For the 2 case studys, please come up with a nutritional treatment plan and answer the following the questions.
1.Come up with a diet and lay it out
2.Come up with a list of supplements and dosages
3.What lifestyle changes does the person need to make?
4.Analyze the lab work that is provided.
5.What labs should get retested and how often should they get retested?
6.What lab tests are missing that would you come up with a better treatment plan?
7.Which issue/symptom would you work on first or work on both of them at the same time?
8.Detail expected outcomes and time-frames of nutritional interventions
9.Detail to client on when to be monitored for potential medication changes
10.Setting client expectations/potential impact of therapeutic plan
11. Identify potential drug interactions, or drug nutrient/botanical interactions
Case Study – AD
A.D is a 12 year old boy presented with ADHD, Environmental allergies, asthma, insomnia, migraines, dysgraphia, muscle cramps, stomach pain, nausea and diarrhea. He was first diagnosed with ADHD at 5 years of age. He repeated kindergarten because of attention and behavioral difficulties. He began methylphenidate (Ritalin) in first grade and continued through forth grade, although parents indicated that it didnâ€™t change his behavior significantly. In 4th grade the drug was discontinued due to growth retardation. Off the medication, he pu ton weight but also started to increase junk food and deli meats.
A.D. has never received a positive teachers report. Off the Ritalin he continued to be disruptive and unfocussed.
A.Dâ€™s allergy symptoms were sinus congestion, and post nasal drip, sore throats and hives for which he took Zyrtec. His mom removed the carpets from his room and installed hardwood floors, but this had minimal improvement. His mom noticed symptoms worse with dairy. He would end up with sinusitis 3-4 times a year for which he was prescribed antibiotics.
As a toddler, A.D., developed asthma, hyperkeratosis pilaris and eczema. For the asthma he was maintained on Albuterol, Levalbuteral ( Xopenex) and Flunisolide (AeroBid). The asthma made breathing and sleeping at night difficult.
He also suffered with cold induced asthma attacks. His skin and anus were frequently itchy, and he got frequent canker sores in his mouth.
A.D. suffered from migraine headaches with hypersentivity to light and sound, and had muscle cramps and spasms for which he was given acetominophen and ibuprofen.
His stomach pain was treated with cimetidine. He also complained of naseau and had frequent bouts of diarrhea.
A.D was a healthy 7 lb. 12 oz baby, but vaginal delivery was difficult. He was treated for hyperbilirubinemia. He was breastfed for 10 months, and then given soy formula due to a â€œsensitive stomachâ€
Gluten-containing grains were introduced before 1 year of age. He was prone to diaper rash, had sensitive skin, and frequent ear infections that were treated with frequent antibiotics.
COMMENT: When introduced before the age of 1, gluten containing grains are associated with a statistically significant increase in incidence of celiac disease in susceptible patients. The use of soy formula in infants with a first relative with allergies may be associated with increased incidence of allergies, food intolerance and eczema. Early antibiotic use is also associated with increased incidence of atopic conditions, including asthma.
Immunization- Full vaccine schedule including annual influenza shots.
Trauma– a concussion at 5 years old. CT scan was WNL.
Family medical history- A.Dâ€™s mother had migraines, sinusitis, and food allergies. His sister had environmental allergies. A.Dâ€™s father was in good health.
Medication and Supplements:
Levalbuterol Inhaler ( Xopenex )
COMMENT: This is an overwhelming pharmacopoeia for a 12 year old boy, and his physical, mental and behavioral symptoms were far from being under control. DINDâ€™s from the medications have been involved in the pathogenesis of his complaints. Cimetidine has ben linked with nutritional deficiencies and GI bacterial overgrowth from gastric acid inhibition. Glutathione depletion results from acetaminophen use; and intestinal permeability with the NSAID such as ibuprofen. Flunisolide has also been linked to inhibition of growth.
Zinc- Low 2.5 ppm
Mg- Low 15 ppm
Cu- Low normal 260 ppb
Mn- low normal 22 ppb
Chromium- Low normal- 1.7 ppb
Comment- A.D was very low in Zinc and Magnesium. Zinc is implicated in Asthma, Atopic Dermatitis, Allergies, and ADHD. Magnesium is also implicated in headaches, insomnia, muscle cramps and spasms. Copper and Manganese are cofactors in the antioxidant enzyme Superoxide Dismutase.
Vitamin E- Low normal 7.2 mg/L
Vitamin A- Low normal .55 mg/L
Beta-carotene- Low <0.2 mg/L
Serum Fatty Acids
Palmitic- High normal 3425 ÂµM
Stearic- High normal 951 ÂµM
Trans- High 215 ÂµM
Arachadonic acid- High 785 ÂµM
Urinary organic acid
Kynurenate High normal 3.0 Âµg/mg creatinine
Xanthurenate- High normal 0.9 Âµg/mg creatinine
Serum D 25OH- Low 24 ng/ml
IgG 0-5 +
IgG antigliadin – High normal 17 units
Urine toxic metals
Lead- High 17 Âµg/g creatinine
Plasma Amino Acids-
Tryptophan- Low 30 Âµmol/L
Urine Neurotransmitter metabolites
Homovanillate- Low 2.0 Âµg/mg creatinine
5-hydroxyindoleacetate- Low 2.1 Âµg/mg creatinine
Breakfast- Eggs, bacon, cereals with soy milk, occasional fruit.
Lunch- Deli meat sandwiches, cookies, peanut butter and crackers, carrots and lemonade.
Dinner- Pizza, pork or chicken, broccoli, green beans, rice/pasta/potatoes.
He has a strong craving for sugar and pasta. He ate candy, cookies or ice-cream on a daily basis. Although he felt better when avoided it.
Environmental Exposures- His home had an unaddressed mold infestation. Type of mold was uncertain. Allergic to tree pollen and mold.
Focus on Goals of treatment: General and specific
Focus on treatment strategies– Lifestyle strategies, diet/nutritional recommendations, Nutraceuticals/Vitamins/Minerals/antioxidants/Minerals
Case Study- VS
VS is a 53- year-old woman who has recently been diagnosed with inflammatory arthritis (IA). She is currently complaining of constant swelling, stiffness, and pain, with occasional numbness and tingling in her hands, wrists, and elbows. She reports her pain as 8 (0=no pain; 10- greatest pain) and states that the morning pain is frequently unbearable, rating it as 9 or 10.
Weight: 170 lbs.
Marked edema, warmth, and tenderness is noted in her metacarpal phalangeal joints and digital flexion is decreased due to edema.
History reveals VS first noted symptoms if IA about 6.5 years ago and they coincided with the development of mold in her homeâ€™s basement after flooding. She moved from the home shortly after this and she experienced full remission. Two years later, after the loss of a close aunt, VS experienced a return of all symptoms and was prescribed several medications, but could not tolerate the side effects and stopped all medication at this time. VS also had undergone a radical hysterectomy due to severe uterine fibroids when she was 32 years old, at which time hot flashes and insomnia developed. The hot flashes and insomnia continue to this day. Additional symptoms and conditions reported by VS include severe fatigue, IBS with constipation, chronic urinary tract infections (UTIs), and weight gain (over 30 pounds in the past four years). She has taken multiple courses of antibiotics over the years due to the UTIs. She has also had a recent diagnosis of osteoporosis with a T-score of -2.7.
Medication and Supplements:
diclofenac and misoprostol (Arthrotec 75)- one tablet twice daily
alendronate with D3 (Fosamax Plus D)- 1 tablet weekly
clonidine (Catapres)- 0.1 mg orally twice daily
Note: Hydroxychloroquine (Plaquenil), methotrexate, and prednisone had been discontinued by VS prior to this visit.
VS reported laboratory results from her last rheumatology visit:
antinuclear antibodies (ANA): 4+ elevation
erythrocyte sedimentation rate (ESR): 53 millimeters per hour
rheumatoid factor (RF): negative
VS typically skips breakfast. She drinks 3-4 cups black tea daily. Lunch is frequently cheeseburgers from a fast food restaurant. Since VS does not enjoy cooking, she frequently eats dinner out as well. She reports her previous nightâ€™s dinner was Mexican chicken with rice, chips, and salsa. VS also mentions that she craves salty and sweet foods and drinks diet soda daily.