October 13, 2017 at 9:55 am #1326Judy MerrickParticipant
Saw this lady yesterday and would appreciate recommendations for tests and supplements to help with very complex case. Main issues Hashimoto’s, Hidradenitis, Hormonal Issues, Pain and reliance on pain killers, Fatigue, Low Mood. Health history:
1. Forceps birth, not breast fed at all
2. Scarlet Fever age 6 wks – nearly died. Mother had it too
3. Severe colic as baby – probably due formula milk
4. Constant ear/chest infections through childhood– lots of antibiotics
5. Very asthmatic through childhood and would get sever chest infection/pleurisy every winter – more antibiotics
6. Developed Hidradenitis Suppuritva (HS) in puberty – severe abscesses in groin and armpit – can be size of a small orange. Very painful, and this has really affected her confidence. Can never swim or sunbathe. However was in remission with just occasional abscess between ages 20 -30
7. Glandular fever age 15 which led to ME
8. Severe endometriosis started at 18rs. Couldn’t be contained, attached to bowel, kidney. Was give contraceptive pill to try to control it – feet and hands turned blue for 3 days so stopped. Constant use of pain killers including codeine, oromorph, morphine and voltarol pessaries
9. Constant thrush in late teenage years
10. Was given date rape drug and raped age 20
11. Was told would never be able to have children due to endometriosis but in fact got pregnant age 23. Repeatedly told would not be able to maintain pregnancy but in fact her daughter was born 2 weeks late by emergency C Section.
12. Endo Ok during pregnancy but constant sickness all throughout pregnancy.
13. Endo even worse once child born. Endo on pouch of douglas – constant UTI’s. More antibiotics
14. Domestic violence after birth of baby
15. Her daughter, now 16, diagnosed with ADHD age 7 and had an epileptic seizure last year
16. Total hysterectomy age 30 including ovaries and cervix. Ablation on bowel
17. HRT – for 6 months after hysterectomy felt better than ever. Then started to get problems with throat/voice. Investigated for throat cancer but when they went in they found cysts on thyroid so did partial left thyroidectomy and dx Hashimotos. On thyroxine 150mg
18. Since hysterectomy HS has been much worse. Can have up to 7 abscesses at once. Takes up to 6 neurofen per day, uses strong antibacterial washes, long term antibiotics
19. Is seeing a gynaecologist who thinks HS is related to hormones and that she needs more oestrogen to control it – level at the moment 38 but thinks it should be more like 200. HRT currently Evorel Conti patches, plus Vagifem pessaries
20. Age 33yrs Gall Bladder removed due alcalculous, she was told possibly brought on by HRT. Now finds it difficult to digest fats but craves fats especially chocolate and avocado
21. Has had pain in her hip and lower back last 9 months but has been much worse since a minor car accident 4 weeks ago. Now on 500mg Naproxen twice per day. Is having MRI & X-ray.
Despite all of this, client is very motivated to try and improve her health naturally. She put herself on auto-immune paleo diet which she followed for 9 weeks and felt great, but then got a really extreme bout of HS which scared her so she stopped. I suspect was something of a detox reaction?
She has come to me to help join up the dots, because as she says, she “doesn’t want to lose any more body parts!” Her diet now is not too bad but b/fasts too high in sugar, and wheat and bar of chocolate a day has crept in. She is 3 stone over weight, can’t exercise because of pain, low mood, extreme fatigue.
Is taking (all self prescribed – all Holland & Barratt)
Ca, Mg, Zn
Om 3 Fish oils – finds them hard to digest
Curcumin & Vit D
Plus Better You Vit D spray
Am waiting for a copy of recent GP blood tests but she was told cholesterol and blood sugar slightly high. Also a question over liver function but she was not sure what.
Have read all the previous posts about Hashimoto’s and Hidradenitis, but there is so much going on with client that not sure where to start. There are several tests that I’d like to do including viral screen, stool test (probably Invivo GI map as shows auto-immune & viral), Cyrex 2, 3 & 5, Organic Acids, but money an issue (client had to give up work because of health issues and family relies on husband’s income). I think they could possibly run to 1 or 2 tests but would need to be sure they are most relevant.
Given long term antibiotics and pain killers I think we can assume leaky gut, and dysbiosis so should I just go in with usual protocols for that? I would really like to be able to help with pain and reduce her reliance on painkillers. KappArest? Anything else? For time being have recommended she start with S. Boulardii and Arthred and have given some suggestions for gentle detox with Epsom Salts Baths and Castor Oil Packs and go back to auto-immune Paleo diet.
Appreciate any help and direction you can give.
Posted by Judy Merrick 13/10/17
March 19, 2019 at 10:03 am #1327Carrie Decker, NDParticipant
Thank you for contributing this case here. It does sound like a very complicated case; because of her many symptoms and very long history, I would approach it from starting from the top (more recent) and significant symptoms will help her to be able to work into the deeper things (trauma, historic viral issues, etc). But it does seem like the gut is central to her case both in recent years and historically. For this reason, I would put testing with a comprehensive digestive stool analysis (CDSA) highest on the list. In my practice I use the CDSA with parasitology (x3) test from Doctor’s Data – http://tinyurl.com/q4256rk – which is available from Regenerus labs; Genova Diagnostics also offers a Comprehensive Digestive Stool Analysis / Parasitology ™ – http://tinyurl.com/p6gopyt.
Given her willingness and positive response (initially) to the autoimmune Paleo diet, resuming this would be my suggestion rather than to spend additional money on food sensitivity testing. It is obvious to me as well that she likely has leaky gut, and a diet with minimal antigenic and immune-response eliciting foods in it would be best. However, there are things which can be done to support her reaction to the dietary changes, which I also agree sound much like a detox reaction. One thing that helps with the die-off reaction is the use of binders such as activated charcoal and bentonite clay. I’m not sure of the availability of these things, but there is a gentle IBS-constipation formula detailed in the suggestions which also has modified citrus pectin which also is a binder, as well as gentle antispasmodics which help relieve IBS type symptoms.
Given her external symptoms with an internal (GI) shift, I suspect that endotoxin related with leaky gut is having a systemic effect on her processes of detoxification. This can lead to impeded liver and kidney function. Given that her gallbladder has been removed, and you also are aware that she has difficulties digesting fats, this also is a core issue that I suspect is contributing to her GI and systemic issues. Supporting her digestion of fats with ox bile, which also supports normal motility and a normal healthy balance of gastrointestinal flora, may help her gut to get back into shape more rapidly. Ox bile should be taken before essential fatty acids and fat soluble vitamins to support absorption. Ox bile, interestingly enough, is often used by holistic dermatologists for the reduction of skin complaints such as psoriasis. Phosphatidyl choline, a nutrient that many lack adequate amounts in diet, also supports bile flow and the elimination of toxins (which leave the body in the bile as well as urine).
Islam KB, Fukiya S, Hagio M, et al. Bile acid is a host factor that regulates the composition of the cecal microbiota in rats. Gastroenterology. 2011 Nov;141(5):1773-81. https://tinyurl.com/ybp4ystd
Hellström PM, Nilsson I, Svenberg T. Role of bile in regulation of gut motility. J Intern Med. 1995 Apr;237(4):395-402. https://tinyurl.com/ydxw55wo
Gyurcsovics K, Bertók L. Pathophysiology of psoriasis: coping endotoxins with bile acid therapy. Pathophysiology 2003 Dec;10(1):57-61. https://tinyurl.com/ybnycn9x
To support the systemic reaction to the gut dysbiosis, in addition to some binders and supporting bile flow for the elimination of toxins, healthy fat absorption, and gut health, you may want to start earlier rather than later with support for intestinal repair. Epithelial Growth Factor (EGF) is a polypeptide that stimulates growth and repair of epithelial tissue such as the oral mucosa and gastrointestinal epithelium. EGF is a normal constituent of saliva production during the act of eating, is also secreted into the gut lumen and found in colostrum and milk. Salivary EGF also upregulates small intestinal absorption of electrolytes and nutrients. Michael Ash has written more about the use of epithelial growth factor in the resource “Epithelial Growth Factor for Reduced Gut Permeability / Pathogen Attachment and Nutrient Uptake” which can be found here – http://tinyurl.com/qf2qbr6. Glutamine has been shown to support integrity of intestinal permeability, as well as slippery elm powder, and N-Acetyl-D-Glucosamine.
van der Hulst RR, et al. Glutamine and the preservation of gut integrity. Lancet. 1993 May 29;341(8857):1363-5. http://tinyurl.com/nrpkbcs
Selenium plays a role in activation of thyroid hormone (conversion from T4 ie thyroxine to T3) and acts as an anti-inflammatory agent, and is important for antioxidant status within the body and a select number of other enzymes in the body. Selenium supplementation in individuals with autoimmune thyroiditis has specifically been shown to decrease levels of thyroid peroxidase antibodies. In individuals with thyroid peroxidase antibodies greater than 350 IU/ml supplementation with 200mcg of selenium was shown to reduce levels to 63% of the initial values after 3 months of supplementation.
van Zuuren EJ, et al. Selenium supplementation for Hashimoto’s thyroiditis. Cochrane Database Syst Rev. 2013 Jun 6;6:CD010223. http://tinyurl.com/jwj6554
Gärtner R, et al. Selenium supplementation in patients with autoimmune thyroiditis decreases thyroid peroxidase antibodies concentrations. J Clin Endocrinol Metab. 2002 Apr;87(4):1687-91. http://tinyurl.com/qddfjrg
Iodine also is important for thyroid function. Iodine deficiency is not uncommon, as soils are deficient in mountainous regions (e.g. the Himalayans and Andes), locations with frequent flooding (e.g. south and southeastern Asia), and inland regions of central Asia, Africa, central and eastern Europe, and the Midwest region of the United States (US). The recommended dietary allowance of iodine varies depending on the source of guidelines, but generally ranges from 100 – 150 mcg for infants, children, and adults with the exception of gravid or lactating states. Other cofactors such as some of the B vitamins, zinc, and vitamin A are necessary for production of active T3. It sounds like she is on many of these, but for the support of thyroid function and detoxification, you may want to add in a B complex as well as the recommended daily amount of iodine. Selenium also supports detoxification.
Andersson M, et al. Global iodine status in 2011 and trends over the past decade. J Nutr. 2012 Apr;142(4):744-50. http://tinyurl.com/zmgthrk
Supporting your client in the development of normal immune tolerance also is an important part of working with people who have autoimmune disease. As a part of a food-based support protocol, you may want to include probiotics via the stewed apple formula developed by Michael Ash that supports mucosal immune tolerance. Of course, the multitude of probiotics in here also will help to shift the flora of the gut back to a more healthy and balanced population. The stewed apples associated with can be taken at a small dosage per day and still be effective. More information about how stewed apples in combination with probiotics support mucosal healing and tolerance (as well as the recipe) can be found here – http://tinyurl.com/o9kpezx.
Topical castor oil to the abdomen and right upper quadrant of the liver is very supportive for gastrointestinal healing, reduction of inflammation, and can be supportive for relaxation. I consider it a key support for patients with detoxification or IBS/endometriosis as primary issues. Dr Todd Born recently wrote about the many benefits of castor oil which can be read here – http://tinyurl.com/kqsrfga. I generally instruct clients to use a simplified castor oil pack by simply massaging castor oil into the region, applying a cotton cloth to protect other garments from the oil, and using the body heat to draw the oil internally. Generally, the use warm water pack is also often recommended for a period of 15 – 20 minutes.
Last, but not least, poultices can be very helpful for things such as abscesses. A potato, grated, or sliced for convenience, can be placed over the abscesses and acts as a drawing agent. It then would be wrapped to the leg with a form of plastic wrap or something to hold it in place so one could go about their day to day activities. There are many “Google-able” websites which talk about the benefits and use of this further!
The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Support for thyroid function and detoxification
Aqueous Selenium (BRC): 2–3 drops daily with food. http://tinyurl.com/oew2lk5
Liquid Iodine (BRC): 2 drops daily with food. https://tinyurl.com/y88s2wej
Super Vitamin B Complex (ARG): 1 capsule daily with breakfast. https://tinyurl.com/y9j299bk
Support for bile flow and elimination of toxins
Ox Bile (ARG): 1 capsule before meals containing fat. https://tinyurl.com/yc4wspgq
Phosphatidyl Choline (ARG): 2 softgels twice daily. https://tinyurl.com/l6rnsh5
AND EFAs, and fat-soluble vitamins with meals.
(or Phosphatidylcholine by Biotics Research if the ARG is o.o.s.)
Whole GI Wellness (ARG): Gradually increase to 2 capsules twice a day. http://tinyurl.com/ohv6mqr Supports normal motility, flora balance, and elimination of toxins.
Perm a vite Powder (ARG): Gradually increase to 1 tbsp 30 mins before 2-3 meals a day. http://tinyurl.com/37dv2cl Provides L-glutamine and gastrointestinal supportive nutrients.
For probiotics you may wish to include one of the following or all with the stewed apple recipe:
Lactobacillus GG (ARG): 1 capsule daily with small amount of food. http://tinyurl.com/mcdcpv3
Saccharomyces Boulardii (ARG): 1 capsule daily with small amount of food. http://tinyurl.com/35392bw
BifidoBiotics (ARG): 1 capsule daily with small amount of food. http://tinyurl.com/35pq3h4
Please consider these suggestions in light of the other clinical information pertaining to your client. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.
- You must be logged in to reply to this topic.
Registered Nutritional Therapist Helen Perks is collaborating with Clinical Education to bring you the first-ever Functional Medicine book club for Practitioners.
- No Replies