Pt A: 57 y/o female with h/o Sjogren’s, possible intestinal scleroderma/MCTD, chronic pain on 3-4 Tramadol a day and topical CBD oil, chronic low iron/ferritin, fatigue. I just diagnosed her with Lyme on Labcorp WB. 2 +IgM bands. Coinfections we know of: HHV6 6.62, neg EBV/CMV/mycoplasma/c.pneum/parvo etc.
Labs: E2 <5 on low dose E2/P patch, T < 3 low, FAI < 0.1 low, DHEA 32.6, ferritin 22, pregnenolone < 10, AM cortisol 17.6, FT3 2.8, TSH 1.8, FT4 0.86, rT3 16.3, mold IgGs + in the 10-25 range
We’re embarking on the vit C/mixed toco/NAC/DHEA/pregnenolone repletion x6 weeks phase before the Biosolve/doxy/metronidazole on weekends/nystatin/binders x 12 weeks phase and prepping her with FMLA. I will also do IV iron gluconate next visit. Would you recommend higher dose E2/P to protect blood brain barrier? What dose? And when, starting now? She’s on Combipatch 0.05mg E2 and 0.14mg P twice a week from her OB. THANK YOU. She’s resistant to keto, is vegetarian. But agrees to no sugar during Tx phase.
Aside from the ID therapies I would make sure she gets Prometrium or other OMP in oil 100-200 mg at bedtime. If 200 I’d do that 6-8 weeks then ramp down to 100 QHS
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