clinical trial. What is going on with this child?

And unless you meet [00:07:00] that child and family where they are and really connect with both the child and in my opinion, both parents, or maybe there are 10 people, takes a village, whatever it is that's taking care of this kid. That, that's, what's really needed to help a child. And one of the things that's changed a lot for me, and I do want to tell this brief story is spellers, which is spelled to communicate.

And one of the things Sid taught me very early on is every child is in there. No matter how anxious, how neurodivergent, how non speaking. Stimming out the yin yang, they are in there and treat them as if they are. And I had one young man who had destroyed his home, destroyed the family, nothing had ever worked.

: He was non speaking and the mom called me right before COVID and said, I want you to see Alex. There's something that's changed and she had found spellers, which [00:08:00] is learning how to communicate through spelling. And this young man who had never said a word in his life knew seven languages when he was flipping, stimming through all the books.

He had a photographic memory and was learning every word. He had a wicked sense of humor. And now with many of my patients who were non speaking. Through this program, I can fully communicate with them through typing.

Adam Rinde, ND: Wow.

Nancy O'hara, MD: And they are there. Our whole, you went to what was then a Defeat Autism Now conference.

The conference now is the Medical Academy of Pediatric Special Needs. And anybody who went years ago, it's changed. It's new in the last two years and just last March, we had a whole conference dedicated to the neurobiology of communication. And Sid was the first person who really taught me that. I had taught children with autism before I went to medical school.

And I always say medical school was a heck of a lot easier [00:09:00] than teaching. And I fully believe that seeing these children as fully present and being present with them is a huge part of the clinical history, physical exam and care of these families.

Adam Rinde, ND: Yeah. And along with that working with the parents and all that they're going through during these moments and helping them.Be able to trust you and trust the practitioner and trust the process, most of them, especially with pans and pandas have been told by so many people and so many providers that this isn't possible. I've never seen something like this. Or, they're the one person where everybody dismisses time after time, and it's such a frustrating and debilitating thing to go through.

Nancy O'hara, MD: Yeah. And a few things on that point, I totally agree with you. [00:10:00] And number one, the most important instrument in my office is a tissue box because, parents have been to three, 13 different practitioners. And not found answers or even permission to talk about such an illness and their lives have changed often overnight, or have been difficult for so long.

They don't know where to turn. And the second piece of it, I have been there, having my own son go through it. And, he didn't even believe he had this disease till a couple of years ago and he's now 25. But anyway, that's another story, but I could say I know the PTSD of this disease, even when your kid gets better.

I always tell the story. My son was 19. He had been totally fine for years. We were in a hotel and he said, mom, I'm feeling blue. I just I feel horrible. I just, I'm not, all these negative things that I'm going through. Is it strep? Is it mold? Is it Lyme? Is it Bartonella? Is it, I'm not sleeping for four nights.

At the end of four days, he finally [00:11:00] says to me, mom, it's about a girl. And it reminded me that my PTSD, my worries were as important. And it's that whole, put your oxygen mask on first. And that goes to also meeting the families where they are, every family can't do or shouldn't do IVIG.

Every family is not going to be able to or want to do, for example, helminthic therapy, which is a big thing Sid and I both talk about. They may not want to do antibiotics. They may want to do herbals or vice versa. It's important to, I always talk about us as their GPS, I may be a pushy GPS, but I'm giving you the route as a patient, as a parent to go down that I think is best for your child, but you're still driving the car.

 And I think that's important, especially I think as a, an MD, we have a tendency to say my way or the highway, I know [00:12:00] best. So you do this.

That is so wrong. And I think naturopaths are certainly much better at it. But even in any practice, we need to meet the families where they are, right.

And work with them, they need, we need to co-captain their ship and help them because that empowerment is so important for the child as well as for the family in getting to help.

Adam Rinde, ND: Yeah, great point. Yeah. And I think, you and I were introduced a second time by Dr. Crista and, all three of us have been through medical ordeals with our children and I can completely relate to that once you've been down that road you no longer look at things lightly and you have to really relearn how to, back up and say, Oh, it is about, It is about a girl or it is about a yeah common things happen commonly, but that world changes once you've had a sick child.

Nancy O'hara, MD: And taking care of you, and realizing that in yourself too, but also the other point that I think is important is to. You know with pans and pandas oftentimes we see that child as a sick child and yeah, they are sick. They are medically ill. There is inflammation in their brain, but that doesn't mean They can still do their chores They can't still wake up in the morning and make their bed there has to be that anticipation and that expectation of you're still part of this family because I call it feeding the beast of the disease.

If we feed the beast of the disease too much and we give them, give in then those secondary gains of not having to do the chores or homework or whatever. Start to take over and that's a really and together with that is also a phrase, a therapist once taught me, which is to say to your child, I get it, [00:14:00] even when you don't, the first words need to be, I get it, not, I get it, but.

But I get it and that way they can feel more comfortable talking to you now later in the car on a walk You may say hey, you know how we talked about this thing and you were saying this I think about it this way maybe but let them know they are her and that goes back to what I was saying about the families too.

That's what I try to do is hear them and what their stress is, what their problem is, and when I'm treating the symptoms. That's part of my three-pronged approach in treating the symptom that's affecting them the most.

Adam Rinde, ND: Yeah.

Nancy O'hara, MD: I may think the sleep is the biggest problem, but they think it's the way the kid is hitting the mom or the tick the kid has or whatever it is.

Treat that symptom first.

Adam Rinde, ND: Yeah, so I think that's one thing that's really Stood out in your approach in this world of functional [00:15:00] medicine, there's this, uh, intended philosophy of treat the root cause, and we're going to reverse this disease by, or reverse this process by treating the root cause.

. It took me a while to learn this, but realizing that's great, however, you need to be able to get to a point where that's the right timing. So, I love your three-step approach, and I think maybe if you could clarify what that is and how that came to be.

Nancy O'hara, MD: Yeah, absolutely. So let me just start with PANDAS, which is Pediatric Autoimmune Neuropsychiatric disease associated with strep. The kids that get it, 1 in 200, although it's about 1 in 2 in my practice rather than the antibodies or the proteins of the immune system attacking the strep in the throat, they instead attack the brain and cause inflammation in an area of [00:16:00] the brain called the basal ganglia.

And that's what leads to OCD, anxiety, tics, urinary symptoms, sleep disorders, on and on. So you need to treat the underlying infection. So if it was strep or mycoplasma or COVID, That's one part. And a lot of people will do that. What is often missed is you have to treat the immune system. And that doesn't mean just ibuprofen, steroids, and IVIG.

You and I both know there are tremendous amount of nutraceuticals, herbals, botanicals that treat inflammation very well. But then the third piece is treating the symptoms. And again, MDs will do that well in just putting them on an SSRI to treat their severe anxiety or whatever, but that doesn't get to the root cause.

But we could add 5 HTP or lithium orotate or N acetylcysteine or, hemp oil or whatever it is to treat that [00:17:00] symptom while we're getting at the underlying root cause trigger. And we're treating the inflammation that has happened as part of that underlying root cause. So if we just treat the root cause, that can take nine months, two years.

And we're letting the kids sit in their anxiety or OCD or getting Herx reactions, die off reactions as it gets worse. No, we have to do all three. So whenever, like I just saw two new patients, two siblings today, and I remind myself, all right, am I treating the underlying trigger? Yeah, they were triggered by COVID.

I've got some antivirals in their herbs. Antioxidants, et cetera. All right. I they, am I treating the immune system? Yep. I got turmeric or curcumin or, hemp oil or SPM specialized pro resolving mediators. Okay. And am I treating the symptom? One of the kids, it was tics, so I was adding more [00:18:00] magnesium.

The other kid, it was aggression and anxiety. And so I was using some GABA and theanine and, so I had a little bit for each one, doing some tests, not much, most of it was through a conventional lab. And then moving forward from there and we'll see what works.

Adam Rinde, ND: Yeah it's brilliant.

People need to have some stability, to do this type of work and feeling better improves psychological health and motivation and all these other things. So I think that's just such a brilliant approach and. I'm glad I've learned that as well with my patients and really, I'm looking to help them feel stable and more comfortable first before getting into these nitty gritty areas of work.

: So you were saying earlier along these lines that the patient will lead with a symptom. And you may feel like there might be another symptom screaming out or what have you, but [00:19:00] you'll follow the patient leading with a symptom. You talk more about that.

Nancy O'hara, MD: Yeah. So we have 30 pages of questionnaires. I learned from Sid and as you've told me, Adam, his list is so long and getting people to fill it out.

Now, yeah. I don't have trouble and he probably didn't either because they've seen that three or 13 doctors before they come to me. So they'll fill out every form I have, but I get a sense from that, what symptoms the child has. So I know, this sleep is really disrupting everything else. So I know I've got to treat that because nobody's sleeping.

So nothing is going to function as well, but they're just so upset that the kid is, acting out in school or something else. So I'll talk to them about both. What I see is the biggest symptom that needs to be treated. And what they see is the biggest symptom that needs to be treated. And sometimes I treat them the same way.

The kid that has sleep disturbances and tics, magnesium may work great. The kid that's [00:20:00] got anxiety and sleep problems. I may be doing the hemp oil at bedtime. I may be doing the 5-HTP. During the day and at bedtime. So it may be the same nutraceutical or herbal that I'm using. And I'll, but I'll talk to them about, I want to treat the symptom that's bothering you the most.

But I also want you to hear that unless you guys are sleeping, unless you guys are eating a little bit better or whatever it may be, this isn't going to get better.

Adam Rinde, ND: Okay. With the inflammation component we're talking about neuroinflammation primarily, and so much of what we know about neuroinflammation comes from cytokines and different receptors in the brain.

Are we at a point where we know what the panda's brain is? Like the inflammation that's associated with the PANS and PANDA’s phenotype of, symptoms. [00:21:00]

Nancy O'hara, MD: Yeah great question. We know that's a breakdown of the blood brain barrier. And that's very important. And we know there are TH17 strep specific molecules that are part of the issue.

We also know we live in a toxic world. So the blood brain barrier is getting broken down, just like the leaky gut and everything else, but in pans and pandas, it is microglial inflammation within the basal ganglia, the potty, the putamen, that area of the brain. And I, I always hesitate when people are doing big, Expensive tests, autoimmune panels, and, brain antibody panels, and cytokine panels, and all that to prove whether the inflammation is there or not.

Every single test can be perfectly normal. Every single one of [00:22:00] them, and it'd still be PANS or PANDAS, if it was an abrupt onset of neuropsychiatric symptoms after three weeks to three months after an infection, or as Jill talks about all the time, mold exposure. And, the mold and the vector borne disease, the Borrelia, Bartonella, Babesia, and more, can be much more subacute.

Also the onset of symptoms can be more subacute when it's the second or third or fourth time that this has happened. And it can be more subacute in adults and it can happen in adults. By the definition, it's pediatric and abrupt onset. But there are a lot of caveats to that.

But I, the, because the inflammation is in the microglia, in the microscopic, you will see it on biopsy, but nobody's going to do that.

 But short of that, you may not see it on a SPECT scan or on MRI or on any blood. [00:23:00] No, it is mass cell activation, particularly with vector born. And as Jill talks about a lot, mold induced, definitely mast cells, cytokine activation, no question about it, but those tests, because they're grossly inaccurate, they, and more positive in a flare.

And when you do it, they may not be in a flare, the test results may be negative.

Adam Rinde, ND: Yeah. And I, that goes back to the original comments about like making a clinical diagnosis. And I think that is challenging for people in this, these times, right? We all want that solid evidence. That, if we're going to treat something that, we have a firm diagnosis.

How do you handle those moments where people are not necessarily easy... they're feeling uneasy about, the [00:24:00] scenario and starting treatments.?

Nancy O'hara, MD: It's a great question. And I, I. I think me today is very different than me 25 years ago, because now after reading, writing the book and, having people wait for months and months, they're much more ready, willing and able to take what I say than somebody that may just be starting out in practice.

So I want to say that first of all. But second of all, I remind them. That this is a clinical diagnosis and just like if they get the common cold. There's not going to be any tests that show you that it was the cold necessarily. Every rhino virus you get may not show up in a culture.

And I say, you have a cold because you're blowing your nose and you feel lousy and so you don't need a test to prove that. And so, I use a lot of analogies in what I do, so I may well use that analogy. I also use [00:25:00] Sid's analogy of our N of one. I, and I say, you may not believe me today, but I hope with these very safe treatments that we're starting today, you'll see improvement.

And then our clinical diagnosis will be in your child,

Adam Rinde, ND: right

Nancy O'hara, MD: so that clinical trial will be in our end of one as Sid said. And I also say we'll do some regular tests, conventional lab tests. And usually, I'd say at least 95 percent of the time, there's at least one thing abnormal, the most commonly abnormal tests in pans and pandas is an ANA it's positive in a a low level, one to.

80, 1 to 160, 1 to 320 with a negative reflex panel. So that means there's no evidence of any other collagen vascular disease, lupus, MS, that sort of thing. But in 60 percent of children [00:26:00] in our practice, 56 percent in the literature, they have a positive ANA. Okay. Those strep titers though. So those mycoplasma titers, even, and especially in conventional labs, the Babesia may all be negative because either 40 percent of kids with these diseases’ minimum will have immunodeficiency.

So they can't mount an antibody response. And that's what you're measuring those antibodies, those proteins. So those may well be negative. I, and But I still do them. The other things that may be positive are C reactive protein. Those may be elevated. ..a sed rate may be elevated. Just a platelet count.

Platelets, ferritin are acute phase reactants. So they may be high when there's inflammation. Eosinophils within a simple CBC, some immunoglobulins like IgG4 may be high when it's mold or Lyme related. C3a, [00:27:00] C4a, some of those, but those are all conventional lab tests where we don't have to charge the families, hundreds to thousands of dollars to do the test that may or may not be positive.

Adam Rinde, ND: Interesting. Yeah. So that's really helpful. And I think. A lot of people can relate to in this world of chronic illness that a lot of times you can take it only as far as you can take it with the data and the evidence and the testing and you're at that moment where you can have to roll out and the treatment often becomes like testing.

At some moment, of course you try to do your best to get as much work up as possible. So back to this co infection world and I want to circle back to the COVID observation. The, I always go back to this analogy I learned from liver disease. Like a, it's more of a toxicant [00:28:00] load issue.

I think they call it Tilt …where one more introduction of another thing, just was enough to push things further in our population. Do you feel like COVID was just one additional thing that we were exposed to that in an already overloaded system Was just a nudge that just really went out of control?

Nancy O'hara, MD: The straw that broke the camel's back.

Adam Rinde, ND: Yeah. Or do you feel like it's just such a different thing that's why we're seeing these patterns?

Nancy O'hara, MD: Truthfully, I think it's a combination. Because I think it was something where we chose as a society to really lock down at least in this area of the Northeast.

And so that depressed our immune system. We're not getting out, getting that vitamin D exposure, getting in the dirt, getting exposed to common viruses. So our immune [00:29:00] systems were depressed. And then we have this new virus that none of us have ever seen before. And then we have an injection that none of our bodies have ever experienced before.

And the combination of all three of those things, and especially when all three were present in one person. It, it tilted our immune systems as well as our neurologic systems and still is having long lasting effects. I do think, though, that the spike protein, the mRNA, have very different impacts on more tick-borne disease than anything else.

And I do think that there was there were dormant infections. Dormant other viruses like the herpes virus, monoviruses like EBV and CMV, and then tick-borne diseases that were present in some of our children's [00:30:00] bodies, but dormant. And when they got COVID, that brought it out more. That we haven't seen with other viruses, and maybe it was just the globalness of it, we’re still trying to figure it out, but we know that we definitely are seeing, right now in the Northeast, 41 percent of ticks carry Babesia.42 percent of the children in our practice that come in with the diagnosis of PANS or PANDAS are positive for Bartonella. And that doesn't even start to mention Borrelia, which is what everybody thinks of as Lyme disease.

Adam Rinde, ND: Yeah. Very interesting. And so in, In the pans and pandas community, you were saying earlier that most of the patients have some inherited or genetic immunodeficiency. And so these co infections that are hanging on is that part of, [00:31:00] for that reason? Is it because these patients just have difficulty mounting a good response when they're exposed?

And it's not all genetic. Certainly, in every disease we talk about genetics loads, the gun environment pulls the trigger, but tick-borne diseases cause immunodeficiency.There is no question about that. It's not a

Adam Rinde, ND: strep, right?

Nancy O'hara, MD: Absolutely. So you can have a low level of immunodeficiency to start with. And I see that just by history. The kids that come in that have had multiple antibiotics, tons of ear infections, sinus infections, they have some level of functional immunodeficiency.

Those that's one set, but then there's the other set that we're perfectly healthy All of a sudden that this happens the strap or the tick borne disease and now they're immunodeficient Okay, so we know that the these diseases do that And cause it

Adam Rinde, ND: that makes a lot of sense. [00:32:00] And so with The current your current treatment approach is there's one therapy I wanted to make sure that we snuck in some time to talk about because it's so unique.And it's the helminth therapy.

Nancy O'hara, MD: Yes.

Adam Rinde, ND: And. I'd love to hear when you first discovered that first and then what we know about How it's helping the immune system

Nancy O'hara, MD: So I first discovered it when my son got sick I had patients that were doing a Form of helminth therapy, which just means worms basically and worm eggs they were doing a form that was much more. Problematic lot more side effects. But I was desperate. My son was deathly afraid of needles. Probably should have had IVIG. But a I couldn't afford it at the time. Would have done it, would have figured out a way, but he was [00:33:00] so petrified of needles. I couldn't even think about doing this.

Nancy O'hara, MD: I said, Oh, let me just try this first while I was doing everything else. And he turned around in three months. And Sid was the one who introduced it to me and it was introduced to him by William Parker, who is a PhD at Duke. And quick story I, as a little kid, he used to catch wild rats in Arkansas to make money, behind restaurants and stuff, and so when he became a PhD, rather than paying for lab rats, He went out and caught wild rats and use those. And he found that his wild rats were healthier, learned the mazes faster, had less rat OCD and anxiety. And so he started studying it and he found it was these grain beetle worm eggs. Now they're, what they're called is HDCs, which stands for Hymenolepis diminuta Cysticercoids.

I'm not going to say it 10 times fast. I had to practice it for a month before the first time I lectured about it. But [00:34:00] anyway these are grain beetle, worm eggs. And when we used to live in hunter gatherer society, we used to dry our grains in large vats. We didn't process our foods and we always ate grain beetles and grain beetle worm eggs.

: So evolutionarily our bodies are used to it. So now we harvest them in a clean lab. We don't Dr. Baker's lab does as well as other labs in the country. And in England, there's a company called Biome Restoration. If you want to learn more, you can go to that biome restoration. com. Learn more about this, but it's a little vial of what looks like cloudy water, tastes like salty water.

And you take it once every two to three weeks. It does not cause any infection. There is no way you can get a parasitic infection from it. Rarely one in more than a thousand children who are either [00:35:00] constipated Or are on an immunosuppressive drug could get what's called an infestation, which is where the egg hatches before it's excreted.

But in the large majority, you take it and what it does is it induces immune tolerance. The immune system says, Oh, I know you and reacts against that liquid you just drank. And instead of reacting against self the autoimmune disease. So it works for alopecia areata. It works for a lot of inflammatory bowel diseases.

It works for other immune diseases. I could go on and on. I don't usually talk about it at my first new patient visit because they already think I'm a weirdo. I don't want them to think I'm even weirder than I am, but I do talk about it by the second visit as a way of. Promoting immune tolerance, and it's a lot less expensive and a lot easier than IVIG. And works very well.

Adam Rinde, ND: Fascinating. [00:36:00] Yeah. I remember learning about different T cell lines that are influenced by worms and parasites, and I just curious that, my brain's going down, like which T cell line is it shifting? And I'm excited to learn more about it.

Nancy O'hara, MD: Yeah, there are a lot of places in the country that are doing it.A lot of other, I know a couple other naturopaths, they're just getting started in Helminth therapy and really developing other ways to give it to.

Adam Rinde, ND: Great. Yeah. So I, there's a lot of podcasts that you've been on and interviews and I really like how this went. Cause looking over your shoulder, if people want more of like a outlined approach and pick up your book that's an amazing resource.And it's so well organized and it's meant as, it's like a reference book really, for looking things up and you can see it over your shoulder, but for people who are listening to Demystifying PANS/PANDAS: A Functional Medicine Desktop Reference on ...and it's an excellent book and they can, if they want more of [00:37:00] a deeper structured view, that's a great discussion.So I want to close by just hearing some of the things you're up to. With your career and, what you're working on these days and how people can get involved with those aspects.

Nancy O'hara, MD: Yeah, thanks, Adam. The word doctor actually at its root means teacher and that's the thing I like doing the most.: So I have a mentoring program where a patient together with their practitioner or a practitioner alone can do a mentoring consult with me and I will advise, give you my considerations, go over all the lab work for free, all of that. And then it's a one-hour mentoring consult that either the patient or the practitioner can pay for.The other thing I have is a membership program and that's an annual membership program. The it's gives you six lectures, over 40 videos and more coming, there are five dripped in every month, and there are two to five [00:38:00] minute videos on nutraceuticals, herbals, the way I look at things, the way I assess a new patient, the way I do a physical exam all, pans, pandas, mold, mycoplasma, all of that, and monthly teachings.Where we take a deeper dive into everything and those monthly teachings are live Where I talk for about a half an hour and then we do a half an hour of q and a and they're also recorded so they're so if you sign up now You have all of them that we've been doing for the past year plus the ones that are coming for the next year So I think the membership program is my biggest passion Because I think it gives you so much information and you get free 15 minute consults plus the q and a's You And you've got so much there more than you get just in the one on one mentoring, but I have both of those in the fall.

I'm going to be taping my audio book. So I'll be taping this book, but I'm adding two new chapters, one on Lyme tick borne disease, [00:39:00] because I've even learned so much more since I wrote this book and one on mold. Because through Jill and Neil, I've learned even more about that than I wrote in this book.

So I want to update that in the audio book. I'm not. Putting a new copy out of this book, so it'll be in the audio book. And then I'm actually going to be doing a podcast too that, it's different things. And one of my guests is going to be my son, because for the first time he said, I want to talk about this mom.

I always say in my lectures, one of the kids in the book is my son, but it's a different name. And every kid is a different name. But he doesn't want to be mentioned and now he's ready. And it's, so those are my biggest passions. I do still see patients within my practice, but my waiting list is over a yearlong and I'd much rather train other practitioners to do this because that's the pyramid effect.

It gives so much more of us the ability to help these families that can be helped, but need us so much.

Adam Rinde, ND: Very nice. Wow. That's [00:40:00] so great. This has been delightful. Is there anything else you'd like to leave us with? You've you're just so pleasant to speak with and so clear and communication and great listener.

And it's just such a blessing to, to have this time with you. If there's anything else you'd like to leave us with, that'd be great. And we thank you for being here.

Nancy O'hara, MD: No, I just want to say there is hope, whatever the illness search for a practitioner that will listen. And as a practitioner, be a listener, you're going to learn more from your patients than anybody else.

And trust your gut pun intended,

You as a parent, know your child. Don't let anybody tell you or push you down that you don't know, and that they know better. But there is hope this can get better. And I got lots of kids that, that helped me to prove that every day.

Adam Rinde, ND: Excellent.Thank you so much.

Nancy O'hara, MD: Thank you, [00:41:00] Adam.