It’s been 7 months and I haven’t seen John, so I am assuming he has done great and was able to gradually wean off Canasa and maintain his improvements. Perhaps he occasionally needs a dose or two, but again I am assuming no news is good news since the last time we saw him he was doing great.
This is another case where we did not need to treat the lab findings. In fact, I would guess that if he aggressively treated SIBO with antimicrobials and high doses of additional anti-inflammatory cocktails, it may have flared him. Yes, labs can help, but don’t use them as a crutch instead of relying on good clinical common sense and logically applying the available treatments.
I am also suspicious that the calprotectin on some functional labs is overly sensitive. There have been a number of cases where the functional lab’s calprotectin did not match the clinical picture nor the LabCorp or Quest calprotectin I have ordered in tandem in some cases. This is just something to be aware of so as to prevent potential overreacting.
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So because he was feeling good, you chose to not address the h pylori? Or rather the probiotics were really how you addressed it before knowing?
Yes on probiotics. Also, remember DNA/PCR testing can have false positive so I always interpret them cautiously.
So because he was feeling good, you chose to not address the h pylori? Or rather the probiotics were really how you addressed it before knowing?
Yes on probiotics. Also, remember DNA/PCR testing can have false positive so I always interpret them cautiously.
As a patient for many many years of multiple doctors I would never assume that not hearing means that things are good.While I know in many cases not hearing does mean this, I think you will find for many chronic patients when we cannot find some kind of win or improvement we tend to slip back to what is known. As in I will tend to revert to what I know makes me feel one specific way, that way might not be great but it is known and more secure. Thus it can lower my anxiety about my health and give me a way to deal with only one set of known effects vs all new and interesting ones.
Dealing with chronic issues is day to day for many of us. We wake up and wonder if the day will hold anything other than issues caused by our symptoms. If I am trying a new regiment of options I will need to wait to try them based on potential side effects or the dreaded unknowns. This prolongs my potential resolutions I might find from these options. But if I do not do this I increase my overall anxiety and loss of work or other work related issues based on those unknowns. We ride this roller coaster daily. Sometimes we have to get off and take a break, even if that break is at a place that still has us feeling miserable daily.
I am curious about why more Dr’s do not “prescribe” for lack of a better word more exercise, I see FM’s doing this but rarely do I see conventional med Dr’s doing this, also equally important is stress management. The worst part about both of these is that they are easily the hardest to actually do for most to include me. But as you state tests and pills are not always or many times the answer. Where as diet and health are clear major life transitions that can lead to real long term results.I am very interested in how overall medical depression affects our overall health. I know I suffer from some sort of this as when you never really win, no matter how tough you might be it has negative effects.
All this brings me back to the point of not hearing back possibly not meaning what you hope it does mean. When I visit Dr’s these days after years of visits and only minimal answers, while I want to be there and want to try to get more answers, I also do not want to be there at all sub concisely. And then when I am gone I try the suggested solutions and if i see little to know help I tend to revert. I am curious how many other patients might see this same reversion but if there is a way to break that to keep the patient better on track. Maybe the future of medicine is in the follow up, and the follow up would assist many in staying on track. I find humans in general can adapt to most things. Pain, suffering, death, natural disasters etc, its usually tomorrows news in a week or so after it happens. Much like nobody cares today what happened in Alaska the other day after a 7.0 earthquake I think many chronic suffers will continue to feel miserable as long as it is less miserable that last week. A plan to check back with patients is a double edged sword in FM I also feel as for some it might be a positive while others might view it as pushy sales tactics. All items to be evaluated. Since I can only speak for myself I would think if I was called back after a set course of time it would force me to do one of a few things, admit I suck and did none of the things asked for by the Dr., or actually admit to improvement, or kick me back into gear as I am in a chronic medical issue slump that I need help getting back out of and back on track.
This all can be small parts of the Dr Patient relationship that is key to trusting Dr’s in general and thus trusting their decisions on plans to help each patient. Well that and a way to prescribe several other things like less stress, more exercise and the ability to stick to long term plans that do not have immediate results in some sort of easy to swallow pill form would be very helpful.
Thanks for sharing Bret. I guess, in short, I can say based on everything in this case study I felt comfortable with this assumption.
As a patient for many many years of multiple doctors I would never assume that not hearing means that things are good.While I know in many cases not hearing does mean this, I think you will find for many chronic patients when we cannot find some kind of win or improvement we tend to slip back to what is known. As in I will tend to revert to what I know makes me feel one specific way, that way might not be great but it is known and more secure. Thus it can lower my anxiety about my health and give me a way to deal with only one set of known effects vs all new and interesting ones.
Dealing with chronic issues is day to day for many of us. We wake up and wonder if the day will hold anything other than issues caused by our symptoms. If I am trying a new regiment of options I will need to wait to try them based on potential side effects or the dreaded unknowns. This prolongs my potential resolutions I might find from these options. But if I do not do this I increase my overall anxiety and loss of work or other work related issues based on those unknowns. We ride this roller coaster daily. Sometimes we have to get off and take a break, even if that break is at a place that still has us feeling miserable daily.
I am curious about why more Dr’s do not “prescribe” for lack of a better word more exercise, I see FM’s doing this but rarely do I see conventional med Dr’s doing this, also equally important is stress management. The worst part about both of these is that they are easily the hardest to actually do for most to include me. But as you state tests and pills are not always or many times the answer. Where as diet and health are clear major life transitions that can lead to real long term results.I am very interested in how overall medical depression affects our overall health. I know I suffer from some sort of this as when you never really win, no matter how tough you might be it has negative effects.
All this brings me back to the point of not hearing back possibly not meaning what you hope it does mean. When I visit Dr’s these days after years of visits and only minimal answers, while I want to be there and want to try to get more answers, I also do not want to be there at all sub concisely. And then when I am gone I try the suggested solutions and if i see little to know help I tend to revert. I am curious how many other patients might see this same reversion but if there is a way to break that to keep the patient better on track. Maybe the future of medicine is in the follow up, and the follow up would assist many in staying on track. I find humans in general can adapt to most things. Pain, suffering, death, natural disasters etc, its usually tomorrows news in a week or so after it happens. Much like nobody cares today what happened in Alaska the other day after a 7.0 earthquake I think many chronic suffers will continue to feel miserable as long as it is less miserable that last week. A plan to check back with patients is a double edged sword in FM I also feel as for some it might be a positive while others might view it as pushy sales tactics. All items to be evaluated. Since I can only speak for myself I would think if I was called back after a set course of time it would force me to do one of a few things, admit I suck and did none of the things asked for by the Dr., or actually admit to improvement, or kick me back into gear as I am in a chronic medical issue slump that I need help getting back out of and back on track.
This all can be small parts of the Dr Patient relationship that is key to trusting Dr’s in general and thus trusting their decisions on plans to help each patient. Well that and a way to prescribe several other things like less stress, more exercise and the ability to stick to long term plans that do not have immediate results in some sort of easy to swallow pill form would be very helpful.
Thanks for sharing Bret. I guess, in short, I can say based on everything in this case study I felt comfortable with this assumption.
Hi Dr Ruscio,
Thanks for the great content.
Quick q on the gut repair cocktail, i’ve not come across this in your book and therefore wondered what circumstances you may favor the use of this along with the other supplements?
Thanks,
Ed.
My pleasure. I’ll be touching on this in a future podcast, but in short
-I usually use gut repair cocktails end phase (after diet, probios, Habx…)
-althought in some cases, especially those with non-GI symotms and/or histamine like reactions I have will occasionally use them earlier.
In those responding to front-line therapeis, I wait and see if more support is needed. Or, in those who I feel need more, or would like to be more aggressive, I’ll use earlier.
Hope this helps!
My 2 cents. I have observed less die off reactions if use the “gut repair cocktails” prior to antimicrobials so have taken to starting them alongside diet and probiotics especially in the more severe cases..
Dr. R – have you always called it a cocktail? It’s actually kinda hilarious – my patients are going to love it if I tell them I’m giving them a cocktail.. 🙂
Hi Dr Ruscio,
Thanks for the great content.
Quick q on the gut repair cocktail, i’ve not come across this in your book and therefore wondered what circumstances you may favor the use of this along with the other supplements?
Thanks,
Ed.
My 2 cents. I have observed less die off reactions if use the “gut repair cocktails” prior to antimicrobials so have taken to starting them alongside diet and probiotics especially in the more severe cases..
Dr. R – have you always called it a cocktail? It’s actually kinda hilarious – my patients are going to love it if I tell them I’m giving them a cocktail.. 🙂
My pleasure. I’ll be touching on this in a future podcast, but in short
-I usually use gut repair cocktails end phase (after diet, probios, Habx…)
-althought in some cases, especially those with non-GI symotms and/or histamine like reactions I have will occasionally use them earlier.
In those responding to front-line therapeis, I wait and see if more support is needed. Or, in those who I feel need more, or would like to be more aggressive, I’ll use earlier.
Hope this helps!