OAT – Female in her 50s

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    • #397

      Attached is the most recent OAT for a woman in her mid-50s.

      Diagnosed hypothyroid is taking Armour.

      Please review the OAT with a eye toward information regarding her IBS-D and candida and provide whatever other insights you might be able to gather from the OAT. Thank you.

    • #412
      DrWoeller
      Keymaster

        Mark,
        Here you go:

        1 – moderately high Arabinose (invasive candida). Doubtful IBS-D would be explain just by this.
        2 – all other yeast and bacteria markers normal
        3 – Oxalates and essential mitochrondrial markers normal.
        4 – Neurotransmitter look fairly normal. Slightly high normal HVA and HVA/VMA ratio, but no specific indicators as to why. Likely not an issue.
        5 – high Kynurenic could be linked to immune activation from virus. Nothing else on the OAT points to why this would be high. Usually some type of infection will drive this up.
        6 – all other sections look fine. Common to see low Ascorbic Acid. The amino acid metabolites being low are normal and not clinically significant. Phosphoric Acid is normal which suggests adequate vitamin D status.

        I don’t see anything on this OAT that specifically would point towards IBS-D or even thyroid problems.

        What other testing and interventions have you tried?

        Sincerely,
        Dr Woeller

      • #422

        Hypothyroid has been treated for 15 years with Armour. TSH is typically between 1 and 2 with free T3 and free T4 toward lower end of ranges. Patient’s mother was hypothyroid also. Have not been able to find an MD to try Wilson’s syndrome treatment with some time release compounded T3.

        Hormone blood and saliva are typically in reference ranges, although those are often wide.

        Extensive food and other allergy testing all came up generally negative.

        Comprehensive stool tests tend to be pretty normal based on your earlier review.

        Hydrogen test was single digits.

        Patient was often on antibiotics from birth until tonsils removed at age 18.

        Had high stress jobs earlier in life and a special needs child – so can assume some impacts of chronic stress.

        I’m happy to try for more testing – any ideas?

      • #427
        DrWoeller
        Keymaster

          Mark,
          My apologies if you answered this previously, but what are her main issues…main areas of concern?

          Sincerely,
          Dr. Woeller

        • #428

          You may see two responses. I replied once but it didn’t post apparently.

          Chronic daily Diarrhea
          Since approx age 30 has had daily IBS-D like symptoms. First stool is sometimes loose but formed. 2nd stool of day is ribbon/unformed. 3rd stool is watery. 4th stool tends to be mucous. This basically ties her to the restroom for the first 2-4 hours of a day.

          Acne
          Adult acne, onset more or less age 25. Treated with topical antibiotics, some oral, accutane and lasers. No long term relief.

          Brain Fog
          For the most part concurrent with menopause. Loss of some ability to recall. Has a “want” for correct words.

          These are the key concerns. Thanks.

        • #429
          DrWoeller
          Keymaster

            Mark,
            Well. There doesn’t appear to be much regarding any type of chronic infection. Accutane has been linked to Ulcerative Colitis so wondering if this may be playing a role? Even if UC is not 100% confirmed, underlying low level inflammation is possible. The long-term antibiotics certainly don’t help either.

            Here’s some suggestions:

            -Sodium/Potasium Butyrate – 6 capsules daily (if possible). I would suggest starting with 1 capsule twice daily and then increase by 2 capsules every 72 hours until taking 6 total daily. Helps to support cellular degeneration.
            -Start incorporating cultured veggies as discussed by Dr. Tranchitella in the SIBO lecture.
            -Also, take a look at GI Revive from Designs for Health – start with 1/2 teaspoon twice daily. Would recommend introducing the Butyrate first and veggies.

            Let us know how things are going. Important not to do too many things at once, but these should help reestablish some normalcy to gut function overtime.

            Dr. Woeller

            • #431

              Thinking a little more about UC and Crohns like treatments, do you have any experience or view on anti-inflams like sulfasalazine, or motility modifiers like Lomotil? Both have found some success in UC/C treatment. Thx again.

          • #430

            Thx. Have learned to do one thing at a time whenever possible, as over history, diarrhea has gotten much worse at times with some supplements. For example, any high fiber food or supplement has led to explosive diarrhea, quite the opposite of the hypothesis with psyllium that it will bulk, slow motility and transit time, and help reduce liquid nature of the stools.

            Sigmoidoscopy didn’t reveal Crohns or UC, not that anything is 100% fool proof or that situations don’t change over time.

            What are your thoughts on Thyroid or Andrenal issues being capable of causing this sort of long term diarrhea?

            She has been hypothyroid (went from TSH of 1 to 3 to 5 in a fairly short progression) and has been on Armour since, after trying both synthroid and levoxyl. Hashimotos test was negative. While they try to keep her TSH around 1, it drifts up, but that could easily be from medication noncompliance or irregulaties in production. When she has good labs on thyroid her TSH is 1-2 and her free T3 and T4 are in the range, but toward the bottom of reference. She’s thought about trying some compounded T3 (Wilson’s syndrome) since her body temp runs low but hasn’t gotten that done yet, largely due to retirement of her prior MD who was pretty open minded and willing to try some alternative therapies.

            I’m re-reviewing bloodwork today for thyroid and adrenal tests.

            Thanks again. This has been a long term tough slog.

          • #435
            DrWoeller
            Keymaster

              Mark,
              Hypothyroidism usually causes constipation. Anything is possible, but normally we don’t see a strong, direct connection between adrenal/thyroid and what you are describing for this patient. However, it does still look like she is under-dosed on T4 and T3.

              Sulfasalazine, I have some experience with, although I don’t directly prescribe it anymore. It is fairly effective for large bowel inflammation. With the sigmoid being clear it’s unlikely that UC is present. The thyroid antibodies being clear too leans away from an autoimmune problem, although ANA and RA may still be present? Lomotil is not something I have used in quite a while, and have only used sparingly.

              Dr. Woeller

              P.S. Other testing would be fecal assessment of Calprotectin, Lactoferrin and Eosinophil-X. Great Plains has the Calprotectin and Lactoferrin. Genova has the Calprotectin and Eosinophil-X.

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