-
Q&A 06.07.24
Dr. Rostenberg Q & A 06.07.2024
Zoom Link:
Dr. Leah:
13 year old with SEVERE arm pain/symptoms-was recently given a diagnosis of Complex Regional Pain Syndrome
Timeline per mom who is an ER physician:
4/25 Partial subluxation left shoulder batting in softball
4/20-5/3 PT
5/2 lots of overhead catches at practice, lots of shoulder pain, then arm numbness
5/3 more arm numbness, went to TCO, normal shoulder plain films
5/4 arm numbness and pain much worse, now with color change purple
Went to Mpls Children’s hospital.
Normal venous and arterial Doppler of the bilateral arms and neck
Normal CXR
Exam: some numbness, and weakness noted left upper extremity
Started on decadron 10mg once and gabapentin 100 TID.
5/6 Increasing pain, numbness and weakness
Went to Masonic U of M ER
MRI with and without contrast of the left shoulder and brachial plexus were normal
MRI cervical spine normal
Seen by Peds Neuro, who thought it was Parsonage Turner syndrome, started on Prednisone 60 mg daily x 5 days, and increased gabapentin to up to 300 mg TID, but Josie didn’t tolerate the Gabapentin, sleepy/dizzy but NO pain relief.
Tried adding ibuprofen, Tylenol, and hydroxyzine/vistaril.
Vistaril seems to help the most.
Seemed a little improved on the prednisone but worse again when 5 day burst of prednisone done.
5/22 seen in Peds neurology clinic, and due to full arm distribution of symptoms and color changes, thought to be Complex Regional Pain syndrome.
Started on nortryptiline and toradol. Significant worsening of pain
Referred to pain clinic who prescribed below as well as specialized pt/ot/rehab for CRPS.
Currently taking nortryptiline, lyrica, ibuprofen, Tylenol, tramadol pen, hydroxyzine. Severe pain 8-9/10 continues. Difficulty sleeping. Unable to go to school.
PROTOCOL:
When symptoms react to changes in position, rotation, traction, extension, etc. they are NOT biochemical in nature – they are structural; Think about what part of the NeuroAxis needs to be irritated/impinged/subluxated in order to cause the downstream effects. If an entire upper extremity is in pain and has symptoms, then you need to look UP STREAM towards the Jaw, upper cervical and Thoracic Outlet and find the one or two areas that could create the symptoms you see further down.
Synapse clinic – Eagan, MN w/ Dr. Troy Spurrill – https://www.officialsynapse.com/
Back to life clinic – Dr. Tyler Nenaber – https://www.backtolifehealth.com/
Marsha:
Case 1:
Post menopausal female supplementing with methylated B vitamins and samE in order to keep homocysteine WNL. Now also taking Lipoflow and homocysteine has decreased again from 5 to 4. Estrogen levels are also decreasing. Further presenting with elevated DHEA-S and testosterone (the prostate version female)?
Can you explain how choline affects estradiol levels as it is a potent methyl donor? Will stopping the Lipoflow possibly increase homocysteine and estradiol levels back into normal limits?
Lipoflow has L-Taurine and taurine inhibits the absorption of Methionine.
She is taking HRT – Estradiol and Progesterone; when DHEA-S and Testosterone increase in females it is the insulin resistant, PCOS phenotype issues…even in menopause; DHEA-S is more adrenal specific, so any chronic stressors can lower sex hormones production (E2) pushing the system towards cortisol…the side effect of cortisol will be transient insulin resistance. The increased insulin resistance will raise her testosterone.
PROTOCOL:
Take SAMe away (2 hours) from Taurine/Lipoflow to increase homocysteine. Increase L-Methionine levels and/or gross protein intake. Lower Lipo-Flow to 1 tablet per meal instead of 2 per meal. Stop the extra Taurine. Retest in 90 days see if the HCY is moving in the right direction.
Case 2:
54 year old female with severe hot flashes, irregular cycles, and weight gain. Has been very estrogen dominant in the past. 5 children with the last pregnancy at 46 years old which resulted in a healthy baby. Recommending Hormone Balance to assist with estrogen detoxification while also providing phytoestrogens for declining estrogen levels. Any other recommendations? No OAT or DUTCH.
PROTOCOL:
Estrovera (Metagenics) – Rhubarb extract that is a potent ER-Beta agonist. This product can dramatically lower hot flashes in most women. Take (1) tablet of Estrovera every 2-3 hours all day long robotically, and again in the middle of the night if she wakes up due to a hot flash. Keep this dose for 1-2 weeks – or – until her hot flash pattern reduces by 80%.
PERIMENOPAUSE SUPPORT – 1 tablet TID. Contains EstroG-100 and Ashwaganda/Milk Thistle.
Cortisol-Lowering Adaptogen Support – SE Serenity, Cortisol Pro
Dr. Spencer:
NW – 40 yr/old female, 5’3″, 155 lbs
Homeschooling mom of 6 kids (vaginal at home births), unhappy with weight gain and excessive gas/bloating.
Has had a total of 10 pregnancies. Earlier this year miscarried and had a D&C and blood transfusion (lots of meds). The gas/bloating and midsection weight gain has been an ongoing problem for the last 10 years, but has been especially bad the last few years. She’s dealt with diastasis recti. Per her size and build, she has an unusual amount of abdominal distention. It’s embarrassing for her, as she is asked periodically by others if she is pregnant (our small children seem to regularly bring it up). She eats mostly clean, organic, grassfed, and little grain. Makes homemade goat milk yogurt and sauerkraut. Six months ago, she began a SIBO protocol (low fodmap/antimicrobials) and was successful in trimming up her waistline and had less bloating. It should be noted that she proceeded with the SIBO protocol without an OAT. We worked on ICV massage and did some hiatal hernia support.
Since her SIBO protocol she has gained all the weight she lost, and then some. She has not been diligent with continuing HCL and digestive enzymes. She feels that Lipoflow helps her. When she remembers, she takes magnesium, omega 3’s and desiccated beef liver. She is frustrated and doesn’t want to have to eat differently her whole life. Any higher fodmap foods result in gas/bloating and she doesn’t know why she can’t handle fodmaps to any degree. She doesn’t exercise regularly. Had a round of antibiotics about 15 years ago. She’s been craving ice cubes lately (used to do that when she was known to be iron deficient).
Although weight gain/gas/bloating are all very concerning to Natasha, I have been concerned that she seems fatigued and needs more sleep than she used to. Historically, I’ve required more sleep than Natasha to function, but as of late she sleeps longer than me (8-9 hrs).
PROTOCOL:
Immunolytic Mold Test
Likely an HLA-DR carrier making recognition of mycotoxin difficult for her system to address
Weed Botanical Co. in Wimberley, TX.
Mycotoxin Test to assess MAGNITUDE of the problem. It could be clear with only one problematic marker on the OAT. OR it could be higher than we thought. Its worth testing.
Stomach – Nutri HCl
Pancreas – Pan 5x
Gallbladder – Stress Essentials Relax 2 TID
Oxalates – Bone Support (1 tablet 5 min b/f meals as needed)
Candida/Mold Bug Killers– Take 2 at a time, rotate every 4 days.
Add’l Support – Binder Pro 2 caps at night;
Liposomal Glutathione – 1 dropperfull 3x per day
MCT Oil 3-4 tbsn QD
L-Glutamine – 10 grams TID
D3 10,000 w/ K2 – 1 QD
-
This discussion was modified 1 month, 3 weeks ago by
Dr. Andrew.
-
This discussion was modified 1 month, 2 weeks ago by Dr. Andrew.
-
This discussion was modified 1 month, 2 weeks ago by Dr. Andrew.
-
This discussion was modified 1 month, 2 weeks ago by Dr. Andrew.
-
This discussion was modified 1 month, 3 weeks ago by
-
6 Replies
-
13 year old with SEVERE arm pain/symptoms-was recently given a diagnosis of Complex Regional Pain Syndrome
Timeline per mom who is an ER physician:
4/25 Partial subluxation left shoulder batting in softball
4/20-5/3 PT
5/2 lots of overhead catches at practice, lots of shoulder pain, then arm numbness
5/3 more arm numbness, went to TCO, normal shoulder plain films
5/4 arm numbness and pain much worse, now with color change purple
Went to Mpls Children’s hospital.
Normal venous and arterial Doppler of the bilateral arms and neck
Normal CXR
Exam: some numbness, and weakness noted left upper extremity
Started on decadron 10mg once and gabapentin 100 TID.
5/6 Increasing pain, numbness and weakness
Went to Masonic U of M ER
MRI with and without contrast of the left shoulder and brachial plexus were normal
MRI cervical spine normal
Seen by Peds Neuro, who thought it was Parsonage Turner syndrome, started on Prednisone 60 mg daily x 5 days, and increased gabapentin to up to 300 mg TID, but Josie didn’t tolerate the Gabapentin, sleepy/dizzy but NO pain relief.
Tried adding ibuprofen, Tylenol, and hydroxyzine/vistaril.
Vistaril seems to help the most.
Seemed a little improved on the prednisone but worse again when 5 day burst of prednisone done.
5/22 seen in Peds neurology clinic, and due to full arm distribution of symptoms and color changes, thought to be Complex Regional Pain syndrome.
Started on nortryptiline and toradol. Significant worsening of pain
Referred to pain clinic who prescribed below as well as specialized pt/ot/rehab for CRPS.
Currently taking nortryptiline, lyrica, ibuprofen, Tylenol, tramadol pen, hydroxyzine. Severe pain 8-9/10 continues. Difficulty sleeping. Unable to go to school.
-
Post menopausal female supplementing with methylated B vitamins and samE in order to keep homocysteine WNL. Now also taking Lipoflow and homocysteine has decreased again from 5 to 4. Estrogen levels are also decreasing. Further presenting with elevated DHEA-S and testosterone (the prostate version female)?
Can you explain how choline affects estradiol levels as it is a potent methyl donor? Will stopping the Lipoflow possibly increase homocysteine and estradiol levels back into normal limits?
-
54 year old female with severe hot flashes, irregular cycles, and weight gain. Has been very estrogen dominant in the past. 5 children with the last pregnancy at 46 years old which resulted in a healthy baby. Recommending Hormone Balance to assist with estrogen detoxification while also providing phytoestrogens for declining estrogen levels. Any other recommendations? No OAT or DUTCH.
-
I would love to hear your thoughts on these recent test results. My biggest concern is the implications for my children.
-
Is there a Q&A this morning? I don’t see a meeting link?
-
NW – 40 yr/old female, 5’3″, 155 lbs
Homeschooling mom of 6 kids (vaginal at home births), unhappy with weight gain and excessive gas/bloating.
Has had a total of 10 pregnancies. Earlier this year miscarried and had a D&C and blood transfusion (lots of meds). The gas/bloating and midsection weight gain has been an ongoing problem for the last 10 years, but has been especially bad the last few years. She’s dealt with diastasis recti. Per her size and build, she has an unusual amount of abdominal distention. It’s embarrassing for her, as she is asked periodically by others if she is pregnant (our small children seem to regularly bring it up). She eats mostly clean, organic, grassfed, and little grain. Makes homemade goat milk yogurt and sauerkraut. Six months ago, she began a SIBO protocol (low fodmap/antimicrobials) and was successful in trimming up her waistline and had less bloating. It should be noted that she proceeded with the SIBO protocol without an OAT. We worked on ICV massage and did some hiatal hernia support.
Since her SIBO protocol she has gained all the weight she lost, and then some. She has not been diligent with continuing HCL and digestive enzymes. She feels that Lipoflow helps her. When she remembers, she takes magnesium, omega 3’s and desiccated beef liver. She is frustrated and doesn’t want to have to eat differently her whole life. Any higher fodmap foods result in gas/bloating and she doesn’t know why she can’t handle fodmaps to any degree. She doesn’t exercise regularly. Had a round of antibiotics about 15 years ago. She’s been craving ice cubes lately (used to do that when she was known to be iron deficient).
Although weight gain/gas/bloating are all very concerning to Natasha, I have been concerned that she seems fatigued and needs more sleep than she used to. Historically, I’ve required more sleep than Natasha to function, but as of late she sleeps longer than me (8-9 hrs).
-
This reply was modified 1 month, 2 weeks ago by Dr. Andrew.
-
This reply was modified 1 month, 2 weeks ago by