J.

L    Age:  25    Height:  6’  7”    Weight:  220      

 
The  Chief  Complaint  (CC):  
Patient  presents  with  fatigue,  digestive  discomfort  and  insomnia.      
 
History  of  Present  Illness  (HPI):  
Patient  has  been  working  with  Dr.  Kalish  for  6  years  and  has  been  tested  and  treated  for  a  series  of  intestinal  infections,  heavy  
metal  toxicity,  adrenal  fatigue  and  neurotransmitter  imbalances.    He  is  currently  recovering  from  a  course  of  antibiotics  to  
treat  a  recently  discovered  parasitic  infection,  and  is  suffering  from  fatigue,  digestive  discomfort  and  insomnia  as  a  result.    
Patient  has  not  slept  well  for  the  last  two  weeks,  waking  often  with  pain  in  the  stomach  area.    He  feels  most  tired  during  the  
morning  and  late  afternoon.      
 
Past  Medical  History  (PMH):  
Patient  has  been  diagnosed  with  Chronic  Fatigue  Syndrome  and  has  seen  a  variety  of  medical  practitioners  without  any  
significant  result.    He  is  a  competitive  athlete  and  is  unable  to  compete  during  bouts  of  severe  fatigue  and  digestive  discomfort.    
His  mother  reports  having  fed  him  a  great  deal  of  fish  growing  up,  which  he  believes  is  assosicated  with  the  heavy  metal  
toxicity.    
 
Medications  (MEDS):  
Patient  has  recently  taken  a  course  of  antibiotics,  metronidazole.    He  is  taking  Vitamin  C  1500  mg/daily,  L-­‐Tyrosine  1000mg  
bid,  5HTP  100mg  bid,  Pregnenolone  15mg  TID  CC,  and  DHEA  3mg  TID  CC.    He  is  also  taking  Probiotics  TID  CC.    
 
No  other  pharmaceutical  medications  reported.    
 
Allergies/Reactions  (All/RXNs):  
 
No  known  allergies  or  RXNs.    
 
Social  History:  
 
No  alchohol  intake.    Non  smoker.  No  recreational  drugs.    Patient  is  very  focused  on  recovery,  as  he  is  currently  training  for  the  
upcoming  basketball  season.    He  is  active,  surfs,  works  out  regularly,  and  seems  to  be  socially  engaged  appropriately  for  his  
age  group.      
 
 
Work  History:  
Patient  is  currently  working  part-­‐time  as  a  fitness  trainer,  though  working  less  due  to  severe  fatigue.      
 
Family  History:  
No  significant  family  history.      
 
Obstetrical  History  (where  appropriate):  
N/A  
 
 
Review  of  Systems  (ROS):  
 
• Skin-­‐no  lesions  noted  
• Head-­‐nothing  significant  noted.    
• Eyes-­‐vision  normal  
• Ears-­‐hearing  normal  
• Nose  and  Sinuses-­‐some  sinus  congestion  and  tendency  to  sinus  infections  
• Mouth  and  Throat-­‐nothing  significant  noted.    
• Neck-­‐neck  pain  and  tightness,  reports  regular  visits  to  the  chiropractor  with  good  results.    
• Breasts  N/A  
• Respiratory-­‐  nothing  significant  noted.  
• Cardiac-­‐  nothing  significant  noted.  
• Gastrointestinal-­‐pain  especially  in  epigastric  area,  especially  after  meals  and  in  the  middle  of  the  night.    

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 • Urinary-­‐  nothing  significant  noted.  
• Genital-­‐  nothing  significant  noted.  
• Peripheral  Vascular-­‐  nothing  significant  noted.  
• Musculoskeletal-­‐  nothing  significant  noted.  
• Neurological-­‐reports  brain  fog  and  difficulty  concentrating.    
• Hematological-­‐  nothing  significant  noted.  
• Endocrine-­‐  nothing  significant  noted.  
• Psychiatric-­‐  nothing  significant  noted.  
• Temperature-­‐  nothing  significant  noted.  
• Sweat-­‐  nothing  significant  noted.  
• Appetite-­‐good  appetite  
• Thirst-­‐  nothing  significant  noted.  
• Taste-­‐  nothing  significant  noted.  
• Urination-­‐  nothing  significant  noted.  
• Bowel  movement-­‐  tends  towards  constipation,  but  with  some  occasional  diarrhea.  
• Pain-­‐neck  and  shoulders  
• Sleep-­‐wakes  frequently  in  the  night  with  epigastric  pain  
• Menses-­‐N/A  
 
 
Physical  Exam:  
Patient  appears  healthy,  with  clear  shen  but  with  dark  circles  under  eyes  and  downcast  demeanor.      
Vital  Signs:  not  reported  
OM  Tongue  and  Pulse:  not  reported  
Skin  &  Lymph  nodes:  not  reported  
HEENT:  not  reported  
Abdomen:  not  reported  
Musculoskeletal:  not  reported    
Neurologic:  not  reported  
 
Lab  Results,  Radiologic  Studies,  EKG  Interpretation,  Etc.:  
Functional  Adrenal  results  showed  Cortisol  levels  of  23  n/ML,  DHEA  of  1.00  ng/mL.      
GI  Pathogen  Screen  showed  positive  for  Endolimax  Nana  and  Blastocystis  Hominis  prior  to  course  of  antibiotics,  follow  up  lab  
in  4  weeks.      
 
Western  Medical  Diagnoses/Functional  Medicine  Diagnoses:  
Parasitic  infection  with  Endolimax  Nana  and  Blastocystis  Hominis  
Adrenal  Fatigue  Stage  3  
Heavy  Metal  Toxicity  
 
Biomedical  Description:  
For  the  purpose  of  this  study  the  focus  will  be  on  the  parasitic  infection  with  Endolimax  Nana  and  Blastocystis  Hominis  
Clinically, both B. hominis and E. nana infection may result in acute or chronic diarrhea, generalized abdominal pain,
nausea, vomiting, flatulence and anorexia. (Shah , Tan & Mustaccia, 2012)  
 
 
 
Standard  of  Care:    
 
Blastocystis  Hominis  and  Endolimax  Nana:      
According  to  a  recent  case  study,  these  two  parasitic  infections  often  occur  together  due  to  their  “  identical  mode  of  
transmissions,  via  the  fecal-­‐oral  route  and  ingestion  of  cysts  from  contaminated  water  supplies.”    It  appears  there  is  some  
debate  about  the  pathogenicity  of  these  organisms,  but  the  authors  suggest  that  clinicians  should  be  aware  of  this    infection  as  
a  possible  cause  for  diarrhea  and  other  digestive  symptoms  in  immunocompromised  as  well  as  immunocompetent  individuals.    
The  method  of  treatment  used  in  this  case  study  was  metronidazole. (Shah , Tan & Mustaccia, 2012)  
 
Bibliography:  

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Shah , M., Tan, C., & Mustaccia, P. (2012, May). Blastocystis hominis and endolimax nana co-infection resulting in chronic diarrhea
in an immunocompetent male. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383306/