April 16, 2019

CASE STUDY // Unravelling Chronic Ear Infections and Gut Health

Fiona came to see me towards the end of 2017.  In her mid-twenties it had been 5 years since she had felt in good health.  As she described her chronic ear infections and gut health challenges it became clear how complex her case would be.

Integrated Functional and Medical Approach

So far Fiona had run “every gastro test in the NHS” in the search to solve her diagnosed IBS, Hiatus Hernia, GERD and Eustachian Tube Dysfunction (chronic ear infections).

Each of her diagnosed conditions had it’s allopathic strategy in place as she was taking an Antihistamine, Medical Enemas, Erythromycin and had undergone a 360 degree Nissen Fundoplication Reflux Surgery.

There was undoubtedly an enormous amount of value and support that Fiona had received from her Doctors and the Medical Profession.  And, importantly, it would be ongoing and integrated.  But she contacted me because at that point she felt there were some unanswered questions and gaps.  What was causing the health challenges and How could she actually enhance her level of vitality?

She wasn’t satisfied with just managing it.  She wondered – could she get herself into a situation where her Doctor would run a test and not identify a diagnosis or condition and therefore not be required to provide prescriptions and may even consider a reversal of her stomach surgery?

Perhaps most significantly, was the fact that so far she had not yet felt in the driving seat or in control of her own healing process.

approached Jack at a time I felt I had exhausted the options given to me by my GP and consultants. I wanted a more functional, all-encompassing, 1-1 approach which could not be achieved by conventional routes.  Admittedly, I was initially a little dubious. My symptoms were debilitating.  I had spent time critically ill in hospital and there was a financial commitment for the programme.

Here’s a full list of the symptoms and health challenges Fiona was still experiencing when she came to see me in the Functional Health Clinic in Newcastle for a Master Your Gut Health Day (https://functionalhealthclinic.co.uk/functional-gut-health-day/):

Pre Symptoms Functional Medicine

I’ll present her progress below on all of these health challenges, but first let’s take an in-depth look at how she did it.

Fiona’s Mindset

From the ‘outside’, with her focussed mindset and positive approach you’d never have guessed the physical health challenges she was experiencing on the ‘inside’.  Many people she knew and worked with had absolutely no idea.  Yet she had her support network in place.  These characteristics and strengths never waivered throughout the 6 months we worked together.  She was simply focussed on how to achieve her goal and prepared to solve the challenges along the way.

Above anything else, these factors along with a little more structure and clarity, were a huge influence on successfully achieving her goals.

When we had the health history and details down in writing as part of her Initial Consultation, even her Partner was quite shocked to actually see exactly what Fiona was dealing with on a daily basis.

One reason we spend a whole day with a client at the beginning of the process is so that we can take the foundational step of establishing individual goals and values and to begin getting creative with human behaviour.  Are they in the right place to achieve their goals?

A Fully Functional Iceberg!

From the beginning we agreed that we would be taking a holistic view and considering her challenges as a whole.  Otherwise she would just be chasing each symptom off in different directions (often a distraction).  So we wanted to acknowledge the hidden or ‘below the surface’ factors that had not yet been identified in solving her chronic ear infections and gut health experience.

Yet – at the same time, we definitely did not want to ignore the ‘tip of the iceberg’.  Each and every one of her symptoms was an important piece of feedback from her body and they would continue to guide us throughout the process.

Could Fiona start to work with and learn from her body’s feedback instead of against/versus/fighting it?

Putting all the pieces together would build the bigger picture (whole iceberg).

In general, that’s the principle she used to completely alleviate symptoms such as her chronic ear infections, neck pain, burning bowels, constipation, burning urination, coating on her teeth and tongue and many more.

I was immediately impressed and put at ease by Jack’s enthusiastic, impartial approach from the first phone call. Plus his genuine willingness to share his knowledge and experience. Having undertaken the 6 month programme, I was able to gain access to enhanced testing, individualised nutritional advice in keeping with allergies and intolerances, supplement protocols, bodywork, as well as tailored exercise and movement sessions.

Uncovering Nutritional Deficiencies

Fiona’s Gastroenterologist had stated that they had no concerns for her Nutritional Status.  I’m not sure whether this was based on testing or symptomology, but in my experience, as soon as the gut is dysfunctional and struggling, then it stands to reason that there will be an impact on nutritional status.

In these situations there are some key reasons why nutrient status may be worth considering as important and influential.  The chronic pain and discomfort often influences food choices that are made over time.  A poor digestive capacity will fail to fully break food down.  Inflamed and congested intestinal tissue will be unable to effectively absorb nutrients. And considering how much stress the body may be under in this situation, the turnover and demand for nutrients is often greater than usual.

For these reasons, one of our primary goals was to use some functional labs to assess and clarify nutritional status and take careful, safe and effective steps to optimise.

What did we find?

Markers of potential Nutrient Deficiencies for:

  • B12
  • Folate
  • Vitamin D
  • Vitamin C
  • Protein
  • CoEnzyme Q10
  • L-Carnitine
  • Glutathione
CBC Nutrient Markers

These findings would be fundamental in putting in place some key gut healing, nutritional and supplemental steps.

The aim, was not to try to state whether this specific nutrient deficiency was causing this specific symptom.  For example, a deficiency in Vitamin C has far-reaching effects throughout the body.  It will affect each system in the body to some degree.

But they were all very important to address. The goal was to firstly educate Fiona as to why these findings helped further explain:

  1. Why she felt the way she did. (Cause).
  2. What she could do about it. (Solution).

Citric Acid Sensitivity

Fiona was particularly concerned about her Vitamin C Status – and been for a long time.  Due to a Citric Acid Sensitivity she was avoiding many ‘vitamin C foods’ and supplements, as they without fail, had been flaring up her symptoms and discomfort.

Vitamin C Deficiency

She knew which foods to avoid, so this was managing her symptoms.

But in the meantime, she had limited sources of this vital nutrient and her Vitamin C levels could be plummeting.

Fiona had tried several Vitamin C supplements, but never one that worked without flare-ups.

Whilst we avoid too much focus on supplementation, especially early on in a process, in this case I had an idea of the trigger. So we quickly identified a safe and effective Vitamin C product that Fiona could take daily without any issues at all.  A great example of all supplements not being created equally!

At that stage Fiona’s Friends and Family commented that “this alone was worth the fee” 

But, onwards…….we had many more tools in the toolbox to add.

Functional Blood Chemistry Analysis

Have you ever been in search of answers to your health challenges and your Blood Test comes back completely ‘normal’?

Well this was the case for Fiona too.  She had just run a Blood Test with her Doctor when we first met, but was told everything was normal.  Several of her specialists wrote in her medical notes that they were pleased to observe this and there was no need for further investigation here.

From a conventional point of view, using conventional ranges, it truly is great that her test results had come back normal.  But what was fascinating is that when we ran a functional analysis, using optimal ranges, on the exact same blood test markers, we could add to the interpretation.

I like to squeeze the value out of any test.  After all the test markers are just another way of getting feedback from the body.  If it has the potential to guide the next steps, then we want to extract that information!

This is not instead of her Doctors’ Medical Interpretation, or better.  Simply a different, functional view.

Take a look at a summary of the Functional Blood Test findings and all the markers that were outside of optimal:

Functional CBC Summary

Its 100% ok that the conventional and functional/optimal interpretations are different.  The model is different.  The remit is different.  One helps a certain type of practitioner do their job and the other helps a different type of practitioner do theirs.

The important person in the equation is neither practitioner.  In this case it was Fiona!

Equipped with a well designed, comprehensive blood chemistry test report the person can be educated and empowered on many things about their health and function. Their nutrition, lifestyle and environment can be considered and altered as appropriate and they can still receive the Medical support as a priority when required.

The point is that we all have this opportunity at our fingertips, so if you are interested take a look here: https://functionalhealthclinic.co.uk/functional-blood-chemistry-analysis/

Weekly Education for Mastery

The Health Restoration Program (https://functionalhealthclinic.co.uk) has been designed with the education of the client at the forefront.

I could never have anticipated the impact this programme would have on all aspects of my life that had been affected by my health. I am astounded by the improvement of all symptoms and the complete eradication of many others. During this time Jack’s programme has supported me beginning a new career and enabled me to play sport again. As well as recover from symptoms relating to surgery.

The Blood Test alone led to many hours of discussion as we made functional links between low B12 and poor digestive capacity, chronic bacterial digestive infections and her original reflux and immune stress and vitamin D status.

The coaching process and client journey goes something like this: Each piece of the puzzle would create more clarity, the client takes more control, less judgement, more responsibility, action steps are put into place, progress is made, challenges are met and solved, results grow, the client is more empowered, takes more control……..and on we go!

This can be summed up as Mastery.

Essentially, it’s a process that is free of Judgement.

We want the opposite of confusion and whose fault it may be!  That could just be fuelling more Mystery; leading to greater fear and anxiety, less control, extreme yo-yoing steps, limited results, diminished confidence, lack of trust in self and others and ultimately a disempowered person waiting to be ‘cured’ by something or someone.

The Role of Gut Health

Clearly not all Fiona’s health challenges were in the gut.  But her health history, medical interventions and ongoing symptomology was certainly a question mark hovering over the function of the digestive system.

Her years of GERD (Gastroesophagael Reflux Disease) had been managed since the Full Nissen Fundoplication operation.  This is where the surgeon wraps the top of the stomach around the lower oesophagus.

The reflux had stopped.  But stomach and gut function was far from optimal.  The causes of the original GERD had not been identified or resolved yet.  And although of great value to Fiona, the surgery presented some of its own, new challenges, such as the inability to belch.

This may not sound like much, but the discomfort and pressure that builds up from this dysfunction is quite intense, as Fiona would testify to.

Therefore, we wanted to find out as much about the gut as possible.  What was it doing well?  Where was it struggling?

Congestion and Constipation

It may be an obvious statement to make, but Acute and Chronic situations are often wholly different scenarios.  Often, with ongoing, long term (chronic) health challenges, the actual ‘original’ trigger becomes somewhat irrelevant.  Not that it isn’t important, but 5, 10, 20 years later there have been many, many different factors that have since come into play. Some of which are much more powerful and influential than the original trigger and onset of the issues.

Constipation is a great example of this.

It’s not always present at the beginning of the timeline.  But following ongoing and accumulating levels of stress, inflammation, toxicity, suppressed immune function, infections and reduced nutrient levels, it often becomes one of the ‘biggest straws on the camel’s back’.  And it needs to be ‘removed’.

Congestion needs to be relieved and Flow restored quickly. This can reduce toxicity and stagnation in the body and re-establish an important cycle/rhythm in the body. This initial focus will help open the Detoxification and Elimination Pathways that will pave the way to further steps in the healing process.

At the beginning Fiona was severely constipated.

She was only able to have one bowel movement once a fortnight and was unable to pass without medical enema and Erythromycin.  This meant her body was most likely stagnant and toxic and furthermore, unable to remove the waste products, metabolites and toxins that the body produces and accumulates on a daily basis.

Six months of the Health restoration Program later and she was having a completely natural bowel movement each day/two days without any discomfort.  Without this progress, her healing process would undoubtedly have been much more demanding.

One-Size-Fits-All?!?!

There was no one step that ‘fixed’ the constipation.  Whilst there are several strategies from natural remedies to over-the-counter products that are effective at creating movement, these are often a short-term measure.  To Fiona’s credit it was down to diligent and consistent work guided by what we knew about her body that restored her natural bowel movements.

Let’s take a look at some of the key findings and insight from the Comprehensive Digestive Health Test that gave us clarity about her gut health:

Digestive Infections H pylori

Here we can see a Helicobacter pylori bacterial infection.  Given the long history of acid reflux and subsequent surgery this was something that would be a major piece of the puzzle for Fiona.  Despite previous Endoscopy investigations this had not been picked up until we ran this test.  This may be due to the location of the bad bug because it isn’t always in the stomach and in a place where the camera would be able to see it.  Of course, perhaps it was not actually present at the time of Endoscopy.

Gut Flora

Above are the results showing the levels of Normal Bacterial Flora (‘beneficial bugs’).  As you can see there are indications of too low and too high.  Importantly, this can indicate why some people are actually creating more problems by taking Probiotics.  This section of the test is often an eye-opener for people who have heavily relied upon supplements previously, but thankfully Fiona had already been quite careful in this area.

GI Inflammation Calprotectin

The Calprotectin marker of the Gut Health Test highlights how much inflammation there was in the upper GI Tract.  Again, another key insight into why Fiona felt the way she did and what we needed to focus on.

Where inflammation is concerned, it is usually due to a combination of 1) several things in the body that shouldn’t be there (eg H pylori, certain foods) and 2) a lack of things that the body needs (eg certain nutrients, hydration).

It is possible that the gut had been inflamed for a short or long period of time prior to the test.  It is hard to tell due to no similar diagnostic being run prior.  But one thing was for sure and that was that we needed to leverage her nutrition, lifestyle, environment, sleep and hydration to support her anti-inflammatory processes.

Inflammation and Contra-Indicated Digestive Enzymes/HCL

Here was an example where one of Fiona’s own prior supplements was potentially causing more harm than healing.  HCL (Stomach Acid) can help in many ways, but is advised to be avoided in the presence of an inflamed stomach or H pylori infection.  With our approach of ‘assessing not guessing’ we carefully reduced and stopped this supplement.

The result?  After just 1 week Fiona’s Stomach burning improved significantly.  After 3 week her stomach and ears were feeling the best they had for a very long time.

Yes – the best results usually do appear to come from the simplest of steps. Yet sometimes we can’t underestimate the structure, process and approach that is required for the simple things to come to light.

Chronic Ear Infections and Gut Health and Structural Integration

Fiona had already been seen by ENT (Ear, Nose and Throat) specialists.  My remit was not to investigate these specialist and detailed structures of the vestibular system in the same way.  My remit is never to diagnose and treat.  But to identify areas of dysfunction/imbalance in the body as a whole and enhance global function and balance.

The chronic ear infection Eustachian tube dysfunction was causing a lot of pressure, dizziness, severe itching in ears and throat, discharge and pain down neck.

Chronic Ear Infections

We observed that as the gut health improved, so too did her reactions to food, digestive symptoms, vitality levels and consequently her ear inflammation, pain and chronic itchiness.

Fiona noted that it was also the hands-on Bodywork / Structural Integration (Bowen Therapy) that had a significant impact on the improvements of her Eustachian Tube discomfort.

So how could Bowen Technique Therapy help with these challenges?

It’s important to state again that none of these methods are treatments for this or that.  I apply Bowen work based on the assessment process.  When we assess, we find out what the body requires and where to do the work.

And that’s usually just the next layer of the onion.

Would you believe that the improvements to ear function that Fiona felt were following re-alignment of her Sacrum and Pelvis?

From Head to Toe – Leg Length to Identify the Stress in the System

Leg Length Discrepancy
Leg Length Correction

These pre and post images identify the change in leg length that we achieved.  This may not immediately appear relevant for someone who was trying to solve chronic ear infections and digestive discomfort, but this progress was a major part of restoring health and function.

In this instance we aren’t measuring leg length so that we can just focus on any asymmetries in leg length per se.  There’s actually more likelihood that a difference in Fiona’s leg lengths was not from the legs themselves, but from elsewhere such as the jaw, cranium, cervical spine (neck), sacrum, coccyx and pelvis!

Used correctly, we have a specific assessment technique that quickly and effectively identifies a ‘stress in the system’.

When there is a ‘shorter‘ side, we know that something further up the chain is creating a stress/pull/inhibition/drag.

It could be an old injury, scar tissue, an inflamed organ, a postural influence, congested bowels, surgery, dental health, prior c-section, exercise-induced and many other possible causes.

The key is to identify where this primary issue is and then to release or change it.

Fascial WebFor Fiona, her asymmetrical leg length was caused by imbalances across the pelvis.  We worked on releasing connective tissues (fascia) and muscles such as the Psoas (hip flexors) to bring more symmetry to the pelvic and sacrum areas and on reassessing her leg length discrepancy we observed the improvement (that you can see above).

Gut AnatomyWhen the body has achieved greater alignment the level of stress response and ‘fight and flight’ experienced should balance significantly.  This change to the ANS (Autonomic Nervous System) should allow greater ‘rest and digest’ functions to come in to play.

Anatomically it’s interesting to see the close relationship between the musculoskeletal system and the digestive system.  In reality these tissues and organs do not exist in isolation or as clean-cut as the text books illustrate.

Consider just how much a congested and constipated bowel would influence the space, other organs, muscles, fascia, connective attachments in and around the pelvis and spine.

Post Symptoms

Let’s take a look at Fiona’s progress after working diligently through the healing process for 6 months.

If asked, she’d tell you it wasn’t easy and there were no miracle cures or quick fixes.  It took dedication and focus.  The previous 5 years had been a different story of a steady and dramatic decline in wellbeing and health.  So to achieve what she did over just 6 months is testament to what can be accomplished.

Post Symptoms

Hiatus Hernia and the Fascial Bow String

Each new client journey will be educational for me too.  I’m always fascinated by the integrated nature of every system>organ>gland>tissue>cell>atom in the body and the holistic principles of Psychology, Physiology and Physical function.

So, here’s another interesting aspect of this Case Study.

Fiona had previously undergone a Nissen fundoplication operation for her Hiatus Hernia repair.  This involved a full 360degree wrap of the top of the stomach around the lower oesophagus.

This may sound quite dramatic, but it certainly helped manage some symptoms at the time.  However, she was also left with what she described feeling like a really tight bow string in throat.  There was a constant feeling of needing to curl up and flex forward to relieve the tension.

Much like if we flexed an Archery Bow, the string would slacken.

Whilst it clearly wasn’t the onset of the health challenges, it may be related to latter factors and was definitely another piece of the puzzle.

A constant need to move into flexion and to create holding patterns in a forward curled position can have a dramatic effect on many areas.

From a Postural perspective the flexion forward through the spine and how this affects the Neuro-Musculo-Skeletal structures can be quite dramatic.

Neurally, might this inhibit the communication between the Central Nervous System and the muscles, organs, glands, tissues and cells of the visceral and reproductive organs?

With such a closing in of space, what type of congestion would this cause in the intestines and would it affect Bowel Movements?

Without the body’s extension, opening out and space how would the breathing muscles and diaphragm move freely and effectively? What knock-on effects would this have on respiratory function, pH, the Autonomic Nervous System, movement, pain and more?

Alongside enhancing the function of the gut, we also wanted to see how the body and these connective tissues would respond to the bodywork that we performed weekly.

Using a Structural Integration Technique called Bowen Therapy (https://functionalhealthclinic.co.uk/bodywork-the-bowen-technique-therapy/) we were able to work primarily with a connective tissue called Fascia.  Think of it like a web that runs through most structures in the body to give it shape and integrity.

By the end of Fiona’s coaching support she had completely relieved this tight bow string like sensation.

She was even considering and discussing the possibility of reversing the Nissen Fundoplication surgery with her Doctor!

Anti-Histamines No More

At the beginning, Anti-Histamines were the only thing that could control and manage the severe itchy ears and throat.  Fiona’s preference was to not need medications, but as they were the only solution that gave her comfort she valued their role in her routine.

One of her major achievements was solving the itchy ears and sore throat occurrence, which meant that she simply had no need to have any Anti-Histamines. She felt great to be in less discomfort and also to have removed one of the chemical stresses to her system.

We all want to have less symptoms and pain.  No matter how great the challenge and discomfort – being involved, interested, curious, connected to and in control of the situation and steps will create a much more rewarding and robust experience.

It’s the opposite to ‘healing by numbers’.

Even Drinking Water Caused Pain

I enjoy and spend a lot of time teaching the basics and often simple steps, such as Hydration. However, in Fiona’s case she was already fully aware of the value of drinking water.  The challenge was the fact that it had been causing discomfort and pain every time she tried.  Every single day.

It’s often the most frustrating for people when something that appears so simple as drinking water is not working for them.

What’s more the knock-on effect is that the person is now chronically dehydrated, which will often be part of the vicious cycle and why it has been difficult to heal thus far.

Fantastically for Fiona, whilst mainly focussing on improving her digestive function and fine-tuning a few advised things about her water intake, she was able to completely alleviate this challenge.

Soon Fiona was able to consume 1.5ltrs of water per day, every day, without any difficulty. Enabling her hydrated body to go from strength to strength through the healing process.

Functional Health Clinic – Newcastle

There were many steps beyond those described above that we implemented.

So how did we do it with a structured, careful, safe and effective approach?

And….importantly, without just creating overwhelm and confusion.

Fiona attended the Functional Health Clinic in Newcastle (UK).  Each week we would evolve the functional medicine, structural integration, nutrition and movement elements of her program.

https://functionalhealthclinic.co.uk/map-directions/

Working 1-to-1 enabled us to put each strategy in place in a stepwise way.  Most importantly we were able to do this in the most safe and effective way.

As Fiona experienced, it’s not just what you do but more about why and how you do it.

There will never be a lack of different strategies, changes to diet, exercises, therapies, supplements etc etc to potentially put in place. There will always be more assessments and ways to get insight into the causes of your health challenges.

But the answer is not to run every single lab test available, try to change everything at once, or bounce from new diet to diet.

In my experience and the focus of my functional health coaching is that the key to success is usually in the way and the order that the various steps are implemented.  The Process.

It maintains some simplicity where enough complexity inherently exists already.

It’s practical.

It provides an opportunity to monitor what is working (and what is not).

It’s inescapably educational!

And fundamentally more effective and robust.

A good example of this is that before we met, Fiona had tried many things and seen many specialists and was already highly motivated.  What we discussed during her Initial Consultation was that so far, these steps had been largely guesswork and ‘hit and hope’.

For example – She’d tried ‘Anti-Fungal’ Diets, which made her symptoms worse.  She’d also taken lots of supplements, which also only aggravated her discomfort.

We could write a whole article on this last sentence alone as it is the scenario that most people describe when first contacting me.

If you feel you are in a similar situation with chronic ear infections and gut health dysfunction and could value the input, support, assessment and solutions that Fiona embraced, then please do not hesitate to get in touch.

Fiona’s Full Testimonial

approached Jack at a time I felt I had exhausted the options given to me by my GP and consultants. I wanted a more functional, all-encompassing, 1-1 approach which could not be achieved by conventional routes.

Admittedly, I was initially a little dubious. My symptoms were debilitating.  I had spent time critically ill in hospital and there was a financial commitment for the programme.  However, I was immediately impressed and put at ease by Jack’s enthusiastic, impartial approach from the first phone call. Plus his genuine willingness to share his knowledge and experience. Having undertaken the 6 month programme, I was able to gain access to enhanced testing, individualised nutritional advice in keeping with allergies and intolerances, supplement protocols, bodywork, as well as tailored exercise and movement sessions.

I could never have anticipated the impact this programme would have on all aspects of my life that had been affected by my health. I am astounded by the improvement of all symptoms and the complete eradication of many others. During this time Jack’s programme has supported me beginning a new career and enabled me to play sport again. As well as recover from symptoms relating to surgery. Following Jack’s guidance during this programme has been the driving force that has improved my quality of life far beyond my original expectations. It has allowed me to do things I had previously given up due to my health restrictions, such as eating out and going on holiday.

Jack’s approach has facilitated my continued improvement, even beyond the programme. I have the tools to further enhance my health, working well alongside continued NHS support.

I cannot thank him enough and would highly recommend him to anyone who wanted to improve their health, performance and ultimately, their quality of life.