Lincoln College of Postprofessional, Graduate and Continuing Education. Case Presentation 3. Instructor: Lisa Shaver, ND, LAc
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1 Lincoln College of Postprofessional, Graduate and Continuing Education Case Presentation 3 Instructor: Lisa Shaver, ND, LAc Faculty and Instructors representing NUHS/Lincoln College of Postprofessional, Graduate and Continuing Education are responsible for disclosing any financial interest, research grants, program support, or other matters that create any suggestion of a conflict of interest. Copyright 2017 by National University of Health Sciences. All Rights reserved. Material attached may not be reproduced in any form without written permission. 200 East Roosevelt Road Lombard, Illinois / Phone / 630/ Fax (Continuing Education)
2 Conflict of Interest Case #3: I have no conflict of interest, no relevant financial interests, activities, relationships, or affiliations to disclose. Lisa Shaver, ND, LAc 2017 Integrative SIBO Conference March 25 26, / yr old female student cc digestive distress x 2 years since travel to Jordan, West Bank, Jerusalem, Egypt and Gaza. Gastroenteritis that was assumed C diff. Given antibiotics at the time but pt stopped when symptoms improved. Sxs returned w/ mucus in stool, C diff identified & treated. Since dx d with IBS: bloating that progressively worsens during the day, better passing gas Sxs improve when she does not eat She tried to remove gluten in April and upon reintroduction my whole body swelled up & presented to urgent care; improved with self tx of juice cleanse Current sxs after the last round of antibiotics: frequent apthous ulcers, occas. dysphagia, occas. reflux, burping, mild nausea, borborygmous, abdom pain, cramping R and L flank, bloating worse at night, gas, constipation (rx d Miralax) w/ rare diarrhea, sticky stools, Bristol 2, 4, 5, incomplete voiding w 1 BM/d; Other sxs: weight gain of 20 lbs in one year, fatigue, PCOS (rx d OC), HA, poor memory 5/2014 Endoscopy esophagitis, hiatal hernia 5/2014 by PCP 3 HR LBT no results yet PE: abdom exam unremarkable
3 Tx: no labs available visit, assume methane present due to constipation predominant sx picture PARQ tx options, pt chooses conventional antibiotics Rifaximin 550 mg TID + neomycin 500mg BID x 14 d Probiotics B CFU QD cc Yeast prevention: oregano oil caps 250mg one QD Prokinetic: LDN titrate up to 4.5 mg QHS Retest w/in days Diet: SCD 6/2014 Juice cleanse prior to tx and bloating reduced in 3 days Constipation improved on antibiotics, gas worsened, abdom pain with antibiotics, bloating no change, fatigue while on antbx but now improved, stopped craving sugar Note: 5/ HR LBT H2 36ppm, CH4 0 She starts Ramadan this weekend x 30 days: wakes at 3am to pray, eats before sunrise, fasts until after sunset (fasts 5am to 9:15pm) Tx: hot vinegar packs for acute abdom pain prn, Iberis amara commercial herbal tincture prn; fast by day, SCD at night; retest after Ramadan 8/2014 ptcxldappt 9/ HR LBT: increase H2 120 min 11 ppm, increase CH4 3 ppm (baseline 0) 10/2014 Sxs resolved with fasting, less bloating, eating SCD diet, rare flank pain 3/10, less constipation, remembers prokinetic 4 x/wk, lost 20 lbs since last visit & is pleased Rx: Elemental Diet (homemade) x 14 d Hiatal hernia maneuver (Functional Gastro by Steven Sandberg Lewis Ch 8 09) 11/2014 Feels much better after ED. On day 13 broke the diet, craved sweets & ate dates, then continued for 3 extra days. Less nausea, bloating, abdom pain. Stools now break apart in toilet. HA during ED improved with honey. Fatigue during ED improved with honey. Tx: intro phase SCD diet, retest 3 HR LBT, cont probiotics, cont prokinetic; add fish oil 2,000mg QD cc; assess HCL status; switch prokinetic to LDE 50mg QHS
4 9/2015 (~1 yr later) Digestive sxs better for months after last tx, then 3 months into eating anything & everything bloating and weight gain returned Busy with wedding preparations: whole life has changed, finds she is an emotional eater Abdom pain central at umbilicus x 2 weeks, burning, burping, hiccups, nausea, BM Bristol 1 5, QOD or occas daily PE: entire upper abdom tender to palpation, lower abdom non tender; Chapman s + GB, Dig, SI bilat Tx: Acup in office for abdom pain, bloating, nausea At home: hot vinegar pack prn Low Fodmap diet Herbal antibiotic prior to or immed after food indiscretions (berberis, hydrastis, oregano, mahonia, coptis, yerba mansa Restart LDE 50mg QHS Retest 3 HR LBT 10/ HR LBT: increase H2 120min 73 ppm, CH4 11 Tx: ED x 14 days 11/2015 Pt pleased with sxs reduction, lost 8 lbs (desired), felt great on ED, didn t have a problem with the taste; sl constipated, bloated Tx: ED repeat 1/2106 Reduced abdom sxs, less bloating, no longer wakes with bloat, less constipation, less abdom pain 3/10 3 HR LBT: increase H2 120 min 109ppm, CH4 15 Tx: rifaximin 550mg TID + neomycin 500mg BID x 14 day Probiotic B CFU QD cc Prokinetic: cont. LDE 50mg QHS Yeast preventive: oregano oil cap 250mg 1/d Slippery elm bark ¼ 1 tsp TID w/ antibiotics Retest days after last dose Low Fodmap diet post tx
5 2/2016 Felt better on antibiotics, worse off diet, better Low Fodmap; decreased bloating, energy improved, lost weight, BM regular Can feel SIBO is still there, wants to tx again rather than retest Tx: Garlic allicin caps 1 2 TID as tolerated x 30 d + Berberine caps 4am 3midday 4pm, or if not tolerated try neem caps TID x 30 d Continue probiotics & LDE 5Omg (compounded) Retest after tx 3/2016 to 12/2016 Tolerated neem better than berberine; ate drastically off diet so extended herbal antibiotics Neurotransmitter balancing improved struggles with emotional eating, cravings and impulses & mood; also experienced acute grief reaction w/deaths in family; followed by layoffs at work w/ staff freaking out implemented changes to NT support Labs: low vitamin D, low B12 addressed & energy improved Managing SIBO with diet, intermittent fasting, ED, fasting during Ramadan; occasional herbal antibiotics Trying to get pregnant, off OC, on metformin 500mg 1 Takeaways SIBO diets are challenging 2 diet is integral part of success with SIBO tx 3 intermittent fasting may be a tx 4 ED is do able I invite you to contact me: Lisa Shaver ND LAc Everyday Wellness Clinic 1033 SW Yamhill #300 Portland, OR drlisa@bewelleveryday.com facebook.com/drlisashaver
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