Dr. Amy Nett: Yeah, if a patient has a significant reaction to dairy that they think is due to the lactose, I agree, I’m not sure if it’s worth doing the lactulose breath test, so this is a case where I would probably give her the option and say, “You know what? If you’re worried about doing lactulose, no problem. Let’s do glucose. It might not be as sensitive. It’s not going to pick up SIBO that involves the more distal portions of the small intestine, but it’s going to give us some information, and then we’re not going to have the concern about the Hashimoto’s skin rash.” Again, we don’t always get to do the testing we want to do! The other thing is if patients are really scared about taking a medication, a supplement, or in this case, taking a test because of the lactulose, our minds are incredibly powerful, and whether the lactose precipitates the rash or the stress associated with taking lactulose precipitates the rash, either way, she’s probably going to end up with a rash, so I would say it’s probably not worth it in this case.