1) Patient History
sex: female
birth year: 1931
weight: height: BMI: 17 lean
Recent History
post-herpetic pain treated with analgesic pills (3/4 a day)
Ferritin: 28 ug/L
Bilirubin
- Total 1,83
- Direct 0,42
- Indirect 1,41
Past History
Previous HSV infection
Gilbert's Syndrome
Familial History
2) Molecular bases of symptoms
Pain
the higher the stimulus, the higher the spikes frequency...
but we get the same results when the intracellula ATP is low....
which local conditions can affect ATP synthesis?
- Less oxygen transport
- Less CoQ
- Less Cyt C
- low estrogens--> low heme synthesis
- iron deficiency
- hypothyroidism
- Less glucose
3) Therapeutic approach aimed to correct metabolic alterations
Iron supplementation
Coenzyme Q
Complex B Vitamins
After 4 weeks
Ferritin: 48 ug/L
Night and most of the day free of pain but...
around 11 a.m. pain requiring an analgesic pill
4 Rule:Oscillating
Serum cortisol at this time is at its nadir: breakfast carbohydrates are gone. Poor gluconeogenesis and sodium retention.
Pain by glucose nerve starvation
but also by lack of Na+ (Hyponatremia)
prevention of pain with saltine crackers at 10.30
After 8 weeks
Ferritin: 76 ug/L
No pain anymore at 11 even without additional crackers