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  4. 85-year-old woman with extreme mood problems of anxiety and hopelessness had two years of recurring bladder infections and lots of antibiotics. Last antibiotic was a shot of antibiotics that brought on diarrhea that lasted for two months with significant weight loss. At the same time she was eating nothing but vegetables, long story which I stopped and put her on to more solid food diet. The diarrhea is improving. Doctor’s Data stool culture was all she felt she could afford. Results are all 4+ except no growth Bifido and 3+ Clostridium. Negative for C. difficile. Commensal flora are all 4+ and Pseudomonas aeruginosa 2+. All other markers in the normal range. Is no growth Bifido enough reason to give it deficiency diagnosis? What about the number and extent of commensals?

85-year-old woman with extreme mood problems of anxiety and hopelessness had two years of recurring bladder infections and lots of antibiotics. Last antibiotic was a shot of antibiotics that brought on diarrhea that lasted for two months with significant weight loss. At the same time she was eating nothing but vegetables, long story which I stopped and put her on to more solid food diet. The diarrhea is improving. Doctor’s Data stool culture was all she felt she could afford. Results are all 4+ except no growth Bifido and 3+ Clostridium. Negative for C. difficile. Commensal flora are all 4+ and Pseudomonas aeruginosa 2+. All other markers in the normal range. Is no growth Bifido enough reason to give it deficiency diagnosis? What about the number and extent of commensals?

Dr. Amy Nett:  No. So if all beneficial bacteria are 4+ except Bifidobacterium, no I don’t think that’s enough to consider it insufficiency dysbiosis. So 4+ for alpha and mucoid E. coli and 2+ for gamma-hemolytic strep and Pseudomonas. No I don’t think that’s enough for me to call it dysbiosis. That’s within normal range for me. And then you also mentioned that her diarrhea is improving, there are no markers of inflammation like lysozyme or calprotectin. So what I would probably do, okay so you’ve switched her diet and I’m trying to decide honestly if I would run one more test for C. difficile. If her diarrhea does not improve, I would run one more test for Clostridium difficile. Maybe run it through BioHealth. Yeah, run it through BioHealth and you can run an individual marker for C. diff, but I think it’s worth ruling out if diarrhea persists just because of the context you put this in.

 

Otherwise, I would try the rebuilding the healthy gut protocol which is going to be the focus of prebiotics and probiotics. And I would see what her symptoms look like at that point because I think that’s going to be the most likely in terms of what’s potentially contributed. And I know we’re seeing all 4+ here, but something disrupted her gut microbiome after that antibiotic and of course we’re not measuring the full spectrum of GI microbes here. So I would try the rebuilding the gut protocol. If she gets worse on that, then reconsider. Maybe do an antimicrobial protocol but anxiety, hopelessness, I would also take a look at her blood panel. In an 85-year-old woman who was eating nothing but vegetables, this could be a nutrient deficiency issue so I would think about really a big focus on a nutrient-dense diet.

 

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