July 28, 2019 at 11:17 pm #767
I have a client who has been dealing with halitosis for a long time, evaluated in the past by multiple dentists & two “breath specialists”. She was initially dx with GERD with endoscopy reported as normal by one of two GI doctors. She has been treated with antifungals, antibiotics, tongue scraping, special toothpaste & mouthwash but continues to complain. She has a twin sister (addressed elsewhere) with the same complaint. They both also c/o longstanding fatigue.
Her workup revealed hydrogen & methane positive Lactulose SIBO test; yeast, k. pneumonia & p. mirabilis on BioHealth 401-H confirming dysbiosis but no H pylori, all of which have now cleared on repeat testing post treatment but they did report Group D Enterococcus w/o quantification & persistent 4+ E coli which I presume to be normal. She has also had restoration of her bacteroides & lactobacillus insufficiency. She had evidence of HPA-G Axis dysregulation on Dutch testing and suspected intestinal permeability. Her SIgA was borderline low initially but has fallen into abnormal low range now with low butyrate and total SCFAs. She had low sulfate and elevated D-Lactate on Organix OAT initially. She had iron deficiency anemia, elevated thyroid peroxidase Ab & elevated T3 & T4 with normal TSH, reverse T3, free T3 & free T4, likely due to malabsorption & leaky gut which I hope have improved.
I held off on repeating her SIBO testing until confirmation of her dysbiosis resolution but now plan to repeat that & order GPL OAT this time instead with repeat bloodwork. I also have considered ordering Cyrex 2 to evaluate her intestinal permeability, but I wonder if you have any other suggestions for evaluating her for leaky gut that you would recommend if her TPO Ab is still elevated. I would also be interested in any thoughts you have about further evaluation if SIBO testing is normal, but she still complains of halitosis. Any other thoughts you have would be greatly appreciated, especially for ongoing support. For now, I was planning the Biomatrix Support Essentials, Support Digestion & Support Mucosa along with additional vit D. I would like to keep her on a soil-based probiotic like Megaspore Biotic which she has been taking during her treatment as well but not planning to start until the breath test has been completed.
Phyllis Gee MD
July 28, 2019 at 11:29 pm #768
I also plan to put her on Inulin in small doses to further support her SCFA production.
July 29, 2019 at 6:31 pm #769
Hello Dr. Gee,
I believe we discussed this patient at length during a phone consultation through BioHealth and came up with some possible options for addressing dysbiosis and maldigestion. Were your questions addressed adequately at that time?
Tracy Tranchitella, ND
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