Practitioner Mentorship

Transcription

1 Practitioner Mentorship Module 1.3 Organizing A Complex Case Presentation With Hillary Thing, MS, LAc., Cert. Herbalist

2 1.3: Organizing A Complex Case Presentation Learning Objectives: Apply the Uprooting Lyme Systems Model to an actual initial consultation; Learn how to organize the information and bring clarity to a messy case history; See how diagnostic and treatment priorities evolve out of the initial evaluation process; Look at realistic expectations for you and your patient for the course of a holistic Lyme recovery journey; Discover the characteristics of genuine healing so that you know what to look for.

3 Meet Mica, 50 year old female MC: Neuro-Lyme ADD Overwhelm, procrastination Can t handle stress Social anxiety PTSD, anxiety OCD, perfectionism Hard to get day started and function Poor memory Insomnia Brain fog Additional symptoms: Fatigue Whole body aches Feels toxic Sore throat, swollen glands Abdominal bloating and gas Muscle cramps and weakness And more

4 Meet Mica, 50 year old female Diagnoses: Lyme-Borreliosis Bartonella EBV, other chronic viruses MTHFR C677 CFS Anxiety and depression, but not bipolar disorder History: Exposure to mold, heavy metals Nasal staph infections (2) Fibroids led to hysterectomy Head traumas Emotional trauma (alcoholic, disconnected parents) Treated for parasites

5 Step 1: Diagnostic Assessment (Overall / Infections) Step 2: Toxicity Assessment Step 3: Gut Assessment Step 4: Current Healing Capacity Step 5: Neuro-Endocrine System Assessment Step 6: Prioritize & Strategize Step 7: Develop A Treatment Plan Step 8: Design An Implementation Plan

6 Step 1: Diagnostic Assessment Infections Known diagnoses: Lab, date of dx, obtain records Suspected diagnoses: based on clinical pic, in spite of negative labs Negative results Other lab findings (C3a, C4a, VEGF, NK cells) Recommended testing Symptoms and signs Pre-existing medical conditions Nutritional deficiencies HEENT Current medications, herbs and supplements list separately Response to past treatments what has helped, what has hindered? Current lifestyle habits

7 Step 1: Diagnostic Assessment for Mica Infections Known Lyme-Borreliosis (Igenex labs, Brain MRI) Anaplasmosis borderline EBV chronic/reactivated 2010 HHV IgG, Parvo Suspected Mycoplasma - Indeterminate Bartonella (neuro-lyme, exposure to feral cats and dogs) Other lab findings High LDL and cholesterol Follow-Up For Infections None

8 Step 1: Diagnostic Assessment for Mica Signs & Symptoms MC: Neuro-Lyme ADD Overwhelm, procrastination Can t handle stress Social anxiety PTSD, anxiety OCD, perfectionism Hard to get day started and function Poor memory Insomnia Brain fog Fatigue Whole body aches- joints and muscles Feels toxic, sluggish Sore throat, swollen glands Abdominal bloating and gas Muscle cramping and weak Slow processing Poor libido

9 Step 1: Diagnostic Assessment for Mica Pre-existing Medical Nasal staph infections (2) Fibroids led to hysterectomy Head traumas Emotional trauma (alcoholic, disconnected parents) Treated for parasites Hep A Parvo Virus Acne rosacea better when on abx

10 Step 1: Diagnostic Assessment for Mica H. Nutritional Deficiencies Magnesium muscle cramping, heart palp B s nervous system involvement D3 immune deficiency Trace minerals Iodine thyroid issues Zinc prone to viral infections

11 Step 1: Diagnostic Assessment for Mica HEENT: head, eyes, ears, nose, throat Chronic swollen glands and scratchy throat Nasal congestion comes and goes History of several accidents when younger involving head trauma Eyes & ears OK

12 Step 1: Diagnostic Assessment for Mica Current list of medications, herbs and supp s Oxytocin, Propanolol (beta-blocker) both as needed for social anxiety Bio-ID estrogen and progesterone DHEA L-Theanine Astra Isatis Lion s Mane Lithium Orotate Phos Serine Nattokinase Ashwaganda Monolaurin Probiotics K2 Turmeric Adreset Zinc Vit C Vit D Fish oil B12 Gaba, Kavinese Betaine HCl

13 Step 1: Diagnostic Assessment for Mica Response to past treatments Positive response to parasite treatment (2x Ivermectin, Alinia) Positive response initially to antibiotics, antivirals, anti-fungals in 2014 Resurgence of symptoms and poor response to other abx (Biaxin, Amoxicillin) Many abx, anti-fungals were tried with gradually decreasing responsiveness and ROI.

14 Step 1: Diagnostic Assessment for Mica Current Lifestyle Habits & Routines Sleep quantity, quality, routines, meds Takes 750 mg Gaba before bed, Kava product; goes to bed very late, wakes up late; doesn t feel rested; lifelong problem, used to take Nyquil, Benadryl or Ativan to sleep. Circadian Rhythm way off Movement what type, how often, for how long, how does it feel Feels good from yoga, esp. hot yoga; very inconsistent Diet Consuming what? How does it feel? Organic? Concerns? Good routines when husband is home; less when he is away. Overall health conscious, organic, diet works well.

15 Step 1: Diagnostic Assessment for Mica Current Lifestyle Habits & Routines Detox routines feels better w/ red lamp sauna but not consistent Work routine sporadic, jobs here and there; big stress related to needing to get a job soon Family routine supportive husband; lacking any daily routines What s working well, and what s not? Feels like a child is running her life; needs structure.

16 Step 1: Diagnostic Assessment (Big pic) Step 2: Toxicity Assessment Toxin exposures past and present Assess for present detox capability» Liver» Large Intestine» Kidneys» Skin» Lymph» Lungs

17 Step 2: Toxicity Assessment for Mica Exposures Known Heavy metals: lead, mercury (lead was very high from urine testing) Vaccines and pharmaceuticals Raised on junk food, candy, TV Suspected Mold exposure: while living in a moldy building, symptoms got much worse with no other provocation

18 Step 2: Toxicity Assessment for Mica Detox Capabilities Liver MTHFR heterogenous positive C677T, low tolerance for alcohol and pharmaceuticals. Large Intestine Hx of parasites, abx; no constipation Kidney / UB - OK Skin Hx acne rosacea; looks OK Lymph Swollen nodes; feels sluggish and toxic; generally puffy Lungs - OK

19 Step 1: Diagnostic Assessment (Overall) Step 2: Toxicity Assessment Step 3: Gut Assessment Abx and pharmaceutical hx and current use Current GI symptoms and disease Nutritional absorption and assimilation Food intolerances Diet Bowel issues GI history

20 Step 3: Gut Assessment for Mica Abx history / current use Past treatment for parasites showed improvement; Substantial history of abx Current GI symptoms and infections Chronic gas and bloating, poor ap, sluggish SIBO test neg Suspect chronic yeast and parasites

21 Step 3: Gut Assessment for Mica Nutrient absorption and assimilation Somewhat poor due to dysbiosis, gut infections Food intolerances, diet Gluten-free, dairy free Feels best when cooks at home; take-out is common and problematic Bowel issues Not constipated but sluggish movement GI history / past infections History of travel, parasites

22 Step 1: Step 2: Step 3: Step 4: Diagnostic Assessment (Overall) Toxicity Assessment Gut Assessment Current Healing Capacity Energy, vitality Immune function Level of inflammation Age Length of illness Amount of pharmaceutical and abx past and present Constitution Mental attitude Support system (+ Hormones, nervous system, stress, detox, and gut health)

23 Step 4: Current Healing Capacity Energy, vitality - poor Immune function - poor Level of inflammation moderate chronic inflammation - *brain, joint, soft tissue Age - 50 Length of illness unknown; presumably decades long / life-long Amount of pharmaceutical and abx past and present a dozen different anti-microbials ; past use of anti-depressants, anti-anxiety and sleep meds

24 Step 4: Current Healing Capacity Constitution Despises cold, loves hot yoga Strong but presently quite compromised Excess presentation (yang) with underlying deficiency (yin) Mental attitude very very difficult to manage mind and emotions Support system supportive husband; isolated from friends, lots of social anxiety

25 Step 1: Step 2: Step 3: Step 4: Step 5: Diagnostic Assessment (Overall) Toxicity Assessment Gut Assessment Current Healing Capacity Neuro-endocrine Assessment Hormonal symptoms Gyn history Hormonal labwork Stress Cognitive complaints Emotional issues

26 Step 5: Neuro-Endocrine System Assessment for Mica Hormonal Symptoms Low libido, difficulty losing weight, insomnia, many sx possibly related GYN History Hysterectomy (2012), prompted by fibroids with heavy bleeding. Followed by HRT: Bio-ID estrogen (miniville patch); Bio-ID Progesterone (200 mg / nt); DHEA 10 mg Other labs Mild + for thyroid antibodies. Suspect low adrenal function get tested Also recommend testing of sex hormones

27 Step 5: Neuro-Endocrine Assessment for Mica Stress levels HIGH; long history of chronic stress and inflammation of the nervous system Cognitive Complaints Brain scalloping brain spect scan Knowledge of heavy metal toxicity Hx. Head trauma Insomnia and circadian rhythm issues Major brain function symptoms - memory, cognition, OCD, etc. Emotional Issues Deep emotional problems (anxiety, social phobias, etc.) Hx. Emotional trauma and anxieties on-going throughout childhood and adulthood.

28 Step 1: Step 2: Step 3: Step 4: Step 5: Step 6: Diagnostic Assessment Toxicity Assessment Gut Assessment Current Healing Capacity Endocrine Assessment Prioritize & Strategize Weakest / strongest organ systems? Patient s top concerns and goals? Practitioner s top concerns?

29 Step 6: Prioritize & Strategize for Mica Weakest & Strongest Organ Systems Weakest: Neurological CNS mental and emotional (Liver, Heart) Followed by immune system (high infection burden) and liver / lymph (high toxin burden) Strongest: Kidney-Urinary bladder, Lung-skin are relatively uninvolved, and the gut is fair how can we use these systems to our advantage?

30 Step 6: Prioritize & Strategize for Mica Top 3 Concerns: Hers: 1. Daily functioning problems due to overwhelm, procrastination, obsessive behaviors. 2. Emotional looping and high anxiety. 3. Brain inflammation and inability to concentrate. Mine: 1. Heavy metal toxicity 2. Large microbial load 3. How her psychiatric symptoms could prevent her from taking necessary action to heal.

31 Step 1: Step 2: Step 3: Step 4: Step 5: Step 6: Step 7: Diagnostic Assessment Toxicity Assessment Gut Assessment Current Healing Capacity Neuro-Endocrine System Assessment Prioritize & Strategize Develop a Treatment Plan Short term (1 month) Medium term (6 months) Long term (1-2 years)

32 Step 7: A Treatment Plan for Mica: Goals and expectations short (1 month), medium (6 month), and long term (1 year) Phase 1: Addressing short-term goals and strategy Open and support the detox pathways Lessen the intensity of the emotional anxieties Sustain a level of anti-microbial activity Strengthen the gut, refine the diet Begin to build and support immune system and energy

33 Step 7: A Treatment Plan for Mica: Phase 2: Medium-term goals and strategy Commence deeper cleansing and heavy metal removal Step up anti-microbial efforts Lower inflammation overall Investigate hormonal issues Begin to address biofilm and anti-microbial rotations Phase 3: Long-term goals and strategy Heavy metal clearing (1-2 years) Emotional re-patterning Health generation and vitality building Continue anti-microbial strategy (1-2 years)

34 Step 1: Step 2: Step 3: Step 4: Step 5: Step 6: Step 7: Step 8: Diagnostic Assessment Toxicity Assessment Gut Assessment Current Healing Capacity Neuro-Endocrine Assessment Prioritize & Strategize Develop a Treatment Plan Design An Implementation Plan

35 Step 8: Implementation of Treatment Plan for Mica: Phase 1: Addressing short-term goals and strategy Hydration with marine plasma and Hydrogen Begin juicing Continue with lithium, B, C & D vitamins Chinese tea focused on harmonizing the liver, calming the spirit and nervous system Herbal anti-microbial protocol with Byron White formulas

36 Step 8: Implementation of Treatment Plan for Mica: Phase 2: Medium-term goals and strategy Heavy metal protocol Rotation of anti-microbials CBD oil / medical marijuana Begin bio-energetic practices Add colon cleansing Initiate daily exercise program

37 Step 8: Implementation of Treatment Plan for Mica: Phase 3: Long-term goals and strategy Continue / rotate heavy metal protocol Develop bio-energetic / meditation practices Continue exercise and cleansing practices; address lingering circadian rhythm issues Continue and rotate anti-microbials including bio-film

38 Sweet Spot is where healing can occur. For healing to occur, all of the spokes on the wheel need to be addressed and restored to normal function over time. Therefore, recovering from complex chronic disease involves achieving a state of optimal health.

39 Preparing for the holistic recovery journey Commit to 6 months of treatment, then evaluate in a way that celebrates the victories. Requires the development of consistent health practices, which may require coaching and support. Be prepared for a roller coaster ride.

40 Realistic Recovery Time is 1-5+ years Attempt initial symptom relief (short-term goals); Convey your understanding of what s going on with them, and how the strategies you re implementing will lead to recovery; Hold the vision for their health and healing and communicate that they can and will heal. It is a process, not typically something that will change overnight.

41 The Results of Genuine Healing include: Decreasing need for medication and supplements; Stability in terms of mood, energy level, body temp, blood pressure, hormonal swings, etc. Increased happiness and sense of well-being; Increased resistance to microbial infection; More energy; Decreased intensity and frequency of pain and other symptoms; Less inflammation; Improved sleep; Better mental clarity and cognitive function; Stronger and more easeful digestion; Repair of damaged tissues.

42 Module 1.3 Homework Rather than complete focus questions, your assignment is to use an existing case in your practice or your life and fill out the UL Systems Roadmap Intake Form. Then answer the questions posted under Module 1.3 Focus Questions about this exercise. If possible, do this before our Module 1 Mentorship call. If you have questions, don t have a case to focus on, or need, help, be sure to call, , or post your question to the Uprooting Lyme Practitioner s Facebook Forum.