Emma in case

Diet

No water

One wine three nights a week

1 Coffee, 1 Tea

High salt diet

Lifestyle

Stressful and demanding job

High achiever

Smoking

Eats while working

Family History

Diabetes

Nervous System

Generally good mood

Subtopic

Sleeping 6 hours. Wakes unrefreshed

Linked to SNS dominance

SNS increases insulin

Light headed and dizzy and difficulty concentrating after diarrhoea

CVD

Low Blood Pressure

Peripheral return slow

high MCH, low MCV, low Haematocrit and low Haemoglobin

Low iron

Immune

Recurrent vaginal thrush when on OCP

Colds linger for a few weeks

MSK

Joint pain 4/10

knees, shoulders, elbows and ankles following bout of watery diarrhoeah which occurs every forntight

Differential Diagnosis

Percinious Anaemia

Given high MCH, low MCV, low Haematocrit and low Haemoglobin

Chrone's disease due to systemic inflammation and no blood in diarrhoeh

Send to GP for glucose tolerance test

GIT

Abdominal Pain 6/10 every 2 weeks

Watery diarrhoea

Foul smelling, explosive, light brown tan

Occurs every 2 weeks

Better for bland diet

Weakness in junctions between enterocytes

Worse for eating certain foods

Has bloating and distention relieved by flatulence

Microbiome imbalance from IBS

Fatigue

Consitipation is normal

Opens bowels every few days

Stools float and fatty sheen evident in toilet water

Antibiotics once a year

Undigested food in poo

hepatobiliary

Pain

Bloating

Endocrine System

History of Abortion. Miscarriage 1 year ago

Headaches during period

On OCP from 17-24

Skin, Hair, Eyes, Nails

Eyes

Pulsating pupil

Stream and white fibres

Grey jagged ANW

Nails

Horizontal ridges

White spots

Glossitis and lichen on tongue

Many bumps. Some infected

Pale clammy skin