CASE STUDIES

It was late at night when Claire was awakened from a deep sleep by intense abdominal pain and nausea. Perhaps it was due to food poisoning, she thought. Hours earlier, Claire had joined a friend for dinner at a favorite local diner, where she had enjoyed a cobb salad with roasted chicken. She had a small piece of dark chocolate for dessert.

As the night and the pain in her abdomen progressed, Claire contemplated going to the emergency room. This was the second abdominal flare-up that Claire had experienced within a year. However, she had no fever, she was tolerating liquids, and wasn't vomiting, so she decided to wait until the next morning to see a conventional physician.

After evaluating Claire, the physician suggested that she consider having her gallbladder removed. The MD suspected that gallstones and an inflamed gallbladder were likely the source of Claire's pain and nausea, and he was very concerned. He informed her that gallstones, if left untreated, could become fatal. He therefore recommended a cholecystectomy—the surgical removal of the gallbladder—which he assured her is a relatively common and straightforward procedure.

Claire decided to consult with Doctor Emi for a second opinion. Doctor Emi recommended that Claire have imaging of her abdomen done, which included an ultrasound, to evaluate gallbladder abnormalities and rule out any other pathology. Test results were normal.

After discussing the pros and cons of moving forward with a cholecystectomy, Claire decided to give Doctor Emi's holistic approach a try. This entailed taking digestive enzymes, taurine, and curcumin supplements. Taurine is an amino acid that promotes liver health and aids in the dissolving of gallstones. Digestive enzymes are known to support overall digestive health. Claire was also prescribed curcumin, known for its anti-inflammatory properties and ability to improve bile flow.

After taking her first doses of taurine, digestive enzymes, and curcumin, Claire felt immediate relief. She continued to take them and has had no further abdominal pain flare-ups.

On occasion, Claire reports feeling a burning sensation in her abdomen, which she discovered with Doctor Emi's help, is due to gluten sensitivity.

Long hours, deadline pressures, changing laws, lack of work-life balance—these are among the many challenges lawyers face in today's high-pressure, high-speed environment, which, when combined with the adversarial nature of the legal profession, can contribute to declining health.

Rob, age 67, is a successful attorney, specializing in environmental law. With a PhD in Engineering and JD in Environmental Law, Rob enjoys the intellectual challenges that his clients' cases provide.

It was a beautiful summer evening and Rob, who had just wrapped up a months-long project, was relaxing in his backyard with his wife, when he felt intense pain in his chest. He was nauseous and short of breath. His wife encouraged him to go to the hospital.

At the emergency room, Rob was asked a number of questions about his symptoms. His doctor also ran a series of tests, including the following:

• Electrocardiogram (EKG) to check the electrical activity of his heart,
• Cardiac catheterization to evaluate blood flow, and
• A series of blood tests to look for clues about Rob's heart health.

After the studies were done in the ER, Rob was diagnosed with a heart attack. The cardiologist recommended that Rob have a stent placed in his heart to improve blood flow. Rob followed the cardiologist's recommendations and agreed to have the procedure done, which went smoothly. He was prescribed statins and blood thinners, and after two days in the hospital, was sent home to recover.

Resting at home, Rob began to wonder "why"– why, without any of the regular risk factors for heart disease, did he have a heart attack? Rob had no family history of early heart disease or stroke. His cholesterol, weight, and blood pressure were all within normal ranges. He was not diabetic.

During his follow-up appointment, Rob presented his concerns to the cardiologist. Unable to determine the root cause of Rob's heart attack, the cardiologist suggested that Rob's heart attack could be attributed to his age—Rob was 67 years old at the time.

Dissatisfied with the cardiologist's response, Rob contacted Doctor Emi to help him figure out the underlying root cause of his heart attack. Doctor Emi reviewed the tests and results ordered by the hospital physician and recommended additional testing—for MTHFR mutation and C-reactive protein (CRP).

MTHFR is a gene that provides instructions for making an enzyme called Methylenetetrahydrofolate reductase. It plays an important role in processing amino acids, the building blocks of proteins. MTHFR mutations inhibit the way the body processes important B vitamins, which are essential for optimizing metabolism function and forming healthy blood and nerve cells. People with MTHFR mutations have trouble with detoxification as the processes in cells which handle detoxification rely on the B vitamin pathways catalyzed by the enzyme MTHFR. These problems with detoxification end up with vascular damage and an increased chance of arterial blood clots. If left untreated, the MTHFR variant can cause a variety of medical problems, including anxiety, depression, heart attack, and stroke.

C-reactive protein (CRP) is produced in the liver and is a blood test marker for inflammation in the body. CRP levels rise during inflammation. Sugar, stress, excess hormones and an imbalanced diet are contributing factors to inflammation and high CRP levels.

Rob tested positive for both the MTHFR mutation and highly sensitive CRP. Doctor Emi treated both conditions with a modified diet and lifestyle changes. She prescribed high quality Methylated B vitamins, designed specifically for people with the MTHFR variant, and curcumin, known for its anti-inflammatory properties. She also worked closely with Rob to help him de-stress with mind-body-spirit wellness classes and therapy.

Because he has a stent, he will continue taking statins. More than a decade later, Rob is no longer taking blood thinners and is leading a vibrant life!

Heather is a 73-year old retiree, who enjoys cooking for her family and friends, and taking long walks. She usually walks three to five miles every day, weather permitting. She and her husband are snowbirds, who live in Arizona during the winter months, where they are both active outdoors.

On a Saturday afternoon, Heather was enjoying a movie in her living room, when she began to feel dizzy. She drank a glass of water, felt better, and decided to take her blood pressure–it was 176/84 and climbing. The week prior, Heather had experienced blood pressure spikes for the first time, which she brought to her primary care provider's attention. Heather's primary care provider, a physician's assistant, ran a series of tests—EKG and lab work–the results of which were normal, and decided to take a wait-and-see approach. Heather was prescribed blood pressure medication that included a diuretic– her primary care provider suggested taking it "if needed." Heather was also advised to see a doctor right away if her blood pressure spiked over the weekend.

That Saturday, when Heather's blood pressure registered at 176/84 and continued to rise, Heather, who has a family history of stroke, took a tablet of the prescribed blood pressure medication and asked her neighbor to drive her to a nearby hospital (Heather's husband was out of state at the time; her daughter was a 2-hour drive away). Heather's blood pressure was 204/87, shortly after she arrived at the hospital. The ER physician placed her on blood pressure reduction medication with IV drugs. After artificially reducing Heather's blood pressure to what the ER doctor considered a safe level, he recommended sending her home; he suggested bringing her back to the ER if she displayed symptoms that were consistent with having a stroke.

Fortunately, Heather had a medical patient advocate at her disposal – Doctor Emi — who was immediately available to address her concerns (e.g., is it safe for me to go home?) and answer her questions. After Doctor Emi reviewed Heather's records and blood pressure readings, which had fluctuated from very high to very low throughout the day – a signal that is associated with a higher risk of stroke and heart attack – Doctor Emi convinced the ER doctor to admit Heather to the hospital for monitoring and further in-depth testing.

At Doctor Emi's urging, Heather was admitted to the hospital as an in-patient. Heather's daughter, who had been out of town when her mother called to notify her of her blood pressure issues, arrived at the hospital shortly before Heather was transferred to her hospital room. That evening, Heather, who had been comfortably resting in her hospital bed, got up to brush her teeth and get ready for bed. Suddenly, she let out a cry — a painful cramp rushed through her entire body and her blood pressure plummeted to a dangerously low level. Heather collapsed in her daughter's arms, who was fortunately in the hospital room with her at the time. Heather was sweating profusely; she was pale and unresponsive. Her daughter shouted for help! Five medical people rushed into Heather's room and worked diligently to stabilize her blood pressure and get her breathing properly again.

At Doctor Emi's urging, Heather underwent a series of tests, which came back normal. It was assumed that Heather's collapse was likely linked to excessive blood pressure medication that had been administered throughout the day. Heather remained at the hospital for two days for monitoring; after her blood pressure was stabilized with a different class of blood pressure medication that did not include diuretics, she was released from the hospital.

After Heather's release from the hospital, Doctor Emi recommended additional testing to uncover the root cause of Heather's blood pressure spikes. Further investigation revealed that Heather suffered from severe anxiety, which can cause dramatic spikes in blood pressure. Heather also had osteoarthritis that caused severe joint pain, disfigured fingers and limited mobility. For the past 10 years, Heather had taken Mobic, a nonsteroidal anti-inflammatory prescription drug used for treating arthritis, and Aspirin, a nonsteroidal anti-inflammatory over-the-counter drug, to alleviate debilitating arthritis pain.

Doctor Emi recommended a low inflammatory diet for Heather and suggested that she increase her water intake to a healthy level (based on Heather's individualized needs). To help reduce anxiety, Doctor Emi prescribed counseling and mind-body wellness classes. With Doctor Emi's help, Heather transitioned from Mobic and Aspirin to curcumin, magnesium and fish oil—all known for their anti-inflammatory properties. Studies have also shown that proper magnesium levels can improve sleep quality and blood pressure management.

Today, Heather has a new outlook on life—she's had no further blood pressure issues; her sleep has improved significantly and she has no joint pain. "Thanks to Doctor Emi, I am alive and well today," said Heather. "I doubt that I would have survived the night if I had been sent home as the ER doctor had originally requested. I am so incredibly grateful to Doctor Emi and her unwavering persistence to ensure that I was admitted to the hospital and that I received the medical care that I desperately needed, which was life-saving."

Zoe, a healthy 28 year old, was excited about becoming a first-time mom. As a dance and fitness instructor, she was committed to eating a healthy diet and maintaining a good exercise routine before and throughout her pregnancy. Zoe had a typical pregnancy for the first two trimesters.

At the start of her eighth month of pregnancy, Zoe started feeling very unwell. By then she had gained 100 pounds; she had shortness of breath, occasional headaches, dizzy spells, and extreme water retention. Her blood pressure was elevated. Zoe's care provider assured her that everything was normal. Over the next few weeks, Zoe continued to feel worse.

At a friend's urging, who suspected that Zoe had preeclampsia, Zoe approached her care provider to discuss the possibility of her having preeclampsia. Test results confirmed that she did. Preeclampsia is a high blood pressure disorder that is among the leading preventable causes of death in childbirth in the U.S., often because doctors and hospitals fail to treat it properly. It can cause seizures, paralysis, and death for both the mother and her unborn child. ^[*]

Zoe was at 35 weeks gestation when test results confirmed that she had preeclampsia. Instead of following best-in-class medical protocols for the treatment of hypertension and preeclampsia, which would entail Zoe being admitted to the hospital for monitoring, her care provider sent Zoe home and encouraged her to relax and return to the clinic "if you feel funny."

At home, Zoe began to "feel funny." Her vision was blurred; her blood pressure was erratic and vacillated between extreme highs and lows; she felt out of touch with her surroundings and had a sensation that she was on the verge of blacking out. Every time Zoe's blood pressure escalated to dangerous levels, Zoe's family drove her to the hospital, where the medical staff checked Zoe's blood pressure and sent her home. This occurred three times.

Confused and frightened, Zoe's mother contacted Doctor Emi to solicit her assistance and guidance. After learning about Zoe's condition and the hospital's refusal to admit her, Doctor Emi advocated for Zoe to be admitted to the hospital immediately, pointing out that Zoe was at high risk for seizure. Doctor Emi also recommended that Zoe take magnesium supplements right away to help reduce seizure risk.

At Doctor Emi's urging, Zoe was admitted to the hospital, her labor was induced, and she delivered a healthy baby girl. Zoe was also given magnesium sulfate, an anti-seizure medication, intravenously.

Preeclampsia can impair kidney and liver function; it can also cause blood clotting, even after delivery. After Zoe was discharged from the hospital, Doctor Emi continued to work with Zoe to monitor her progress and help her make appropriate diet choices to aid in her recovery. She also helped Zoe safely wean off of blood pressure medication that Zoe temporarily had to take.

"Thank God for Doctor Emi," said Zoe. "I shudder to think how things could have turned out without her involvement. It was a scary, horrible time. No one at the clinic or hospital would take me or my concerns seriously until Doctor Emi intervened. Thanks to Doctor Emi, both my daughter and I are healthy and thriving!"

Staring at her alarm clock, watching the minutes go by, Maggie was worried. It was 1 am and she had been awake for at least an hour. Another sleepless night. How was she going to function at work in her chronic, sleep-deprived state? Maggie, a 36-year old mother of two high school children, with whom she has a very close, loving relationship, recently started a new job, which she enjoys very much. With her divorce behind her, Maggie can't understand why she feels anxious all of the time and why she has trouble focusing. Could the remnants of her contentious divorce be the underlying cause of her health issues and her inability to sleep properly?

About six months ago, Maggie started a new exercise and diet regime with the hope that these lifestyle changes would help her concentration and sleep problems. To ensure that she got all of her daily nutrients, she bought protein smoothies at a major retailer and drank them daily. Soon thereafter, Maggie began to feel worse. Her muscles and joints ached–sometimes it was her back; other times it was her ankles and wrist. There were days that her entire body hurt. When she started experiencing abdominal pain and uncomfortable bloating, Maggie made an appointment to see her primary care provider.

Maggie's doctor ordered lab work, which ruled out rheumatoid arthritis and lupus. Unable to determine the root cause and based on Maggie's symptoms, her doctor informed her that she probably had fibromyalgia, a medical condition that mostly affects women and is characterized by chronic musculoskeletal pain. Poor sleep, cognitive dysfunction, and widespread pain are also symptoms of fibromyalgia. Antidepressants and pain-relief medication are often prescribed to help manage the pain and fatigue associated with fibromyalgia. Muscle relaxants and sedatives are used to promote sleep.

For Maggie's abdominal pain and bloating issues, her primary care doctor recommended that she increase her fiber intake. He also prescribed antidepressants, which caused Maggie to gain weight, and muscle relaxants, which made her groggy. Although Maggie experienced some pain relief, overall she felt worse. Distraught about her fibromyalgia diagnosis and exasperated by an overwhelming feeling of malaise, Maggie decided to seek out a second medical opinion.

Maggie reached out to Doctor Emi, who is well known for her integrative and functional medicine expertise. Working in close collaboration with Maggie, Doctor Emi was able to uncover health-related insights that were previously overlooked. Doctor Emi's in-depth root cause analysis and specialty testing, which includes lab tests not typically offered by conventional medicine, revealed that:

• Maggie had an underactive thyroid (hypothyroidism), which can cause fatigue, muscle pain and stiffness, impaired memory—all of the symptoms that Maggie had been displaying for the past year.
• Maggie's adrenal glands were out of balance, which can lead to fluctuations in cortisol, a stress-response hormone best known for fueling the body's "fight-or-flight" response. Cortisol levels fluctuate throughout the day and are normally at their lowest at night and at their highest in the morning shortly after waking. If the adrenal glands produce too much cortisol in the evening, this can have a negative effect on sleep quality. Maggie's cortisol was spiking around midnight, which caused Maggie to wake up.
• Food sensitivity testing showed that Maggie had a severe reaction to bananas, which she ate daily, and beans, which she ate frequently throughout the week. She was also sensitive to ingredients in the protein smoothie powder that she had recently started drinking and, unbeknownst to Maggie, were contributing to her abdominal pain and bloating.
• Maggie was deficient in Omega 3, magnesium, and other key minerals and vitamins. Symptoms of Omega 3 deficiency include difficulty sleeping, depression, and unwarranted anxiety. Magnesium deficiency can cause insomnia, mood problems, aches and pains, and other symptoms.

Doctor Emi's treatment plan for Maggie started with an elimination diet to help clear her body of foods and chemicals to which she was sensitive and that can cause inflammation and pain. She also prescribed high quality, third-party tested supplements to address Maggie's vitamin and mineral deficiencies. Maggie's personalized wellness plan included taking magnesium to reduce joint pain and promote sleep; curcumin, known for its anti-inflammatory properties; fish oil for joint pain and for treating Maggie's Omega 3 deficiency; and herbs such as Holy Basil, to support adrenal glands and control cortisol spikes. Maggie was also prescribed Mind Body Wellness meditation classes to help combat anxiety, promote restful sleep, and enhance emotional and physical well-being.

Maggie was diligent about following Doctor Emi's dietary and lifestyle guidelines–her pain dissipated almost immediately after she started the elimination diet, and shortly thereafter, her sleep improved and anxiety significantly lessened. Maggie now has a new, improved outlook on life and is looking forward to embarking on new adventures with her children!