Case Studies. Erin Lommen, ND CEO, Labrix Clinical Services

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Darcy Higgins
5 years ago
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1 Case Studies Erin Lommen, ND CEO, Labrix Clinical Services

2 Charlotte, 52yoF History Extreme fatigue( Temporary Disability d/t fatigue) Irregular Menses (v heavy flow past 6 months) Always had GI distress; heartburn, rumbling, bloating, constipation alt. with diarrhea (IBS) just became part of her normal Has always worked full time (front office support) for 35 years until now Weight approx. 310 lbs. #1

3 Charlotte, 52yoF Symptoms Chief complaints Insomnia (3 4 nights a week) cannot stay asleep Anxiety (1 10 worst, 3 6) Fatigue 10 (1 10worst) Stress intolerance Gastric distress (IBS) Frequent Heavy Menses (q weeks) Joint pain

4 Charlotte, 52yo F Test results

5 Charlotte, 52yo F Results summary Estrogen dominance Low DHEA Adrenal dysfunction phase II Remember to consider subclinical thyroid soon (labs and conservative treatment tbd)*

6 Charlotte, 52yo F Therapy Progesterone cream 40 mg bid Supplements to include Adrenal support; (rhodiola, B5, B6 and Vit C) Gut Health: Probiotics and mini elimination DHEA 15 mg Hydrocortisone 10 mg in am 5 mg at noon Adrenal Adaptogens (dsf), Vits, B5, B6, C Treatments: Iodine, Digestive Enzymes, Probiotics and betaine HCL Anti inflammatory Diet

7 Charlotte, 52yo F Cortisol series /2011 9/2011 5/ /2012

8 Charlotte, 52yo F Follow up therapy End of 2008; Charlotte returns to part time work and continues the rebuilding treatment approach which includes rest 3 4 times throughout the day while in the workplace. Mid 2009; back to full time employment and added Naturethroid ½ gr x 2 months then up to 1 grain present dose. By 2010, reports feeling well for the first time in decades, her adrenal function improved enough that hydorcortisone dose dropped to 5 mg qd, and by 2011, 2.5 mg qd (with an occasional second pellet prn). December 2012: Tragic Event October 2012, feels like she is losing ground rapidly tests reveal more support needed and she again regains adrenal robustness.

9 Heather, 49yo F History Busy, self employed professional performer (Singer) Travels and works v. long hours, stress is high Peri menopausal Menses q. 2 3 weeks 110 lbs, 5 4 Difficulty falling asleep as well as staying asleep, sometimes getting as little as 2 3 hours/night #2

10 Heather, 49yo F History Has been using Xanax and/or Ambien on and off to sleep (more on than off x 3 years) but doesn t want to become reliant on it* Has been supplementing with L Glutamine for past 6 months for gut health Is also having symptoms of hormone imbalance shorter cycles, heavier bleeding, increased irritability and extreme anxiety Had been trying to conceive for the three years prior to her visit to see me At present she and her husband have stopped trying (hoping to conceive) and are moving on

11 Heather, 49yo F Professional singer Symptoms Is finding it increasingly difficult to make it through the day due to fatigue and anxiety Extreme anxiety panic at times prior to performing Chief complaints Insomnia 2 4 hours awake each night typical Anxiety (10/10 on worst days) Fatigue (8/10) Stress (9/10)

12 Heather, 49yo F Neurotransmitter test results (7/26/2012)

13 Heather, 49yo F Test Results Estrogen dominance Phase III adrenal gland dysfunction

14 Heather, 49yo F Results summary Low range Serotonin* Elevated GABA and glutamate Elevated / upper range catecholamines Upper range norepinephrine / epinephrine (N/E) ratio indicates difficulty in conversion of norepi to epi

Heather, 49yo F NT Therapy Discontinue glutamine (as is potentially raising glutamate levels) and switch to other gut support Though inhibitory NTs are not overtly low, must support to balance

15 Heather, 49yo F NT Therapy Discontinue glutamine (as is potentially raising glutamate levels) and switch to other gut support Though inhibitory NTs are not overtly low, must support to balance excitatory NTs L Theanine 200 mg TID 5 HTP 200 mg qhs Adaptogen blend (rhodiola, ashwaganda, eleutherococcus) to modulate adrenal medullary production of catecholamines 2 capsules in am, 1 capsule at noon Methylation support for conversion of norepi to epi SAMe 400 mg bid

16 Heather; Additional support for hormonal balancing and Adrenals Adrenal Phase III to include Protomorphogen instead of hydrocortisone (felt bloated and worse more anxiety on hydrocortisone) Sublingual E2/Pg drops q 2 4 hours OMP ( mg) at bedtime Melatonin 6 mg at bed

17 Heather, 49yo F 3 month follow up Sleep is significantly improved, now sleeping at least 5 and sometimes as much as 7.5 hours/night, 3 4 nights ambien instead of everynight Fatigue (was 8/10, now 4/10) Anxiety improved (was 10/10 at times, now 3 5 on worst days) Two cycles; 26 days not as heavy Planning to do follow up testing in 2 months (combo kit)

18 Marsha 48 yo F Symptoms/History Hx of s/p hysterectomy on Premarin Severe fatigue (10/10) DX CFIDS 2005 Insomnia Depression mostly due to fatigue and inability to function Left job as Statistician (at Intel) due to fatigue and health issues 181 lbs #3 AD

19 Marsha, 48yo F Results Summary Estrogen dominance Androgen deficiency (T and DHEA) Severe phase III adrenal fatigue AD

20 Marsha, 48 yo F/ Cortisol Series

21 Marsha; DHEA

22 Marsha; Pg/E2 ratio

23 Marsha BHRT (transdermal) E3 1mg/E21 mg*/pg 60 mg/test 0.75 mg DHEA 5 mg (titrated up to 20mg) Hydrocortisone 5mg, 5mg and 2.5 and additional phase III adrenal support 5 HTP and L theanine and melatonin

24 Thank you for my life back Marsha Patient feels great and grateful! 2013 began her own soap making business Fatigue 2 3/10 Weight 159 lbs. (initial weight 181, down 22 lbs. from initial visit)

25 Case #20 VickiAnn, 64yo F Symptoms/History Hx hysterectomy 10 years ago on Premarin (x 10 yrs) Complains of overwhelm and nervousness for the past 6 months Hot flashes, vaginal dryness, fatigue, depressed sx but not clinically depressed for about a year #4

26 VickiAnn, 64yo F Test results EQ low Estrogen dominance Suboptimal testosterone Low DHEA Phase III adrenal dysfunction

27 VickiAnn, 64yo F Treatment Topical BHRT Wean Premarin* *Note: biest stronger initially; (1:1 x 3 6 months, then 2:1 etc E3/E2) Adrenal support and Hydrocortisone 10mg q am and 5mg noon

28 VickiAnn, 64yo F Follow up test Elevated estrogens, EQ optimal. Residual estrogen dominance Testosterone within supplementation range DHEA elevated Phase III adrenal gland dysfunction

29 VickiAnn, 64yo F Treatment She did not have improvement and was getting very frustrated this doesn t work? She was one that answered everything s fine when queried on digestive habits and health intake; one day she mentioned prolonged (x 15 years) GI sx that we had not discussed before (frequent bloating, constipation, and drained feeling after eating even worse after surgery. GI evaluation; to include clinical intake and testing; SIBO(later we look at food allergy if still lingering). Her hormonal and adrenal improvement both took hold (successful intervention) following resolution of GUT issues:

30 Catarina, 47 yo F History/Symptoms Hot flashes/ night sweats 8/10 in severity Anxiety /Insomnia 9/10 Recently moved to the metro area (18 months ago) Had been living in Slovakia and was on something there for hormones not sure what but quit when she came here Has been gaining weight around the middle (7 lbs in past 18 months) Feels agitated and more prone to depression not sure if that is from moving different employment or changes in her hormones #5

31 47 yo F Test results

32 *insulin resistance * alcohol consumption

33 Catarina, 47 yo F New intake history Treatment Catarina states on the telephone that she was detoxing from alcohol day 3 when she saw me and she is now in in patient treatment (3 days following our visit) requests help for sleep and anxiety following her medical detoxification (lorazepam) in two days

34 Catarina, 47 yo F Treatment Lo E (E dominance) Lo DHEA but relatively higher T* Adrenal dysfunction (phase I)when seeing fall off throughout the day and notice it especially when there is insomnia) Low Serotonin Low Gaba/High Glutamate

35 Topical Biest/Progesterone 1mg/60 mg DHEA 10 mg Multivitamin/Multimineral B vitamins Adrenal Adaptogens L tyrosine, 5 HTP L theanine and melatonin

36 47 yo F/ Follow up test results

37 Has had almost no anxiety and is sleeping well day 21 of 28 day residential treatment program. Energy Level good. Plan to address possible early insulin resistance and continue NT program retest in 6 weeks.

Case Studies. Aimee C. Duffy, M.D. Carolina Integrative Medicine

Case Studies. Aimee C. Duffy, M.D. Carolina Integrative Medicine Case Studies Aimee C. Duffy, M.D. Carolina Integrative Medicine Claudia, 67 yo F History/Symptoms S/P hysterectomy for fibroids at 48 Currently using natural hormones Phyto B 3-4 pellets in am and 3-4