Case Study: Member Submission: Kelly J. and Deborah E.July 25, 2018 –
This month we'll focus on a case study submitted by a member. If you'd like yours to be considered for discussion, use the Submit a Case Study form.
History for Kelly's case:
32 year old mom of three who is trying hard to figure out her health picture. She saw a nutritionist who did a comprehensive blood panel and went over it with her, giving her supplement recommendations, a few months ago. She's not been able to connect with him since. She's ordered an adrenal panel on her own and is awaiting results from a free Ubiome. I have her blood test and her adrenal panel. This is a distance client.
Main concerns: food sensitivities, anxiety/panic, joint and muscle aches, recent UTIs, general state of gut/liver from what she's been told, iron situation (conflicting blood test results). Also has irregular periods with clotting, some bloating, diarrhea and constipation but mostly constipation, 3 UTIs this past year, sugar cravings, and her blood chem shows thyroid autoimmune markers. She's tried going AIP but lost weight she couldn't stand to lose. Her NAQ corresponds really well with her history and her blood test results. Her priorities are blood sugar (hypoglycemia) and digestion, with her higher consequence scores being in thyroid, cardiovascular, and immune. (nothing very high though...except blood sugar off the charts)
Her NAQ has these at the top of her possible conditions:
hypoglycemia, hypochlorhydria, liver/gallbladder, adrenal hypofunction, and dysbiosis/yeast.
Supplements taken since visit with other nutritionist: Methylgenetic Nutrition Multi Mins 3x day, Methylgenetic Nutrition B Specific 1/day, NOW Vit D3 5000 IU twice a day at first, now down to 1 a day, SP Liver Blend 3x day (not sure if this is Standard Process or what? She started with another liver support but switched to this one because the first one had ALA and she read that this is associated with heavy metals), Biotics Hydrozyme 1-2 each meal, NAC 300 mg 1x day (because the first liver supp had NAC in it and the second one does not). Had comp blood chem, adrenal panel (I have both) and Ubiome which she's not received results from yet. *Her adrenal panel lists Alprazolam (xanex) as a med she was on at the time.
HER CURRENT CHALLENGE: When she becomes too restrictive with diet she doesn't consume enough calories, so she's having trouble finding balance. She is concerned about always being concerned about what's wrong. Wants a healthy relationship with food and improved blood work or at least answers to some unknowns. She needs help with sugar cravings. Doctors have acknowledged inflammation and thyroid issues but says she's not "bad enough" so they've not addressed anything.
MY CURRENT CHALLENGE: the iron panel. It is very confusing. TIBC and total iron should have an inverse relationship but she's really high in both. Low ferritin, high percent saturation. High MCV. I would say it's possible she's headed toward anemia except that her total iron is so high (maybe she's still in stage 2?) but she's also got some overload symptoms. I know that a gut pathogen could cause iron issues but she's not storing it apparently, it's just the total iron, not ferritin, that's high. I know that the iron thing is a priority to get right otherwise any other protocols won't help as they should.
I'd want to run a GI map and MRT on her first (I have her adrenal panel) and address anything there along with her apparent hypoglycemia, in the hopes that the attack on her thyroid would settle down and she would have some improvement in her cycle/female hormones, cardio and immunity issues, and anxiety/panic.
Wondering if she has a bug that is known for causing UTIs or one that is associated with autoimmune thyroid after listening today to the GI map presentation. The blood work she sent was from awhile back and I'd like to see another one after being on an initial protocol. I would suggest cycling female panel if she's still out of whack after this, as it appears that she may be estrogen dominant/low progesterone with her irregular and sometimes short cycles.
I know I need to help her with getting off sugar/gluten/other inflammatory foods, but still give her enough to work with that she doesn't lose weight. (I just received the intake from this client. She's working on her food journal. By the time this call happens, I should have had our initial consult and should have more information, as I do have some questions for her.) And there's obviously a big mindset/anxiety component surrounding food.
*Side note: This is a client who was sent to me by an NTP who is no longer seeing one-on-ones. I'm a part of her nutrition consulting team. This NTP offers 3 packages, and this client chose the one of shortest duration - 3 consults. I have explained that if I see a need for further testing, and we find a pathogen or a yeast issue for example, she will need to work longer with me due to the length of the protocols and to see a resolution of her issues. She chose this shorter package so that she could put back some $ for testing. It's not ideal and I hope that she sees the importance of continuing if she really wants to get anywhere.
Blood Marker Tracker
Lab work
uBiome test results
Blood Marker Tracker after
History for Deborah's case:
50 year-old woman that is perimenopausal, married with 3 children (2 teenage daughters). Works as a realestate agent.
Client History:
-She’s had asthma along with allergies to cats, dogs, dust, and mold for her whole life. She still has a high level of inflammation in her lungs based on a recent exhaled nitrous oxide test, and she’s taking some asthma medication but not the full dose of her inhaler.
-She’s had giardia a couple times and taken antibiotics for that. After the antibiotics she had trouble digesting protein and now she gets diarrhea from some meals.
-She’s been seeing a cardiologist for heart rhythm and racing heart issues that she’s had for the past couple years. She’s been diagnosed with SVT (supraventricular tachycardia). Her blood pressure is typically slightly elevated at 137/91.
-A colonoscopy found diverticula pouches. The 1st stage of diverticulitis.
-If she takes an antibiotic then in 2-3 days she almost always has a yeast infection.
-When she came to me she had recently done the Whole30 and felt it helped a little with pain and inflammation, but now she was eliminating additional foods that are listed as inflammatory and was ending up with a lot of restriction.
She has trouble getting up in the morning, hits a 2nd wind at night between 8-9 and goes to bed late. She finds it hard to settle down to go to sleep. Her energy is best late morning and after 7pm.
Her main symptom are the following:
-Pain: It’s often back and hip pain with lots of pain in her left hip, but sometimes its overall, flu-like pain.
-Brain fog/memory issues.
-Anxious and unfocused, uneven energy.
-Hormonal issues that she thinks could be the beginning of menopause. Irregular periods, very heavy or very light flow, brain fog, and a few hot flashes
Current Medications:
-Symbicort 160mg 1 puff 2x/day: Asthma steroid that she’s been on for 20 years.
-Estrogel 1pump/day: Estradiol
-Progesterone capsules 100mg 1/day
Current Supplements:
-Lacto Prime and fermented foods, vitamins C, D, and omega 3
-She’s also taken Seriphos and liqua-A and was fine with them but has stopped recently.
-I’ve recommended a protocol that also included l-glutamine, digestive enzymes, hydrozyme, beta TCP, and Megasporebiotic as well but she had a lot of digestive issues such as gas, stomach gurgling, and diarrhea (even when adding things very slowly) so she’s stopped all of those for now.
Tests performed:
GI/MRT/Dutch/Blood Work Attached
Doctor’s Data Notes:
no pathogens
Some dysbiosis and a lack of beneficial bacteria
Rare yeast
Dutch Summary:
Cortisol is on the low side but cortisone is at the top of the range.
Metabolized cortisol is fine so the total production is ok but the amount that is available is getting depleted.
It looks like her body is slowing itself down. Stress is telling her body that it needs to make more cortisol but then it’s deactivating the excess.
Organic acids: 8-OHdG is a sign of chronic inflammation
Summary from Recent Blood test from 5/17/2018:
TSH: 0.984. Very slightly depressed but almost perfect.
Free T4: 1.34: Perfect.
Free T3: 3.00: Exact bottom of the functional range.
Thyroid antibodies are both negative.
WBCs: 7 so no sign of a chronic infection here.
Neutrophils: 60: At the absolute top end of the range: (chronic bacterial/viral infections, inflammation, emotional/physical stress, intestinal parasites.)
Lymphocytes: 32
Monocytes: 6: Getting towards the top end of the range of 0-7.
Eosinophils: 1: perfect
Basophils: 1: Top end of range from 0-1. (Inflammation, infections, parasites, hypothyroidism.)
RBC: 4.87: Slightly elevated: Dehydration, asthma or respiratory distress.
Hemoglobin: 14.8: Slightly elevated: Dehydration, asthma or respiratory distress, etc.
Hematocrit: 44.2: Very slightly elevated: Dehydration, respiratory distress, diarrhea, etc.
MCV: 91: Slightly elevated: B12/Folate anemia, hypochlorhydria, vitamin C need.
MCH: 30.4: Fine
MCHC: 33.5: Fine
RDW: 13.1: Very slightly elevated: B12/folate anemia, iron deficient anemia.
Iron: 121: good
Ferritin: 66: good
MRT:
Red: Cauliflower, Soybean
Yellow: Apple, avocado, banana, cod, cow’s milk, egg yolk, red #40, yellow #5, green pea, green pepper, honeydew, ibuprofen, lime, MSG, mushroom, phenylethylamine, solanine, spinach, venison, whey.
She’s having lots of trouble tolerating supplements. I feel like I'm missing something and I'm not sure where to go next:
-L-glutamine and HCL made her gassy and gave her diarrhea. She stopped them both.
-She was good about the diet but her pain seemed to be increasing.
-Now she’s having sinus infection issues so they put her on Cefuroxime for 10 days, prednisone for 11 days (60 mg for 5 days, 40 mg for 3, and 20 mg for 3 more). And that didn’t knock it out so now she’s doing another antibiotic. Her pain is back now that the steroids are out of her system.
These are some of the thoughts I’d had for potential next steps, but I’m feeling very undirected at this point:
-Take the GI Map test in case that finds something that Doctor’s Data missed. Maybe it will show yeast or h. Pylori.
-Do a yeast protocol regardless since she often gets yeast infections after taking antibiotics (but actually hasn’t yet with this current round).
-Revisit adding supplements from the gut healing protocol I came up with initially extremely slowly.
-Explore BioResource/Pekana homeopathics: Detox trio and apo-rheum in case there’s a toxic buildup that’s leading to the pain.
-She has silver fillings that could be removed.
-Consider adrenal supports and B vitamins for methylation.
