3rd functional doctor visit: Results and a treatment plan for GI issues

To start off- I’m not a doctor, nor do I pretend to be one on TV. I’m sharing my results and what treatments were recommended to me by my doctor in the hopes it’s useful for others to hear about someone else’s experience.  None of this information is intended to diagnose or treat anyone.

 Also, my brain fog is pretty intense at times. I try to make sure what I write is correct, but I may get things wrong from time to time.

On August 28^th, 2018 I had my 3^rd appointment with the functional medicine doctor. We reviewed the data for the SIBO breath test, the stool panel, and the urine analysis.

My 1st appointment was a 2 hour long session to cover my health history and order tests.

My 2nd appointment was to go over bloodwork results, hormone results, betaine HCL trial results, and talk about a treatment plan given the findings from those tests.

At the end of the 2^nd appointment, the doctor noticed that the SIBO lab had come in early so she looked at it quickly. She told me I had methane dominant SIBO, but didn’t go into much detail.

I spent much of my time between the 2^nd and 3^rd appointment looking up as much information as I could about SIBO and related issues. Based on what I had read, I went to the 3^rd appointment prepared for a complex treatment plan.

What is SIBO, you may ask? I'll summarize it a little here, but this article gives a pretty good overview.

SIBO stands for small intestinal bacterial overgrowth. While there is bacteria present all along your digestive system, your small intestine is not supposed to have much compared to the large intestine and colon. As far as I understand, the bacteria that overgrows in your small intestine is not necessarily bad bacteria, it's just that it's growing in the wrong place. SIBO can cause lots of digestive issues and icky GI symptoms. Before the test, I did not think I had SIBO because I really only ever experience one normal SIBO symptom- constipation. However, I also found that SIBO can cause fatigue and brain fog, both of which I have experienced for about 2.5 years.

We started out reviewing the SIBO test results, which was pretty quick since I already knew I had methane dominant SIBO.

My treatment course for SIBO looks a little different than others I had seen online, but I’ll talk more about it at the end of this post. The reason for this is because my SIBO treatment takes into account other issues that came up in the tests. Just like every person is different, each SIBO treatment for an individual may vary depending on what other issues they have. 

The doctor then walked me through the results of the GI effects stool profile. I did look up the interpretation guide for this test a few weeks prior to the 3^rd appointment, but I didn’t spend as much time looking at it, because there are lots of potential results.

The results indicated I have a parasite, I don’t digest fats well, I have a yeast overgrowth, and the bacteria in my gut are not well balanced.

The parasite results are pretty easy to understand- they’re either found in your stool or they’re not. It turns out I have blastocystis hominis.

When I asked my doctor how one obtains blastocystis, she said it was fecal to oral transmission typically from contaminated food or water. Gross! I learned from the CDC website  just now that people who have blastocystis may or may not have any symptoms. Given everything else we found, I don’t know what, if any role, it might play in my health issues. My treatment for this parasite is an antibiotic called metronidazole.

The stool samples had quite a bit of fat in them, meaning I don’t break down fats well. The test splits fats into triglycerides, long-chain fatty acids, cholesterol, and phospholipids. My values for phospholipids and long-chain fatty acids were over the reference range, the triglyceride value was on the high end, and cholesterol was normal. The total fat count was over the reference range. I was prescribed a digestive enzyme that should help with the fat break down until my gut health improves.

The yeast result was not a surprise to me in general, but the way it showed up in the lab was surprising. I have had issues with yeast in the past, and I know if I eat lots of sugar I will end up with a yeast infection. In the stool results, yeast showed up on the low end of the range, but apparently, if it shows up at all it indicates the number would have been higher before it reached the lab. The yeast will be treated with a round of Nystatin.

The gut bacteria imbalance results were the ones I found most interesting.

 I had previously thought that lots of good bacteria in your gut are good. However, having too much good bacteria in your gut can be bad, because they can out compete the other good bacteria. For example, I have some lactobacillus, but it’s on the low end. I have lots of other bacteria that are quite high and aren’t allowing some of the other types of good bacteria to thrive.

In conjunction with the bacterial levels being imbalanced, my results indicate I have low short chain fatty acids (SCFA). SCFA’s are produced by good gut bacteria as part of their fermentation processes and help the gut to be healthy. Until we can get the gut levels rebalanced, I’ll be taking a supplement called probutyrate to help with the low levels.

After all of the GI effects results, we went over a small portion of the urine analysis results. I had completely forgotten I had given urine samples, so I was surprised when we went over those too! I think I forgot about them because they were the easiest sample to give.

We really only looked at the bacterial dysbiosis markers. Since this was towards the end of my appointment, my memory on what the doctor said about them is fuzzy. I think she was just pointing out that the gut dysbiosis markers were wonky in the urine analysis, which confirmed the results of the stool samples. I was told the urine results would be gone over in more detail at the 4^th appointment.

Let's loop back to SIBO for a moment so I can tell you how my doctor arrived at my treatment plan. There are both manmade and plant-based antibiotics that can be used to treat SIBO. The manmade antibiotics have had more studies done, and the results are pretty well established. While the plant-based antibiotics aren’t studied as well, those prescribing them have seen that they can work just as well as the manmade antibiotics.

In my research, most others treating methane dominant SIBO use a combination of Rifaximin and Neomycin that are taken at the same time.

Because of the blastocystis, I need to take a course of Metronidazole to kill it off. Apparently, Neomycin and Metronidazole can both be used in SIBO treatment. Since I already needed one manmade antibiotic, it made sense to go ahead with the Rifaximin assuming my insurance covered some of it. Rifaximin is quite expensive and tends to only be covered in certain instances, so we’re waiting to see what amount insurance might cover.

Apparently, we can replace the Rifaximin with herbals if necessary, but I got the feeling from my doctor that it’s more typical to pair like antibiotics together.

The doctor had mentioned that she had seen a different patient earlier in the day that had SIBO and other concurrent issues that needed herbals, so in that case, it made more sense to go the herbal antibiotic route for that patient. Again, depending on what other conditions a person has, the treatment can be quite different.

I had read in several others blogs that people took either Allicin or a type of guar gum to help activate the SIBO bacteria so they could be more easily killed off during the treatment phase. When I asked about this, the doctor said to focus more on food sources that cause symptoms for me rather than on another supplement. I found her to be very conscientious about level of functionality during treatment and number of pills taken at a given time.

Speaking of functionality, most other treatments I had read about combined the Rifaximin and Neomycin at the same time. With my treatment plan, I’ll be taking a course of the Nystatin to kill off the yeast, a course of Rifaximin for the SIBO, then a course of Metronidazole (Neomycin alternative) that will help with the SIBO and the parasite. The courses are taken one after the other instead of at the same time to help with functionality during the treatment.

After all of that, I’ll have a four-week course of Berberine and an olive leaf complex. This was at the very end of my appointment, and I honestly don’t remember the exact reason for this. 

The whole treatment period will take about 10 weeks.

During the active treatment, I will also be taking some supportive supplements:

•      A digestive aid
•        A SCFA supplement
•        A probiotic
•        An immune globulin concentrate to help with passive immunity

I will also be taking supplements to support other issues that were discussed in my 2nd appointment, which I’ll talk about in a different post.

While hearing about the treatment itself wasn’t overwhelming during the appointment, sitting down and trying to figure out how to get through it is becoming increasingly overwhelming, especially with decreased mental capacity. I’ll talk about prepping for the treatment phase in a different blog post.

CRASH!

This year on June 17th I turned 35. I also had the worst adrenal crash I've experienced to date.

Over the last year and a half, I had slowly been regaining my energy. I was doing so well that I spent a whole day at the end of May helping my best friend move, and was totally fine!

I had several plans in mind for the summer- camping, paddle boarding, and hiking were all high on my priority list.

My body had other plans.

The day I crashed was a Sunday. The Thursday prior I had picked my husband and daughter up from the airport after a late flight. We probably got home around one in the morning. Friday, Saturday, and Sunday I didn't sleep well at all and definitely didn't get enough hours of sleep.  When I woke up on Sunday morning I was exhausted. That day, our church was having its service at a local park, and I was supposed to give announcements. I knew when I woke up there would be no way that I could go that day, so I had to ask someone else to take over my emcee responsibilities.

The next several days after the crash I realized that I hadn't felt that level of exhaustion since quitting work. All of my previous crashes had been minor; I would overdo it one day, then be a little tired for 3-4 days. I would never go back to being exhausted, though.

In the previous year and a half, there were nights that I stayed up late and/or couldn't sleep, and there were plenty of nights that I didn't get enough sleep. I couldn't understand why the crash in June was so bad when I hadn't done anything drastically different.

The whole thing was disconcerting, to say the least. I started to obsess about what had happened. I tried to think of everything I had done that might have been a contributing factor, and there was nothing I could come up with.

I finally had this thought: there must be something else that's wrong.

Not knowing what else could be wrong, I tried to think about how I could figure it out. A few years prior I had got a postcard in the mail about a functional medicine doctor that sounded really good. I happened to think about them, and looked up their website. They had a package that included 4 visits and a bunch of tests up front. The more I read, the more convinced I was that I needed to go see them.

In my old job, I analyzed data sets for complex environmental sites. Over time, my team and I discovered that when you have more data and multiple people from different specialties looking at the data, you end up with a better idea of what's going on with the site.

It made sense to me that the same concept that we applied to environmental sites could also be applied to my body. With all the tests that were run up front, and with at least 2 different doctors in the same practice looking at the data, I figured I would get some answers!

 After talking to my husband about the functional medicine package benefits and costs, we decided to go for it (even though the office visits would be out of pocket).

I had one more visit with my old doctor two days before my first functional medicine appointment. It was hard to tell her that I was going to seek a second opinion and that I would undergo more testing. She seemed surprised but told me to do what I needed to. I'm glad that I had already booked the appointment with the functional medicine doctor- if I hadn't I may very well have just kept going in the same direction with the same doctor. The things she was telling me made sense, assuming I only had adrenal fatigue. I felt that perhaps I had overreacted a bit to the crash and that maybe I was going to waste a bunch of money going down a different rabbit hole.

It turns out I was correct in my thinking that there was more wrong than just the adrenal fatigue.

I just completed the third of four visits. I'll try and post about each visit individually over the next few days.

Flailing

I'm not someone who is really into watching the Olympics, but my husband and I would catch an occasional event on TV this past summer.

Some of the events we watched were the 100 m and 400 m races.  For whatever reason, I remember the commentator pointing out that when the runners got close to the finish line some of them started to flail, which caused them to slow down a bit.

My current finish line is on October 6th, my last day of work. As I approach that finish line I feel myself flailing...slowing down.

It's harder to get up in the morning, harder to make breakfast, harder to get out of the door on time.

When I make it to the office, it's hard to pay attention.  Hard to know how to finish out my responsibilities.  Hard to know I'm letting people down.

I stopped by the grocery store on the way home from work today. After I got all the groceries put away, I had to go take a nap.

I only worked 4 hours.  Grocery shopping didn't take that long.

I know adrenal fatigue makes you exhausted, but sometimes I'm surprised by just how little I can do before I reach the point of exhaustion.

The other thing I remember about the Olympic races is what happened after people crossed the finish line.  Some people fell over, some people stayed upright.

I have obligations over the weekend, but once the 10th rolls around, I have a feeling I'm going to fall over.  I feel like this is not a bad thing....it seems like a good place to rest for a bit.

Starting Somewhere

Originally written 9/24/16

I don't know where to begin with explaining where I am.

Perhaps I'll start with the fact that after about 9.5 years, I just recently gave my employer my two week resignation notice due to health reasons.

In July 2015, while in town for my sister's bridal shower, my mom had commented that my hair was looking a little thin.  At the time, I hadn't really noticed.  Suddenly, I found myself staring at other women's heads in an attempt to ascertain if my hair was actually thinner than an average women my age.  I came to the conclusion it was.

At the time, I juggling the equivalent of 3-4 roles in my company, traveling every few weeks, and navigating relationships with people who would eventually become my husband and step daughter. I was maxed out and anxious. I didn't really have time to think about my hair being thin, or what it implied. 

Summer 2015 turned to fall.  Paul and I were engaged in early October, and married two weeks later. we both were traveling right before and after our marriage. We barely saw each other that first month as husband and wife.

Work continued to be stressful. The holidays happened in a blur.  

In late December/ early January, I felt the need to put on a multi day training for the new hires at work.  I was so overloaded with client deadlines that the training was designed, written, and scheduled almost entirely by me, and almost completely on weekends.  I essentially worked for an entire month straight.

I had gotten really good at doing what needed to be done for everyone else but myself.

The week after training, when I had some time to breath, was when I started to notice that things were going downhill. My hair loss seemed to be increasing.  I was abnormally tired.

I went to the doctor.  

We did some tests and discovered I had adrenal fatigue. The stress I had been under had maxed out my little adrenal glands, and they weren't working quite right anymore.  I found out, when you have adrenal fatigue, there are lots of things that don't work right anymore.

I couldn't work 8 hour days anymore.  I was using my flex time and vacation time to lessen the number of hours I was at work each day.

My Dr. told me to take time off work, then start working reduced hours. I did.

The time off was interesting.  I had weird symptoms pop up when I stopped working.  Heart palpitations, fluttering in my throat, waking up in a panic.  Sometimes it felt like I was being lightly choked.  The symptoms lessened over time, but were still disconcerting.

Going back at half time seemed like something I could manage. I got an office outside of my house to deal with some of the stress I was experiencing.  It helped for a while.

The summer  of 2016 had it's challenges and heartaches. We had a family tragedy in July.  My beloved dog Claire battled cancer for a month, with me as her hospice nurse. She finally had to be put to sleep in early September.

At this point it doesn't matter where stress comes from, whether it's work or home. Any stress from any where effects everything. 

I've come to the point where I feel like I am barely functioning on most days.  Sometimes I can only complete one thing well - making breakfast lets say-  and after that I'm spent. Oh I do things the rest of the day, like go to work, but I function like a zombie.

Which is how I got to the point of leaving work.

The best medicine for adrenal fatigue is rest, and that's what I plan to do.

I was reading the Bible the other day, and Matthew 10:39 jumped out at me:

"If you cling to your life, you will lose it; but if you give up your life for me, you will find it."

And all of a sudden, the verse made perfect sense.  It spoke to me in a way I had never heard before.

I had been clinging to my job, to my sense of pride that I could do it all and then some.
I was clinging to what the world saw as worth.

I remembered what some dear friends had told me repeatedly... that I had worth because I was a child of God, not because of all the stuff I did.

I feel like I'm in the process of being deconstructed. That the life I had clung to is being torn away.

I hold onto Matthew 10:39 as a promise.  A promise that my old life, the one I had created around the world, is passing away.  And in that death, a new life will be constructed for me that is built around God, and I count that as a joy!

A few people have asked me, and I'm sure more will, what I'll do in the future.

Will I go back to my old job?

Find a new one?

Become a permanent housewife?

The honest answer is that I'm not even thinking about it. 

I can only take care of myself one moment at a time, anything else is overwhelming.

I'm choosing to trust God in this deconstruction.  He is calling me to rest. In my Bible reading this morning, Matthew 11:28-30 spoke to me: 

28 “Come to me, all you who are weary and burdened, and I will give you rest. 29 Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls. 30 For my yoke is easy and my burden is light.”

And once I read those words, it felt like my whole being sighed and said yesssssss. Please.

So what I will do moment by moment moving forward is:

• rest

• trust that God has a plan for me

• trust that He will provide

 I have no anxiety about that. No indecision, just peace.

From Pagan to Chrisitan

Originally written on 2/6/16

When I’m trying to make my mind up about something, I typically search the interwebs to help me find information on both sides of a decision.

Sometimes my searches are not satisfying.

I identified as Pagan from the time I was a senior in high school, until just before I turned 32.

In thinking about making the switch from Pagan to Christian, I was unsure of myself.  I searched the internet for others who had made the journey before me.  While I found some information on those who made the switch, it was typically only a few sentences on a forum someplace.

I was craving a much deeper discussion than what I was finding in my searches.

So, for others thinking about making the switch from Pagan to Christian (or for those just wondering why on earth someone would even think about switching!), I want to give you the discussion I was looking for.

I also want to shed some light on things that Christians did that I found weird (or just didn't understand) when I was still Pagan.

Ultimately, I made the decision to follow Jesus after an encounter in love, an encounter with community, and coming to terms with two issues that were gnawing at me.

In winter of 2014/2015, I was dating a man named Paul, who was Lutheran. We lived about a half hour apart, and one day while driving home from his house, I discovered a Colorado based Christian Radio station called Grace FM.  When I first started listening, I was mainly interested in what they were saying about the culture in Jesus’ day.  As I continued to listen, I started to wonder, is this stuff for real?

One night I was looking at Paul, who I loved dearly (and who is now my husband!), and I thought to myself ‘if he goes to heaven and I don’t…. I don’t like that idea’.

It was that thought, that we might not be together in heaven, that inspired me to keep listening to Grace FM, and start looking a little harder at Christianity.

After a few misses, I found a church in May 2015 that resonated with me. I can (and will) write a whole post about The Pursuit Church and what it means to me, but for this post, let’s just say I found a place that welcomed me for who I was, and was full of really authentic people. It was like God knew I needed REALLY fertile soil to be planted, and so he led me there.

And then there were my two hang ups, the things that kept me from taking that step of belief:

11. What are people going to THINK?!

I was so adamantly against Christianity for so long, that the thought of telling people I was considering Christianity as my new life seemed…..ridiculous. I kept playing the conversations I was going to have with people over and over again, and I couldn’t wrap my mind around how to make that conversation work. One day, I realized that my decision to follow Jesus would have ETERNAL ramifications.  Once I started thinking about things on an eternal basis, I stopped caring what people here on earth thought.  I realized it really only mattered what GOD thought of me.

   2.  I’m too BAD for salvation!

We have all done things we regret. I personally have made a ton of mistakes. I have hurt people I cared for. I had spent my whole adult life pretty much marinating in sin. How could I come to God, unclean as I was? During the time I was thinking about converting, I was listening to a Grace FM fairly often. In a one week span, I had heard on Grace FM multiple times that salvation is not something that is earned, it is something that is given.  That there is no reason to ‘clean up your act’ before coming to God, that God meets you where you are. Once I heard, for the umpteenth time, that salvation isn’t earned, I started to believe it.

If I had to sum up in one word how I decided to go from Pagan to Christian it would be LOVE. There was no amount of logic, no amount of arguing, and no amount of guilt that ever could have moved my decision along. My decision to follow Jesus was about LOVE.

All work and no play makes marcy a mess...

So I learned the lesson that actual work when out of balance with actual life is bad.  What I apparently failed to connect is things that are work-like also count against balance even though it wasn't actual work.
What am I talking about?
I decided to move in with my boyfriend in December, and since then I've been 'working' almost non stop to make it happen.  First it was purging stuff from the house, then it was the packing, then it was the moving (which happened over a period of a few months, since I was relativity close and could move jeep loads sporadically), and THEN it was getting my house ready to rent, which was WAYYYY more work and time than I ever expected.  Now that the house is rented, we have projects at our house- building and planting the garden, rearranging the basement, STILLLL unpacking....

It's been one thing after the other for about 5 months, with almost zero down time.

I've slowly been going downhill, but the last 2 or 3 weeks I've really noticed that I'm feeling off. It's funny- for only moving a half hour north to a town I was already familiar with, I feel out of place still.  I dont necessarily know where everything is, or where to go, or what to do.  There are events I never would have attended before on week nights because the drive was too far....and now it would be easy, but I never think about doing anything because I'm so used to living farther away.

One of the results of the above is that I haven't gotten out of the house much since I've moved, which was starting to drive me a little batty.

I also haven't been playing much music since the first of the year...being busy and stressed for me basically crushes any creative impulses I have.  I know from experience that I do better as a whole when I'm playing music, but it's hard to convince myself to play anything when I'm exhausted.

Now that I recognize all of this, it's time to get out of the house more, play more music, and enjoy the fact that I no longer have to deal with my house!

Set Backs and Such

I had a panic attack today, which is kind of funny because I have been telling people in recent weeks that, yeah, I had anxiety once that was debilitating!  But I'm over it now.

Apparently I'm not as over it as I thought.

I have been careful in the last year not to overwhelm myself with too many activities, and be busy more than a few days in a row. However, I have a tendency, when I start feeling better, to push faster than is wise....and it always catches up with me.

I imagine this panic attack has been brewing for about a week, I've been way busier than normal, I haven't been eating quite as well, and the new responsibilities I've taken on at work are starting to feel a little heavy. I've been more reactive with my coworkers, and nit picky details have worn me down.

I'm not sure exactly what the trigger was this afternoon, but I started to feel panicky.  It may have been all the work I need to finish by the end of the day, and all of the things I needed to accomplish tonight to prepare for a trip this weekend. I remember thinking about how my boyfriend had asked me to go to his neighborhood HOA meeting since he couldn't be there, and that I was planning to go, but with all the other things going on it seemed like that HOA meeting would prevent me from getting everything done.  In my mind, I was letting my bf down big time by not having the capacity to go to the HOA meeting, I had just found I let some things slip at work, and I lost it.

I called the bf and left him a nearly hysterical message about how I was overwhelmed, and that I was sorry, but I wouldn't make the HOA meeting.  This was approximately 8 minutes before a client meeting.

After hanging up, I cried, hyperventilated, and generally panicked. I then pulled myself together enough to sit on a web conference.

The bf called a few hours later, and I tearfully walked him through what was going on.

I think the most upsetting thing about the whole episode is that I had said to myself 'I am never going back' ...not going back to the stress, anxiety, unhealthy habits, etc.

I have forgotten how disastrous panic attacks are to ones day... I couldn't concentrate afterwards, I felt scattered and exhausted. I felt like I was a huge disappointment.

I was barely functional for several hours.

This is not the place I want to be.

The bf reminded me that it was about the middle of the month, and that he's noticed that I tend to be more emotional during that time.  I'm not entirely sure what my hormones are doing, but there is a time between my period and ovulation that I seem to loose it a bit.

We also talked about how I've had a bunch of body work lately- acupuncture, chiro, and lymph massage that could have stirred some things up.

I'm hopeful that it's just a convergence of events that led to this, and that I'm not slipping into a new normal, because I desperately don't want to go back.