Practitioner Case Study – November 2018

Impression:

• 1/20/17 – Today’s GI finding are likely major driver of sequelae. Has done little other than diet so I expect she should respond well to Habx. Bear in mind other ddx if non-responsive.

Recommendations:

• Continue
  • Dietary
    • Please start on the paleo low FODMAP diet
  • Treatment
    • NRT: vit. D/K, omega 3,6,9 blend
    • Adrenal: Adrenal Support formula
    • GI: Lact & bifido probios blend, enzyme with HCl formula, S. boulardii probiotic, soil-based probiotic
• Starting
  • give the diet 1.5 weeks before starting the initial program, then
  • start on the initial program 1.5 weeks, then
  • start on the antimicrobials
  • GI: Habx, base protocol – oregano, antimicrobial blend 1
    
• FU: 6-8 weeks, midway through the antimicrobial program
• Rationale
  • Remember, we don’t need to jump right to antimicrobials. If I were seeing this patient today I would have had her start on diet, then on initial program, then fu.  At the fu we could consider Habx if indicated.

Visit 4

Subjective Assessment:

• Paleo Low FODMAP diet – clearly helpful
• Initial program – helpful
• + Oregano, antimicrobial blend – more helpful.
• Needs less Levothyroxine now 🙂 – took a flare of overdosing to determine this
• Improved:
  • brain fog, fatigue, anxiety, obesity (20lbs), hair loss, migraines
• Same:
  • insomnia
• Worse:
  • the feeling of yeast infection

Impression:

• 8/30/17 – Megan has improved vastly, as expected, from initial program plus Habx. She even had a bout of hyperthyroid likely from increase absorption of thyroid Rx, which was alleviated by decreased dose.  Will transition to low dose antimicrobials since it seems particularly helpful, in addition to maintaining the previous plan.  Option to start vaginally applied hormone cream if vaginal symptoms persist.  Fu in 3 months to reintroduce diet, curtail program and consider any retesting.

Recommendations:

• Same a prior, however, we had her start using ¼- ½ dose of antimicrobials.

Dr. Ruscio’s Comments

A few important points from this case.

1. A decrease of thyroid medication is possible when you heal the gut. Is this because you have ‘fixed’ the thyroid?  Not likely.  It’s likely concomitant to increased absorption of their medication.
2. Note, sometimes a flare of yeast infection can occur when on antimicrobials. This has appeared to be self-limiting and short lived in most cases in my experience.  If an antibiotic is needed, I am not worried about it since it fits in with the theme of the previous antimicrobial treatment anyways.
3. We did not jump to retesting. I am sure her tests would have looked better.  But this is not the point.  The goal is to assess and support/treat her but until she has achieved and maintained the clinical outcome.  If you achieve this, the labs usually support what the patient presentation has found.  Megan, who wasn’t great with compliance, followed up 14 months later.  She had been doing great other than recently when she started noticing some of her symptoms returning.  She had been under quit a bit more stress and had been quite lax with her diet.  She was also off everything in her program.  I anticipate a gentle push with probiotics, combined with being a bit more careful with her diet (but not going to the point of dietary zealotry), will get her back to her previous optimal.  Consider this, what a waste the retesting at this point would have been.  What would it show us?  At most, we would have seen a less severe variation of her original labs.  OK, and then we would do what?  Exactly the treatments that had worked for her before.  Great, so we spent several hundred dollars to do the same treatment again.  This is exactly where functional medicine trips over its own feet.  Yes, some testing can be helpful, but serial retesting needs serious reconsideration.
4. This is one of the more rare cases where there is a high agreement between different stool/GI evaluation (LabCorp and Doctor’s Data).

I’d like to hear your thoughts or questions regarding any of the above information. Please leave comments or questions below – it might become our next practitioner question of the month.

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