Case Histories: Pediatrics and Teen – Dr Mary Bove
Case #1
15 Year Old Female Athlete with Iron-Deficiency Anemia
- Complains of fatigue, burning in her muscles when playing soccer for more that 45 minutes
- Has had 2 episodes of fainting after big soccer games in which she played hard
- She reports being first string for offense until recently she has been on the bench more
- Her parent report her mood as down and sulky which was not like her
- She reports difficulty with concentration and getting her home work done which is not like her
- She is 5 ft 11 inches, wears a size 10 shoe, is very thin and slender, she reports growing 5 inches over the past summer
- Vegetarian since birth, family grows most of the food, eats a whole foods, family is close
- Menstruating since age 13, 5-7 days moderate, regular monthly cycle, no other complaints
Objective Info
- BP 96/62, HR 72
- CBC – RBC low normal, HCT 30.8, HBG 10.0, Ferritin 11
- Transferrin level and TIBC are slightly elevated
- MCV and MCH decreased
- RBC -microcytic, hypochromic, anisocytosis, poikilocytosis
5ft 11 inches 108 lbs
Therapeutics
- Education on high iron foods, substances that interfere with iron absorption, increased iron need with growth and menstruation
- Whole Food Iron; 1 tab 3 times daily with food equaling 60mg daily
- Herbal Bitters– 10 drops w/meals, (dandelion, fennel, turmeric)
- Rhodiola phytocaps 100-200 mg daily
- Electrolyte powder with Vt C – 500mg
- Fresh veg/fruit juice daily- greens, beet, grape
- Licorice Root Tea taken prior to soccer game or practice
Outcomes;
4 wk F/U – Patients reports less burning in her muscles, no fainting, a normal menstrual cycle, able to comply with supplements, veg/friut juice and at about 80% with diet
8 wk F/U – Patient reports no burning muscles, better stamina with playing soccer, less irritability and moodiness, BP 98/72, HR 66, 108 lbs, recheck lab values at 12 weeks
12 wk CBC- RBC/ HCT 31.4, HbG 10.9, indices improving, RBC normal size and shape, dc bitters
6 month F/U- patient report being “back to herself in so many ways”. She is playing great soccer, her energy is back along with her concentration, school work comes with ease again, and no moodiness or sulky sessions.
- Shoe size stable and ½ inch growth in last 6 m
- BP 100/68, HR 66, 110 lbs
- CBC – HCT 34.8, HBG 11.9, Ferritin 21
- MCV, MCH, Transferrin level and TIBC normal
- RBC normal shape and size
- Continue iron diet, daily dose of plant based iron 20 mg, rhodiola, & electrolytes, licorice tea and veg/fruit juice if desired
- Labs checked in 3-4 months
QUESTIONS:
- What is your assessment as to why iron deficiency anemia occurred for this 15 year old?
- What actions doses using the Herbal Bitters have as part of an iron deficiency anemia approach?
- What specific action does the adaptogen Rhodiola have on muscle tissue and function?
- Why use licorice root tea prior to physical activity?
Case #2
18 month old girl with CA-MRSA skin lesion
- Mom reports this is the second outbreak on the skin in a month
- Saw her pediatrician cultured and ddx with MRSA
- 2 lesions on lateral left thigh, 1.5-2mm, red, swollen pustules
- Breast feeding along with some solids
- Cloth diapers, home washed
- Family bed and bath, 2 sibling and parents, no known carriers
- No history of skin rash, dry skin, or atopic allergies
- Some GI discomfort associated with food intro; gas and bloating
- Hx of URI with teething x2 in life
- Normal growth and development, happy, sleeps well, independent
Treatment Strategies
- Systemic support with probiotic blend; B bifidus, L. acidophilus, L. casei – 5 billion daily
- Immune/Adaptogen Support – Astragalus Root, Schisandra Berry, Ligustrum Berry 20 drops / dose BID
Topical Strategies
- Turmeric Clay Paste with EO- apply directly to lesions 3-4 times daily, after washing area with EO soap and herbal wash
- Herbal Wash – chamomile flowers, pau d’arco, and acorus calamus
- Topical Strategies
- No family bathing, pjs in bed
- Diaper washing, add EO to wash water, hot dyer for at least 30 minutes
- Cotton cloth house bacteria for up to 21 days
- Terry towels house bacteria up to 7 days
- Poly/cotton combo houses bacteria up to 4 days
- Family hygiene, nasal ointments, diffused EO in home air
QUESTIONS
- What herbal essential oils (EO) might you suggest mixing into the Turmeric Clay Paste for topical use on the MRSA skin lesion?
- The Herbal Wash consisting of chamomile flowers, pau d’arco bark, and acorus root brings several medicinal actions to this formula other than being anti-microbial. What would be other actions of such a formula?
- How long might you suggest the use of oral systemic immune and microbiome support for this child?