Cases Studies. Lynn Chadd, ARNP Labrix Advanced Workshop 2015

Size: px

Start display at page:

Download "Cases Studies. Lynn Chadd, ARNP Labrix Advanced Workshop 2015"

Valentine York
6 years ago
Views:

1 Cases Studies Lynn Chadd, ARNP Labrix Advanced Workshop 2015

2 PB-56 year old female Symptoms/History 2005 PB came in to discuss options for hormone balancing Post menopausal bleeding related to poor hormone balance Hot flashes Night sweats Poor sleep Vaginal dryness Painful intercourse Osteopenia

3 PB-62 year old female Test results: DEXA 4/28/2003

4 PB 56 year old female Comprehensive hormone panel results-2005

5 PB 56 years old Treatment Adjust hormones DC Biest capsule and change to Biest 0.5 mg, topically, twice daily. Continue Progesterone 30 mg topically, twice daily. Add Testosterone 0.25 mg/dhea 2.5 mg, topically, twice daily. Iodoral 12.5 mg one tablet daily Calcium Citrate 500 mg once daily Magnesium 500 mg once daily Vitamin D IU once daily No caffeine Increase weight bearing exercise

6 PB-62 year old female Test results: DEXA 10/4/2009, 2010, and 2011

7 (PB-62 years old) Test results: DEXA 10/4/2011

8 (PB 64 years old) Test Results: DEXA 10/4/2011

9 (PB 64 years old) Test Results: Basic hormone panel 12/2012

10 (PB-64 years old) Test results: DEXA 11/27/2013

11 PB 64 years old: Vitamin D3 levels 12/2012

12 KB 43 year old female History and Symptoms Severe anxiety, Irritability, mood swings, and depression Severe fatigue remembers being really fatigued in high school Poor sleep She was raped in college which increased her symptoms significantly Eliminating gluten, sugar, and dairy from her diet had a positive effect on her symptoms Wellbutrin was helpful but she did not want to continue to take medication. Long history of dysmenorrhea She had difficulty with tolerating Progesterone cream in the past she thinks the dose may have been too high.

13 CBC and Comprehensive Chemistry results (4/4/2012) brought by her to visit. All normal TSH Free T Free T3 3.0 Vitamin D level 18.2 she has been taking 2000 IU daily since

14 Plan Draw Methylation Pathway Profile today Check Neurotransmitter and Adrenal function panels Increase D3 to 5000 IU QD

15 KB-Results Methylation Pathway Profile

16 KB-43 year old female Adrenal Function Panel results

17 Test Results: Neurotransmitter (4/2014)

18 KB Treatment Probiotic one daily Magnesium Malate 500 mg daily Methylation support Methyl-Guard (3) capsules daily Molybdenum 500 mcg tablet daily GabacholaCalm (2) capsules twice daily Rhodiola 100 mg twice daily Continue Kavinase (2) capsules at bedtime for sleep Continue Vitamin D IU daily Vitamin C 2000 mg daily

19 GabacholaCalm Ingredients Ingredients per 3 capsules: Vitamin C (as Ascorbic Acid) 100 mg Thiamin (Vitamin B-1)(as Thiamine HCL) 50 mg Riboflavin (Vitamin B-2)(as Riboflavin-5-Phosphate) 10 mg Vitamin B-6 (as Pyridoxal-5-Phosphate) 5 mg Vitamin B-12 (as Methylcobalamin) 2 mg Pantothenic Acid (Vitamin B-5) 50 mg Magnesium (as di-magnesium Malate) 75 mg Taurine 300 mg L-Theanine 200 mg Lemon Balm (Melissa officinalis)(leaves) 100 mg [standardized to contain 3% rosmarinic acid] Passion Flower (Passiflora incarnata)(flower) 100 mg [standardized to contain 3.5% flavonoids] Valerian (Valeriana officinalis)(root) 100 mg [standardized to contain 0.8% valerenic acid] Ashwaganda (Withania somnifera)(root) 100 mg [standardized to contain 1.5% withanoloids] Phosphatidylserine (from soy lecithin) 50 mg

20 Follow up symptoms Anxiety almost completely resolved. Fatigue significantly improved. Sleep is improved. Dysmenorrhea is resolved. Depression is significantly improved.

21 Follow up plan Add Progesterone cream during the luteal phase at a low dose considering her prior reaction to Progesterone 12.5 mg BID days 10 of cycle until period starts. Continue everything else as she has been doing. Repeat Basic Hormone Panel once we see how she responds to the Progesterone cream.

22 Case Study Poly-Pharmacy Do we think it is better to give multiple medications or balance hormones? A clear case of Peri-menopause and Progesterone deficiency gone awry! Ambien Citalopram Dicyclomine Activella Levothyroxine Endometrial Ablation Hysterectomy

23 SL 45 years old: History and Symptoms 9/2012 Recent history of thyroid cancer with thyroidectomy--now taking generic Levothyroxine 137 mcg daily Endometrial ablation for heavy bleeding then due to menopausal symptoms she was put on Activella. When the bleeding worsened she was given an ablation. Currently taking Activella but has developed breast tenderness and weight gain. Her sleep has also been poor for which she was given Zolpidem. She is taking Citalopram for mild depression. Dicyclomine mg twice daily as needed for prn for IBS! Diet needs improvement. Too much dairy, gluten, refined grains, and sugar. She is going through a divorce. It has not been a good marriage for her.

24 Plan Stop Levothyroxine and change to Naturethroid 65 mg (2 ½) tablets by mouth every morning. Stop Activella. Start Progesterone cream 20 mg, topically, twice daily. Decrease Citalopram to ½ of a tablet. 5-HTP 100 mg at bedtime.

25 Supplements B-complex (1) capsule daily Vitamin C 1000 mg twice daily Vitamin D IU daily Iodoral 12.5 mg ½ daily Selenium 200 mcg daily Calcium-d-Glucarate 500 mg daily Ground Flax Seeds as much as possible

26 Follow up 1 month She will collect a basic hormone panel 2 weeks after starting the Progesterone cream and making the above changes. Follow up to review results

27 SL-Comprehensive hormone panel results (Taking Progesterone 20 mg topically twice daily-10/4/2012)

28 Follow up thyroid labs (10/14/2012) On Naturethroid 65 mg (2 ½) tablets TSH 0.12 Free T Free T TPO less than 0.6 (Normal 0-1.9)

29 Plan Adjustment Continue Progesterone cream 20 mg, topically, BID. Continue Naturethroid 65 mg (2 ½) tablets every morning. She is not experiencing any symptoms of over supplementation. Add DHEA 15 mg, by mouth, every morning. Ashwaganda 500 mg, by mouth, daily. C 1000 mg twice daily Basic B Complex one daily. Recommend she consider Neurotransmitter testing before next visit.

30 Follow up February 2013 Estradiol level increased to 3.20 Progesterone increased to 2387 Progesterone/Estradiol ratio is a little high at 745 Testosterone high end of normal at DHEA improved with oral DHEA 15 mg PO QAM. AM Cortisol is improved.

31 Follow up February 2013 Thyroid labs TSH 1.25 Free T Free T3 5.44

32 Follow up November 2013 Sandra is feeling much better in general. Her sleep is improved. She has stopped using the Ambien/Zolpidem. She was able to slowly taper off of the Citalopram and feels she is doing ok without it. She is not needing the Dicyclomine now that she is eliminating wheat, dairy, and sugar from her diet. She has lost 15#

33 Neurotransmitter Panel Results 10/2013

34 Results Comprehensive Hormone Panel 11/2013

35 Changes to Plan Decrease DHEA to 10 mg, by mouth, in the morning. Continue Progesterone 20 mg, topically, twice daily. Continue Supplements as she has been doing. Methyl-Guard (3) capsules daily. Follow up in 1 year or as needed.

36 AD-Case Study Anita is a 71 year old female who comes in to discuss a long history of anxiety. She has continued to work full time doing Christian missionary work with adoptive children. She travels a lot with her job. She lost her husband in 2000 from Lymphoma. She underwent a bilateral mastectomy for fibrocystic breast in her 30's. See current list of symptoms and surgical history intake form. Labs brought with her to the appointment all normal with the exception of a low Vitamin D.

37 Assessment/Diagnosis Anxiety state, unspecified [ ] Major depressive affective disorder, recurrent episode, severe, without mention of psychotic behavior [ ] Sleep disturbances [ ] Other malaise and fatigue [ ] Fibromyalgia [ ] Headache [ ] Symptomatic menopausal or female climacteric states [ ] Hypothyroidism [244.9]

38 AD-Plan Comprehensive hormone panel Neurotransmitter panel Add Vitamin D IU to her current supplements.

39 Comprehensive Hormone Panel Results

40 Neurotransmitter Report Results

41 AD-Plan: Hormones Progesterone 20 mg/0.1 ml lipoderm topical cream [ Compounded: Medaus Pharmacy ] Apply 0.1 ml of cream (20 mg), topically, at bedtime. Dispense : 3 Milliliter Refills : 5, Compounded, Cannot be substituted, Faxed to Medaus Compounding Pharmacy (800) : 12/2/2014 DHEA 5 mg oral capsule [ Thorne ] Take one capsule, by mouth, every morning. Dispense : 90 Capsule Refills: -1, Manufactured, Cannot be substituted

42 AD-Plan: Supplements Vitamin C 1000 mg --, Once a day Vitamin D 5000 IU 1.0 capsule(s), Once a day, Oral Probiotic 1.0 capsule(s), Once a day Fiber supplement 1.0 tablet(s), Once a day Melatonin 3-5mg 1.0 capsule(s), Once a day The Big One - Metabolic Nutrients 1.0 capsule(s), Once a day, With Meals, Oral Thorne MethylGuard 2.0 capsule(s), Once a day, With Meals DGL 1.0 tablet(s), 4 times a day, Before Meals Weaning Schedule : Chew and swallow one 20 minutes before means and at bedtime. NT Uplift - Wellbrain 1.0 capsule(s), Twice a day, Oral Weaning Schedule : If she has not noticed any improvement in her anxiety after 2 weeks--she will increase to 2 BID and gradually decrease the Citalopram as directed. Calcium Citrate 500 mg 1.0 capsule(s), Once a day, Oral

43 AD-Follow up plan Continue your medications as you have been doing: (Citalopram,Omeprazole, Levothyroxine). Citalopram 40 mg daily we can work on decreasing this slowly when you are ready. The NT uplift can also increase Serotonin levels. Too much Serotonin can cause the following symptoms: Agitation or restlessness. Confusion. Rapid heart rate and high blood pressure. Dilated pupils. Loss of muscle coordination or twitching muscles. Muscle rigidity. Heavy sweating. Diarrhea. If you notice any of these stop the NT Uplift and call my office. The idea is to slowly decrease the Citalopram while adding in the NT Uplift. So once you are settled in with the above changes you should start to gradually decrease your Citalopram by 1/8th of a tablet every 2-3 weeks. Follow up in 3 months or prn.

44 AD-3 month follow up AD is feeling much better Anxiety is reduced She has been able to reduce the Citalopram by ½ the dose Energy is improved Sleep better

45 Plan She will continue everything as she has been doing. Increase NT Uplift to (2) capsules in the AM and (1) capsule in the PM. Continue to improve diet and self care.

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