Practitioner Mentorship - uprootinglyme.com€¦ · Practitioner Mentorship Module 1.3 Organizing A Complex Case Presentation With Hillary Thing, MS, LAc., ... • Slow processing

Practitioner Mentorship Module 1.3

Organizing A Complex Case Presentation

With Hillary Thing, MS, LAc., Cert. Herbalist

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.

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

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

UPROOTING LYME SYSTEMS MODEL - Assessment

• 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


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


Step 1: Diagnostic Assessment for Mica – Infections• Known

– Lyme-Borreliosis (Igenex labs, Brain MRI) - 2009– Anaplasmosis – borderline – EBV – chronic/reactivated – 2010– HHV IgG, Parvo - 2014

• Suspected– Mycoplasma - Indeterminate– Bartonella (neuro-lyme, exposure to feral cats and dogs)

• Other lab findings– High LDL and cholesterol

• Follow-Up For Infections– None


Step 1: Diagnostic Assessment for Mica – Signs & SymptomsMC: 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


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


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


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


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


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 2014-2016 with gradually decreasing responsiveness and ROI.


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.


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.


• 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


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


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


• 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


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


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


• Step 1: Diagnostic Assessment (Overall)• Step 2: Toxicity Assessment• Step 3: Gut Assessment• Step 4: 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)


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 2014-2016; past use of anti-depressants, anti-anxiety and sleep meds


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


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


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


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.


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


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?


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 toxicity2. Large microbial load3. How her psychiatric symptoms could prevent her

from taking necessary action to heal.


• Step 1: Diagnostic Assessment• 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– Short term (1 month)– Medium term (6 months)– Long term (1-2 years)


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


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)


• Step 1: Diagnostic Assessment

• Step 2: Toxicity Assessment

• Step 3: Gut Assessment

• Step 4: Current Healing Capacity

• Step 5: Neuro-Endocrine Assessment

• Step 6: Prioritize & Strategize

• Step 7: Develop a Treatment Plan

• Step 8: Design An Implementation Plan


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


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


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

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.

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.

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.

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.

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, email, or post your question to the Uprooting Lyme Practitioner’s Facebook Forum.

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Practitioner Mentorship - uprootinglyme.com€¦ · Practitioner Mentorship Module 1.3 Organizing A Complex Case Presentation With Hillary Thing, MS, LAc., ... • Slow processing