Female, age 56 – Sinus pain, allergies, weight gain, sore knees

Name: D.A.
Age: 56
Gender: Female
Height: 64 in.
Starting Weight: 164.4 lbs.
Ending Weight: 149.6 lbs. 

Health History
Chief Complaint: Sinus pain and allergies. Takes Allegra to control them with Advil Sinus. Weight gain started around 2015, age of menopause (50). Very sore knees. Was told to get a total knee replacement. Limited with vigorous exercise, lifting, carrying and going up or down stairs. 

Medical Testing Results: UA Initial lab Low BUN. Alk Phos. EBV positive chronic Cortisol low. Vitamin D low 27 Cholesterol elevated for LDL- lipoprotein subfraction Elevate LDL medium and low HDL large. LDL small are WNL LDL patter A with Peak Size WNL *Insulin A1C LDH fasting glucose all WNL and gluten negative 

Length of time on the SHAPE Program: 6 months 

Medications/Supplements: SHAPE Drops, Vitamin D, P5P, B12, CoQ10, Advil, Allegra Sinus, liquid D and Vitamin C 

Patient has fired the orthopedic surgeon as she has no pain and full ROM doing all movements and activities she wanted to do. Allergies are no longer an issue and has maintained the weight loss for the past 3 months. Now taking SHAPE Drops 1x a day for maintenance and staying in Phase III. 

Follow-up labs. BUN WNL. EBV negative antibodies for chronic vitamin D 74 Med sups Phase I start 4.18 measurements UA – Large Leuko Nitrate trace protein. To 10/15 Phase III Weight loss 19.7 lbs
L arm minus 1/2 in. R arm -1/2 in. Chest -2 inches Abdomen -2 inches. Hips -2 inches. L leg -1 inch. R leg minus 1 in. BMI. 28.5. 24.5. Body fat 34%. 25% 

Additional Notes
For this patient, we chose to stay in Phase I for 8 weeks until ketosis was declining. It was then we transitioned to Phase II for 4 weeks and then maintained into Phase III. Her knees did not fully recover until we were in Phase III to where she could walk and play with her grandchildren without any pain with motion. After the first 2 weeks, she had lost 8 pounds but was holding steady. We introduced L-carnitine fumarate and her weight loss increased. I chose the L-fumarate version because she has a family history of dementia, and she didn’t have brain fog so we did not want to use the acetylation compound. Also, with cardiovascular diseases and a plateauing weight loss, we have found clinically the L-carnitine fumarate metabolite to be more efficient than L-carnitine. During this process, she has also noticed how her immune system was vastly improved because her children, grandchildren and husband were constantly getting and passing around colds where she was, for the first time, not getting them. 

Although this is a great success story, there are a few key reminders that we can take away from this process. This patient was not under a great deal of emotional or mental stress where many of my patients are. She did have physiological stress, and once she understood her mechanisms for inflammation and her concerns, she knew what triggers affected her and what she could do to mitigate them. It was very fortunate that she was not autoimmune or systemically inflamed to where we were limited in movement and needed additional therapies for success.  

While her UA did not ever show urobilinogen and her serum bilirubin did not go below .4 or above .7, it is my impression this patient had a sluggish or underactive gallbladder. If we look at the original blood panel, this patient was in a chronic phase of EBV and low vitamin D even though she was taking 10,000 IU/day. If the gallbladder is insufficient, you cannot digest vitamins ADEK because they are fat soluble and therefore, she cannot illicit an immune response to an immune challenge.  

Her history also states that all challenges were in defeat given her history of infections. Therefore, it is my humble opinion based on physiological processes that this patient improved on inflammatory pathways, digestion and immunity. Further studies with our patients will involve heart rate variability and other markers for immunity including CD4,8,NK panels to assess their need for length of phases and the results from the SHAPE Program and other therapies used in our office to balance the autonomic nervous system 

Submitted by Dr. Alan Trites 

Dr. Todd’s Teaching Assessment 

At the 2019 SHAPE Symposium, we emphasized the difference between “Name & Blame” (standard medical approach to disease) and “Think & Link” (SHAPE’s approach to disease). Dr. Trites has given a classic “Think & Link” plan for this patient. His conclusion is brilliant and needs no additional comment. 

I specifically love the “fired the orthopedic surgeon” comment. I always taught my patients that they were the employer and not the employee in a healing situation. 

This patient was advised to have total knee replacement (average cost between $30,000 -$44,000!). Now, no knee surgery needed. This is one of the reasons for the title of our 2020 symposium: “You Can’t Measure What You Prevent” (thank you, Dr. Davis Brockenshire for the phrase). Dr. Trites prevented total knee replacement, but who knows what else was avoided! 

Great job, Dr. Trites!