Practitioner Question of the Month – May 2019

Keri asks, “Is having elevated ASCA and taking S. boulardii a concern for you? If not, why?

Was it the reduction in gas that prompted you to stop the digestive enzymes? I’m still trying to figure out when to pull them out of protocols.

In the last visit, the impression says she will continue EPA/DHA and the recommendations say she will stop. Which one and if stopping, why? Thanks!”

First, regarding S. boulardii: In my opinion, no. Mainly because those with IBD (Crohn’s) have shown benefit with S. boulardii.

Next, I look to risk factors for HCl (age, autoimmunity, history of anemia) and response to treatment to dictate. In those with suspected histamine intolerance, I am much more cautious.

Finally, it’s optional, can’t hurt but also not essential.

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Alberto asks, “I´m relatively new to the group. I practice in Mexico. Just wondering what´s the rationale behind the visit flow in your practice. I’ve noticed that you have an initial consultation and then some days later testing and recommendations, why is that? Why not make those in the initial consultation? Are you reviewing the case?”

Great question. In my opinion, it’s important to take some time with all the data from the exam visit and spend some time thinking and constructing your therapeutic hierarchy for the patient. So I take time right after the exam and construct our big picture plan/map.

Reminder, take time to step away from the minutia and think about your practice.

Every time I do this something significant comes to my attention and I make a meaningful change. Schedule time once per quarter for this.

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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.