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My daughter has CIRS and yes, that can cause tics. In her case, the mold exposure was/is in the schools. We found three things helpful - improving the environment, treating a fungal infection in her sinuses (frequently accompanies an infection called MARCoNs) and helping the body detox. I could write a novel on all of this, so I'll only focus on the environment since that's what you asked about. We did some basic cleaning up of our home (replaced carpets with hardwood, tossed lots of things from the basement, run a dehumidifier, got rid of house plants) but our ERMI test showed that the house wasn't the problem. And there wasn't much we could do about the schools. So we fought a long battle and eventually got the district to put IQ Air GC Multigas air filters in each of my daughter's classrooms. Her attendance went from a few hours a week to full time. So definitely consider this kind of filter - it's portable and most sellers give you a 60 day return policy if you find it doesn't help. For your house, if the problem is with the AC, then it's likely that mold spores have been spread throughout the house. So it's not crazy that the 2nd company is suggesting such an intense approach. But...I'm wasn't born wealthy, so I can understand wanting a more realistic approach. The AC system obviously has to be fixed in a way that the problem doesn't come back. And I would definitely ditch carpets (even if it means having bare subfloors for a time) - make sure the carpets get rolled up into heavy mil plastic and removed out of the house through the closest windows, not carried through the rest of the house. Remediate what makes sense in the bedroom, and clean everything you can on your own in the rest of the house (window treatments, all clothes, wipe down everything you can with Benefect or EC3 cleaning supplies). Get the IQ Air filter for your daughter's room and maybe the family room. Consider mattress encasements and replace pillows. Make sure your washer doesn't have mold. Do the easy/cheap/obvious stuff yourself. Then between this level of remediation and detox, see how she feels. If the tics start to subside and she starts to feel better, you can chip away at the problem until she gets healthy. If she doesn't recover fully, then keep looking for a mold source and consider more extreme measures. You can find helpful information here http://moldcontrolonabudget.com/ The site is run by May Dooley and she's super helpful. You may ultimately need to go full out, but nothing says you need to do it as a first step. Hope this helps.

Mountainmom, My son had Lyme/Pandas and a month-long steroid taper helped him immensely twice, and did nothing once, over the 5 years he battled his illness. Our LLMD isn't a huge fan of prednisone but does recognize it has it's place for Pandas kids. Like your son, my daughter was in her darkest days yet had no definitive infections. She did have Marcons - you may want to ask about that. I may never know what exactly she was fighting, but I do know that a combo of bactrim and zith and prednisone saved her. Low dose naltrexone was also helpful. She has struggled immensely from mold issues - mold in her elementary school and now her Jr High. Prednisone isn't recommended for mold situations either, but desperate times called for desperate measures. She recently started Zoloft and although I've tried everything I could to avoid it, she does get relief and is glad she's on it. Inositol, Ashwagandha, Bacopa and looking into how your genetics affects methylation are also options for reducing anxiety. Cognitive behavior therapy wasn't hugely helpful for my daughter, but now that she's a little older, she's having great success with EMDR. So something to keep in mind as your son gets older, if he continues to struggle with anxiety. I know it feels like this will never end - and it is a grueling journey. But my son "grew up with" MomWithOCDSon's son - and he's now the healthy, obnoxious teenager I always hoped for, while her son is enjoying college. My daughter's journey has been harder and more complicated, but she too is making progress. So don't lose hope. Our kids do get better. But first they need to eat

Is your son still being treated for Lyme & co? Are you working with an LLMD? My DD suffered from Pans-induced anorexia and it was terrifying. For long term healing, I'd say you need a combo of antibiotics, rotated periodically. For the near term, you need to treat this for what it is - life-threatening, regardless of trigger/cause. Google the "maudsley approach" to treating eating disorders. It may be OCD that's keeping your son from eating, but his body needs calories or you end up with a cascade of physical health problems and mental health problems. For my DD, it took a combo of 2 antibiotics plus a month long steroid taper (starting at 60mg for a week, then 45 mg, then 30mg, then 15 mg per week). Within 36 hrs of starting this, she willing sat to eat for the first time in months.

Will PM you

My son struggled with Pandas/strep/lyme/mold from the ages of 6 to 12. It took him about 2 yrs to fully recover his cognitive/academic abilities. He went from an "IQ" (using a crude standardized test) of 93 to 116 and I suspect he'd score higher if tested now. The tests showed large discrepancies between his verbal abilities and his spatial math abilities. These have narrowed as he's recovered. Two things, in addition to fighting infections, really helped him academically. First, he was diagnosed with pyroluria - a zinc/B6 deficiency caused by his body produces excess pyroles, which are a waste product in the body's production of heme (blood). Pyroles bind to zinc and B6 and as your body eliminates the pyrole waste via urine, you end up peeing away zinc and B6, creating a deficiency. Taking a very high dose of zinc/B6 helped almost immediately (we use the supplement called Core by Biopure) and he will probably continue to take it well into adulthood. The second supplement that helps is phosphatidylserine. He takes PS10 from Jarrow. It plays a big role in concentration and focus. Phosphaytidylserine is one of the primary ingredients in Vayarin - an ADHD medication. He only takes it during the school year and it's not habit forming. I also try to remind myself - daily - that my role is to help my kids grow into healthy adults - mentally health, physically healthy, emotionally healthy. Grades are way down on my list. Life is filled with "grades" - even beyond academics. But what matters is helping my kids believe in themselves and to not focus on external judgments. If he's not ready to handle a traditional high school, there are online options, homeschooling, etc. Many ways to have a "successful" life. Sounds like your son has great support from you. Don't underestimate how important that is.

No, we're not looking at yeast. We're looking at Lyme and chronic residual effects from mold illness. I've unfortunately been in this world of chronic infections for a long time, so my kids aren't strangers to nystatin, diflucan, anti-fungal herbs, molybdenum, arginine and the slew of other supplements used to manage fungal issues. My daughter is responding well, but in an unexpected way, to tindamax. Instead of herxing, it seems to just make her feel better - not home-run better, but incrementally better on the days she takes it. She also has a long history of mold illness and inflammation. Our LLMD has seen some Lyme patients respond well to diflucan as part of a lyme protocol. From Stephen Bhuner's site: http://buhnerhealinglyme.com/lyme/diflucan-for-lyme/ Dear Stephen, I was going to try Diflucan for systemic mold symptoms, and in my preparatory research, came across this interesting article A New Approach to Chronic Lyme Disease by Jill Neimark that tells about Dr. Fritz Schardt’s use of Diflucan (fluconazole) to treat chronic, advanced lyme disease. He says that fluconazole inhibits the enzyme cytochrome P450 that our livers use to detoxify chemicals and drugs. He believes that diflucan inhibits the growth and replication of borrelia, which has a primitive P450 defense. It does not necessarily kill it. He also says it penetrates into the cells, nervous system and brain, where borrelia may hide. What are your feelings on using Diflucan for chronic lyme, and for that matter, to treat systemic mold? Do you know of herbal counterparts that might have the same actions—for mold and lyme—yet potentially safer for our livers (or would that counteract the P450 weakening effect)? Much thanks. Stephen’s response: The excitement about this antifungal is due to one study that I am aware of: Eur J Med Res. 2004 Jul 30;9(7):334-6. Clinical effects of fluconazole in patients with neuroborreliosis. Schardt FW. Eleven patients with neuro-borreliosis had been treated with 200 mg fluconazole daily for 25 days after an unsuccessful therapy with antibiotics. At the end of treatment eight patients had no borreliosis symptoms and remained free of relapse in a follow-up examination one year later. In the remaining four patients, symptoms were considerably improved. At the end of therapy immune reactivity (IgM+) disappeared in three patients. Since borrelia spp. are almost exclusively localised intracellular, they may depend on certain metabolites of their eucaryotic host cell. Inhibition of P450 and other cytochromes by fluconazole may incapacitate Borrelia upon longterm exposure. The study is a small one and is difficult to extrapolate from, however it is promising and I would certainly consider the use of fluconazole for lyme. Certainly the use of the pharmaceutical for 25 days (and perhaps 50 as is now being suggested) is worth it with long term chronic lyme that has not responded to antibiotics. As to herbal counterparts: The exact actions of fluconazole in the treatment of lyme are unknown; there is more involved than simply inhibiting the enzyme cytochrome P450 that our livers use to detoxify chemicals and drugs. There is a specific kind of inhibition of specific aspects of that system. As yet, I have not done any research on those exact pathways and what herbs would do the same thing, so I cannot give an informed answer on it at this point in time. But diflucan can prolong the QT Interval, as can Lexapro and Azithromycin - and DD is on both. So before we can try diflucan, I want to get her off of Lexapro. As for herxng when you kill yeast - look into molybdenum, yucca root and arginine. When yeast dies, it throws off Acetaldehyde, which the body then converts into ammonia. A similar conversion takes place when your body detoxifies from drinking alcohol - which is why kids with yeast can act drunk - the same chemical reactions are happening in their bodies - as if they were drunk. Moly, yucca and arginine can all help detoxify ammonia and help with the "herx" symptoms of die-off.

I think of two things when I hear brain fog and chronic fatigue as dominant symptoms - Lyme (or co-infection such as bartonella, babesia, ehrlichia, mycoplasma) and mold. i think the benefit of seeing a Pans specialist (i.e. not one who focuses solely on strep as a trigger, but one who will explore environmental factors and chronic infections) is that s/he will dig deeper to find the trigger and do various trials of treatments. My DD12 developed anorexia and panic attacks that but us in a critical situation. I have always been reluctant to use SSRIs (tho I don't at all judge those who need them). My reluctance stemmed from wanting to uncover the root issue without SSRIs masking or complicating our fact gathering. My kids' symptoms were manageable without an SSRI - until last summer. When my DD was faced with potential hospitalization, I felt pressure from our pediatrician and our therapist and my husband to use an SSRI - after all, how could I claim to be doing everything possible to help her if I was denying her relief, even if it went against my personal feelings? I couldn't justify letting my reservations take priority over er well-being. Her panic attacks and OCD were crippling. So I relented. I chose Lexapro due to it's long half-life and relative risk profile, given her medical and genetic/family history. I'm not sure the Lexapro did much, except help her sleep at night. We also started two antibiotics and prednisone a few weeks after starting the Lexapro, so I'll never be able to tease out what role the Lexapro played. But I do know there was an immediate and huge turn around within 36 hrs of antibiotics and steroids, so I tend to give much more credit to those. It's been 6 months and her doctor wants to introduce a new medication (diflucan). But both the Lexapro and azithromycin she's on increase the risk of prolonged QT intervals of the heart beat, as does diflucan. So it's too risky to have her on three meds that carry the same risk. We've started weaning off Lexapro and will probably switch to a different antibiotic and then add the diflucan. I can tell you that weaning off even a small dose of Lexapro (5mg) is proving to be difficult. Withdrawal symptoms are rough. So in hindsight, I wish I'd refrained from the Lexapro. But I think it made sense for where we were at back then. Follow your gut is all I can advise - and then don't beat yourself up for whichever decision you make.

Given your kids' histories, I think it's very reasonable to suspect that there's a common infection, as well as possible genetics, that link your family's health issues. It could be Lyme (either congenital or from all of you being exposed during a shared hike or trip to an endemic area) or mycoplasma, which is highly contagious, or both, or these plus some other shared infection. It can also be that some of the mutations in the genes your family shares are contributing to the way your bodies are handling the strain. The first place I'd put my money is on seeing an LLMD (lyme literate MD). Initial visits are costly, and most don't take insurance, so you have to pay out of pocket and then submit your own claim for hopefully partial reimbursement. But these doctors specialize in chronic infectious diseases that can affect a variety of systems (endocrine, immune, gastro, neurological, etc). And they tend to be good at seeing things from an interconnected perspective instead of specialists who only look at one body system in relative isolation. They're good problem solvers. If finding or seeing an LLMD isn't something you can do quickly because of where you live, then I'd at least see if you can get Lyme tests for your 12 and 6 yr olds, preferably from Igenex Labs, as they test for lyme-specific bands that other labs don't test for, and can potentially catch cases other labs would miss. Finally, you might consider testing thru 23andMe, which consists of getting your kids to spit into a vial. You then get genetic data that can help you understand how their bodies might be struggling to make and balance neurotransmitters. Your 6 yr old might benefit from some supplements like niacinamide (flush-free niacin aka Vitamin B3), which for some people with genetic COMT mutations, can help them process/degrade adrenaline better and help them calm down more quickly (less rage/meanness). Both 23andMe and Igenex used to have special pricing for testing multiple family members at once. You can check to see if that's still the case. Follow your instincts. It seems very possible that there's a common link. Good luck!

Since your DS is +/+, his body is struggling to convert any form of folic acid or folinic acid into methylfolate (+/+ means he's probably only converting about 10% of the raw stuff into the end product of methylfolate). You need to introduce both methylfolate and some form of B12 (cobalamin) - since these work as co-factors and you need both as part of your supplement plan. You want to avoid synthetic folate (found in cereals and other fortified foods and most multivitamins). I'd start with this product http://www.holisticheal.com/methyl-folate.html because it's a liquid and each drop is 67mcg. So you can build up slowly and drop down quickly while you tweak dosing. Later, you can switch to a tablet if you find he does well on a 400mcg or 800mcg dose. If he needs more than that, you can get a prescription for Deplin, which comes in 5mg and 10mg doses. But for now, start with 1-2 drops/day (I put mine into a small dixie up of water). Do this for a few days. Then add a sublingual B12 tablet. Any B12 that's swallowed doesn't make it into the blood stream - most of it doesn't seem to make it past the stomach acid. It's estimated that about 10% of a sublingual will get into your blood stream. So dissolving a tablet of 3000mcg of cobalamin will get roughly 300mcg into the blood stream. There are 4 forms of B12 - cyanocobalamin, which is the least desirable form and not very useful to the body. There's adenosylcobalamin and hydroxycobalamin -which is tolerated by most people. And there's methylcobalamin, which is good for people who are true undermethylators really need methyl groups. Which form is best for your son is going to be a matter of trial and error. If you happen to know the status of his COMT gene, this can help. But if you don't know it, I'd start with either 2000-3000 mcg of adeno or hydroxycobalamin. I'd start with one of these https://www.seekinghealth.com/adeno-b12-60-lozenges or https://www.seekinghealth.com/hydroxo-b12-60-lozengesor https://www.seekinghealth.com/hydrox-adeno-b12-60-lozenges Later, you can try methylcobalamin or different doses of any of the above to see if you can improve results. But these suggestions can get you started. Start with a low dose of methylfolate (maybe 150-200mcg) and a few days later, add in a sublingual form of B12. Do this for a week. If you see nothing, or if you see improvement to mood, increase the dose of methylfolate to maybe 300-400mcg for a week, and assuming you still see improvements, keep increasing dose until you start to see "bad" mood stuff creep back in. Then, if you start to see mood swings or mania, stop both the methylfolate and B12 for a few days to let things "drain". Then re-start at the last dose where things were good. While you're tweaking dosing, if you "overdose" on the methylfolate, you can give 100mg of niacinamide (vitamin B3) and this will quickly (20-30 min) soak up the extra methyl groups. Niacinamide is also useful any time you get rages. https://www.amazon.com/Source-Naturals-Niacinamide-Vitamin-Tablets/dp/B00020I7IU/ref=sr_1_2_a_it?ie=UTF8&qid=1489360057&sr=8-2&keywords=source+naturals+niacinamide Hope this helps

I can't imagine anyone who understands mold saying that it wouldn't impair a child who has an autoimmune disease. That's nuts. My daughter struggled with mold exposure in her classroom and it definitely contributed to her Pans symptoms. We ended up home schooling for one year until she was able to matriculate into the Jr High School (different building). I would recommend two things - run an HLA-DR blood test to see if your daughter is among the 25% of people who can't rid their bodies of the toxins that molds throw off. If hr HLA-DR gene results put her into this category, you need to get her out of that environment, regardless of Pandas. A great place to read up on the subject is Dr Shoemaker's first book, Surviving Mold. And run some of the inflammation tests listed on his website http://www.survivingmold.com/diagnosis/lab-tests especially HLA-DR, C4A and MSH The second thing you can do is move your daughter out of the house for a few weeks - a hotel, a relative's house - and thoroughly wash everything she brings out of the house with her (clothes, stuffed animals, paper goods, etc). Then see if her health or symptoms improve. Knowing what I know now, I consider mold to be as much a threat to my daughter's mental and physical health as strep or lyme or any other illness.

I will add that at 12, she's entering her final growth spurt. Calories are critical and being underweight now could have permanent effects. I think you need to be very vigilant. Fwiw, we reluctantly turned to lexapro. It didn't help with ocd. It only made her tired, and helped her fall asleep. That was a good thing. But there's a small study suggesting ssri's may stunt growth, so we'll be weaning off as we approach summer. Between the anorexia and lexapro, my dd12 hasn't grown any in the past year. I'd try adding a second antibiotic before adding an ssri. Imo

In our situation, fbt was essential and the "why" behind the anorexia was temporarily irrelevant. It was eat or face a feeding tube. So we endured rages and hatred. We were in crisis. But once my daughter started antibiotics and prednisone, she became a partially willing participant. We still had to count calories and use fbt in order to fight the ocd. It just wasn't as intense of a battle. I would use bmi as a guide. You cannot let someone battling anorexia just eat when they want to. Whether it's from body dysmorphia or from pandas ocd, you can't trust an anorexic to eat responsibly. I agree with those telling you that the why doesn't matter, at least below a bmi of 18. It's too dangerous. If she's been battling this since last summer, you can't just wait for this flair to go away. You need anorexia triage until she gets rid of whatever infection is triggering the pandas

Welcome to the forum and "welcome" to Pandas/Pans. I've unfortunately been at this for many years, first with my now recovered son and now with my daughter. I home schooled my daughter last year because her health was too precarious. Because it was only for one year and we always had the intention of returning to public school when she was able (for social reasons), our approach was probably different from yours. But I'll share what worked in case it helps. I think the biggest thing that was helpful was mindset. Like your daughter, mine went from being very capable to being very handicapped in what she could handle in terms of workload and abilities. There's a medical reason for this - inflammation in the brain creates what's called a cytokine storm. There are many inflammatory cytokines that become elevated, but one - CaM Kinase II - is essential for learning and memory - from Wikipedia: Ca2+ /calmodulin-dependent protein kinase II (CaM kinase II or CaMKII) is a serine/threonine-specific protein kinase that is regulated by the Ca2+ /calmodulin complex. CaMKII is involved in many signaling cascades and is thought to be an important mediator of learning and memory.[1] Misregulation of CaMKII is linked to Alzheimer’s disease, Angelman syndrome, and heart arrhythmia.[6 https://en.wikipedia.org/wiki/Ca2%2B/calmodulin-dependent_protein_kinase_II We had bad days and worse days. Some days, she was able to learn in a fairly typical manner and other days, it was like teaching someone who had suffered a brain injury like a stroke or car accident. So the most important thing I did each day was to feel out where she was at, what she was capable of that day (and I also had to realize that every day might put us at a different starting place, and sometimes she'd have different capabilities throughout the day). Re-setting my expectations on the fly was essential. Otherwise, I'd expect too much, she'd stress over disappointing me and over her own sense of loss. Much like working with someone who's in rehab for a stroke - how frustrating it is to not be able to do things you've easily done for your whole life. So forget about what she used to be able to do. Forget about what her brother can do. These are, for now, false points of reference. Start each lesson by assessing where she is at that moment and work with that. Do not show your frustration or expect more than she can give. That just blames her for something that's not in her control. You wouldn't do that to someone in rehab. You can push the way a cheerleader might - "hey, do you think you can do one more problem? No? Ok, take a break, you did a good job." But don't push with the thought that you can somehow push her back into being her old self (spoken from experience). My daughter (12) reads at a 12th grade level. But there were many times she couldn't focus on the words on the page. But she could listen. So I'd read her social studies book to her while she doodled (drawing helped her stay focused, ironically, because it's something that relaxes her and it distracted her from her anxiety). Then she'd answer questions about what I'd just read to her. Sometimes she could write the answers herself, sometimes I could see from her horrible handwriting that I'd have to scribe what she verbally told me. We just had to be flexible. We did a lot of verbal discussions. We broke lessons up into very small chunks - sometimes as little as 5 minutes. Then we'd re-group 15 minutes later, or an hour later, or a day later. I had to let go of my scheduling, my goals, and just listen to her body and support her. The old her was temporarily gone. I had to teach the person who showed up that day and just help that person do her best for that day. Not easy for a Type A mom. But it's what she needed. She is back in school this year, on a modified school day, with many absences (but for social reasons, she is adamant about being back in public). We often find ourselves having to do do school work at home to make up for missed days, and our approach is to do things in very small chunks. When she's feeling well, she takes pride in doing things independently. When she's in a bad place, I sit with her and coach her every step of the way. It's very much a teaching-as-if-you're-a-rehab-therapist approach. The amazing thing is that once the body heals, the old child comes back. You don't need to worry about her getting lazy or developing bad habits. No one wants to get back to her old self more than she does. When she heals, she will return to the independent, curious child she's been.

The other thing to focus on is inflammation. You can only detox just so much, and based on your genetics, many of the things suggested for detox can actually work against you (if you have a genetic mutation in your CBS gene, which regulates your detox pathway). So taking things to reduce inflammation can also be very helpful. In addition to or instead of motrin, we use 1/4-1/2 tsp of Japanese Knotweed for general inflammation and 1/2 tsp of Red Sage 3-6 times/day. I've not used Burbur or Pinella so I can't comment on those. I highly recommend Stephen Buhner's books on Lyme and co-infections for excellent herbs that can be used in tandem with antibiotics to act as antibacterials and anti-inflammatories. You may also want to consider an anti-fungal like diflucan or nystatin. Doxy can be brutal on the gut bacteria and I'd imagine her gut is already vulnerable.

With both COMT + and MTHFR +, I don't think it's a question of over or under methylation. It's both. Ben Lynch describes it as driving with one foot on the gas and one foot on the brake. My DD is in a similar situation - both in terms of her snps and lyme/bartonella. Every body is different, but here's what we've found helpful: CBS - my DD is only CBS +/-, so not as bad a predicament as you face, but we need to avoid the supplements commonly used for Lyme detox. No NAC, no alpha lipoic acid, no tumeric, no glutathione, no epsom salt baths. However, I don't restrict the foods you're supposed to avoid with CBS. My DD is recovering from Pans induced anorexia - the last thing I'm going to do is give her a list of foods to avoid. Instead, we just focus on reducing ammonia and managing sulfates/sulfites. She takes: 150 mg/day molybdenum 500 mg carnitine (important for her b/c she doesn't like beef, pork or chicken, so she doesn't get enough of this in her diet) 500mg arginine + 250 mg ornithine 3x/day - this not only fuels the urea/krebs cycle and helps the body eliminate ammonia and some toxins thru the kidneys, it also reduces inflammation in the endothelial layer of the blood vessels. This is really helpful for bartonella and for DD, it makes a huge difference in her stamina/fatigue sometimes we've also used yucca root or habiscus sabdarifa for ammonia but since adding the arginine, not so much, as the arginine gives us both ammonia reduction and inflammation reduction. For MTHFR - a B complex that doesn't contain B9 (folate) or B12. We use Seeking Health's B Minus, but I cut the dose into 1/4. A full capsule is far too high a dose IMO and my DH and DD don't feel well on it. I buy empty size 0 gel capsules from amazon and divide one capsule into 4 capsules. methylfolate - you need to experiment with dose. My DD12 only needs 135 mcg (only used 67 mcg when she was younger) and my DH takes 400 mcg from Solgar (Metafolin). I recommend Yasko's Methylmate B liquid methylfolate to start with. Each drop is 67mcg, so you can experiment with changing doses in small increments until you zero in on what works best. This is easier with a liquid than with tablets, so I'd start with the Methylmate B. B12 - because you have COMT, you probably don't want to use methylB12. I like Seeking Health's adenoB12 or hydroxyB12. Supposedly, you only absorb 10% of a sublingual B12, so 3000mcg nets you 300 mcg into the blood stream. You need to try both types to see which your DD prefers. There's no way to tell without experimenting. For COMT - despite needing methylfolate for MTHFR, your DD is staying ramped up on adrenaline a lot of the time. So Lynch suggests adding niacinamide (flush free niacin). My DD takes 100mg daily (or you can split the pill (Source Naturals makes a 100mg tablet) and give 50mg twice a day to even things out) the additional niacinamide helps with anger - a lot! It's also a good antidote for when you're tweaking methylfolate dosing and give too much. 50-100mg niacinamide will calm things down w/in 30 min. For MAO - if addressing MTHFR and COMT aren't enough to even out the moods, copper (1-2mg) can help MAO spin a little faster. You also need to avoid OTC cold and cough meds that say "do not take if you're using an MAO-I" - having an MAO+ already inhibits MAO, so you don't want to take anything that will make it work slower stillLyme detox - you get clobbered with messages that tell you you need to detox with Lyme treatments. This is hard when you're CBS+. So instead, I follow Stephen Buhner's advice, which is to focus on inflammation. If you keep inflammation down, the body is better able to detox itself. In addition to the arginine, I use 1/2 tsp of Japanese Knotweed and 1/2 tsp Red Sage - both 3x/day and on days where herxing is a concern (as we're currently pulsing tindamax), I do the Japanese Knotweed 6x/day. Again, I use the empty gel capsules - one size 00 capsule holds a little more than 1/4 tsp of liquid. You have about 1 min before the capsule will start to dissolve, which is enough time for DD to swallow the capsule. No way would she drink some of the herbs unless the taste is masked by the capsule. I know I didn't address the other snps. It's been a few years since this was my main focus, so I don't have much input on the others. Addressing MTHFR, CBS and COMT were enough to get DD stable emotionally, (when not in a flare). We've also had to treat the chronic infections but addressing the methylation issues definitely helped a lot. In doing this, DDs allergies became almost non-existent. One or two days in the spring, she'll need a quercetin, but most days, they don't bother her anymore. hope this helps give you a few ideas