Yes, absolutely. Polychondritis of the ear, so uncommon chronic disorder of the cartilage that’s characterized by recurrent episodes of inflammation of the cartilage of various tissues of the body. Relapsing polychondritis can be progressive, and I’m not clearly finding whether or not this is autoimmune. It looks like it’s more likely just within the inflammatory category rather than autoimmune. I’m not seeing any specific antibodies that are specific here. Again, this is just from a really quick Google search. I don’t know with certainty. But Adam says, “It’s a mysterious diagnosis.” That sounds about right. I remember seeing this as a radiologist, but I haven’t seen that as the functional medicine practitioner. That’s absolutely fine if you want to avoid nightshades and eggs. It sounds like you’re doing more of an autoimmune Paleo diet from that slant. If she’s open to that, then go for it. Just because it sounds like she disappeared after you suggested a food elimination diet, it might just be best in terms of compliance to do a strict Paleo diet. I would be more interested in having her really strictly grain-free, dairy-free, avoiding any added sugars, processed or refined foods. If she’s open to avoiding nightshades and eggs, that’s fine. I think avoiding eggs could make sense just because they can be a common trigger, but if she’s having a hard time with the compliance, then maybe run the Cyrex Array 4.
For testing, I would think of right away, I always do a comprehensive blood panel because they don’t want to miss anything obvious. For her, I want to see markers of inflammation. What’s her C-reactive protein and copper-to-zinc ratio? I also want to make sure her vitamin D level is where we want to see it. I would probably target it around 50 to 60 for her, look at her reverse T3, look at her homocysteine, so comprehensive blood panel just to cover our bases. For nervous system, sort of testing the HPA axis, I would run — How old is she? Because I would run the Precision Analytics advanced adrenal assessment. I would probably run the complete hormone profile in her. I know we’re not really covering the sex hormones in this course.She’s about 40. She could be perimenopausal. A lot of women have are in perimenopause for about 10 years. If she’s somewhere in her 40s, we could be starting to see some of the hormones shifting, maybe progesterone dropping a little bit. We could think about running the DUTCH complete hormone profile or Precision Analytics DUTCH hormone test. That’s one way to look at her nervous system as well as her sex hormones, or I should say her HPA axis. Then I would also run a BioHealth cortisol awakening response test. We’ll be going over the DUTCH advanced adrenal assessment profile and also the BioHealth cortisol awakening response test later on in the course. We tend to run both of those tests at the same time. There are just different ways for understanding the sympathetic nervous system response.
We always run gut testing. I would still probably do a SIBO breath test, CSAP x3. If she is not having got symptoms, then I would use BioHealth only for the Helicobacter pylori test. I think that’s a good basic place to start. If she has mercury amalgams, then I would probably run the Quicksilver mercury tri test, but I would probably say of having metal testing for the next step. I think the comprehensive blood panel, HPA axis assessment with the Precision Analytics DUTCH test, the BioHealth cortisol awakening or CAR test along with SIBO breath test, Doctor’s Data CSAP3, BioHealth Helicobacter pylori, and then if needed Cyrex Array 3 or 4. That should keep you busy for a little bit. If you need to prioritize those, comprehensive blood panel, food sensitivity testing if she is not compliant with an elimination diet.
Adam says, “Wow.” I know, but this is normally how we work with our patients. That’s why I’m saying if you need to prioritize, I feel like a comprehensive blood panel has to be part of it because you just don’t want to miss the obvious things. If she has a primary care doctor who’s already run one that’s fine, but you don’t want to miss something like anemia. Maybe her vitamin D level is 9. I feel like we can’t afford to miss the really basic things. If she’s sort of sympathetic nervous system, you’re saying like she’s a little bit on the high stress side, I would prioritize honestly gut testing over HPA axis testing. The reason is because on the DUTCH advanced adrenal assessment test, and again, you’re looking at free cortisol, free cortisone, total cortisol production, and so my guess is it may surprise us, but most likely you’re going to see high cortisol levels, maybe high free cortisol, maybe high total cortisol production, some combination of a wonky HPA axis. While we can do some supplements to help modulate HPA axis and modulate cortisol response, really, the way at addressing cortisol and cortisone is getting to the underlying inflammation — the toxins, the inflammation, whatever is driving that wonky HPA axis. I would say my top priority would probably be gut testing as a first step because I have a lot of patients who come in with something totally unrelated to the gut.
A patient the other day with Meniere’s disease, and his gut was like a total disaster in terms of looking at the test. His symptoms never would have suggested that. I would say comprehensive blood panel, then the priority would be gut testing because if you don’t have — Yes, gut testing. Adam’s asking for clarification. SIBO breath test, Doctor’s Data stool test, and then someone over maybe 35 also a BioHealth Helicobacter pylori test. If it’s like, well, we have to just do one at a time for financial reasons or whatever, then you can kind of go based on symptoms. If she doesn’t have bloating or your classic SIBO symptoms, then do the Doctor’s Data CSAP3 and a Helicobacter pylori test through BioHealth. Then, if those are completely normal, unlikely, do the SIBO breath test, or if you have something to treat on the Doctor’s Data stool test, treat that. Do your 60-day protocol, two weeks off, do a follow up stool test for whatever you needed to follow up on, and then do the SIBO breath test at that time to make sure the SIBO is treated. Do gut testing once you have gut in alignment, once you have the blood chemistry profile spot on where you want it. Then you do HPA axis testing, so then that would be the DUTCH complete hormone profile if you’re comfortable doing that or at least the advanced adrenal assessment along with the BioHealth cortisol awakening response test because hopefully by then you’ve brought down inflammation.
Do you think I should add the Cyrex autoimmune panel? My initial response is no, only because when I listed all those initial tests, you said “wow” as in that’s a lot of testing. What are you going to do if that Cyrex autoimmune panel comes back with a whole bunch of markers out of range? Well, you’re going to need to test the gut, and you’re going to have to get the gut treated. Then you’re going to have to get the HPA axis in balance, and then you’re going to have to remove any heavy metal toxicities. Then you’re going to have to find are there any foods that are still triggering her. You can do the Cyrex autoimmune panel if you’re going to use it to motivate her to say, “Look, these workers are out of range. We need to do this…” that and that “This is why we need to take diet seriously.” “This is why I want to make sure you don’t have heavy metal toxicity.”
But remember, in Tammy’s case, that backfired because she tested a patient with the Cyrex panel so that she could say, “Look you have sensitivities to wheat and gluten, absolutely must take it out.” Then there were no sensitivities, so then that takes away her argument. What do we do if the Cyrex autoimmune panel comes back positive? What do we do that comes back negative? If that would change how you go, then I think you could do it. But in terms of like, if we have to prioritize financially and just what she’s willing to do, I’m not sure an autoimmune reactivity panel is necessarily going to change it, but I see what you’re saying in the sense of like polychondritis is a sort of mystery disease. We don’t know if the patient has an autoimmune disease. It depends on her motivation. You could also ask any family history of autoimmune disease. If yes, maybe you want to run it if that would help her be more compliant with a strict diet or feel a little bit more inclined to do an AIP diet or something like that. I think take care of her. Let me know if you have any other questions about that.