[INTERVIEW]
Ronda Nelson: Happy New Year — 2026 is here. We are starting a six-week series called Clinical Thinking. This is episode number one, as I promised, and we are gonna talk about the cracked toothpaste. So I kind of gave away the answer in the beginning of the title, but I’m gonna walk you through the whole thing — what happened. And this one was actually kind of a fun one.
So here’s the thing. I’ll give you all the background. This is a female patient. She is someone who, on paper, looks beautiful. Impeccable diet, physically very fit, very, very active, great at self-care. She owns her own business. She doesn’t have any history of anxiety or emotional upset or anything like that. Just a super solid human being. You would never expect that this individual would be coming in saying the things that she’s saying.
When she came to me, she just said, “I can’t stop crying. I can’t think. I am tired. I don’t have any physical stamina. I can’t figure out what’s wrong with me. I don’t know what’s going on, but something is wrong. Something is wrong, and I don’t know what it is.” Well, that’s always a pretty gray area, because how do you say, “Something’s wrong, and I don’t know what it is,” and I’m gonna have to try and figure it out now? I don’t know what’s wrong either.
So as we’re chatting, my first question is, “Well, when did you start feeling bad?” That’s always the first question. It’s the “never been well since” moment, right? So I say, “Okay, well, when did you start feeling bad?” She goes, “I don’t know.” She said, “Well, I went to Croatia in the summer…” So I just jumped to the conclusion — well, that had to have been it. You got sick while you were gone. Had to have been it. Nope. No, it wasn’t it.
And so I start digging a little bit more, asking a few more questions, and come to find out this is not an “I’ve always struggled with stress.” This was literally like a sudden onset, doing all the right things. She could not pinpoint a “never been well since” moment.
So we ordered labs. We got blood, we got an ASI from Diagnostics, we got a female hormone panel from Diagnostics, and of course, it all looked fine. There wasn’t anything wrong. So I’m thinking, okay, well, the adrenal glands are working. And her hormones were a little bit funny, but if she’s got so much stress going on, that did not surprise me. Her estradiol was low, and you could tell it was just off. The HPO axis was just off. But I wasn’t surprised, because we got all this stress and crying going on here.
So as we’re chatting this up, she tells me that in March she was ready to go all-in on this big physical athletic training thing, and she was feeling amazing in March. This is a recent case, just happened. Feeling so good in March, and then all of a sudden she didn’t feel good. And I’m thinking, well, what? I said, “Well, what happened?” “I don’t know. I don’t know.”
So here’s the findings on her labs. You ready for this? CRP was 87. So we know there is some significant inflammation going on here. This is not just a little stressed and the CRP goes up a bit. Something is actively going on. Her fibrinogen is high, so that’s another inflammatory marker. She didn’t strike me as being like a cardiovascular-kind-of-risky person. Cholesterol’s fine. But here was when I went, okay, something’s going on in there.
Her neutrophils were 72. The percent neutrophils were 72, and the lymphocytes were 11. And that screams bacterial. Something’s going on. The body’s fighting something. With all of those white blood cells being used, that was 83% of the white blood cells being used just on infection. Then she’s only got a few percent left to deal with the monos, the basos, and the eosinophils. They were all bottomed out, of course.
So I looked at this and I thought, okay, well, what else is there? A blood sugar issue? Nope. Her blood sugar was fine. There was no anemia. There was no nothing else. Her glucose was 96, maybe a little higher. A1C 6.0. But that does not tell me why the CRP is up and why the neutrophils and lymphocytes are up. Cholesterol was fine — like 230, LDL’s 132, triglycerides were good, lipids were good — all fine. Her ALK phos was 440, and at first I was like, “Oh, hey, wait a minute.” But she said that’s super normal for her. So okay, I’m not gonna go there.
So the clinical picture tells me there’s significant inflammation. There has to be an infection going on. But there’s no source. There’s no fever. There’s no illness. There was no “never been well since.” She wasn’t sick when she went on vacation. None of that happened. Nothing. And this is where, in my mind, I’m thinking, well, I don’t know. We’re gonna have to go deal with this stress and crying. So there’s gotta be something in the adrenal glands. You know, see, I’m in a rut. I’m now judging myself looking back, because you’ll hear how the rest of the story works, but I’m just kind of down that road.
So I said to the patient, “Okay, here’s what we need to do, and here are the supplements that I’m gonna recommend. I’ll get them ordered for you on Fullscript, and we’ll get them.” And we just kind of keep talking and talking and talking as I’m thinking, is there an autoimmune component? There must be a gut infection somewhere. Because I always say, if your CRP is high and it looks like a bacterial or viral issue, then suspect the gut. Because if you can’t see it — in other words, there’s not like a big infected sore somewhere, or they’ve got a respiratory issue or something — suspect the gut. So I’m thinking there has to be something in the gut. That’s all. I’m gonna address her adrenals. Let’s see if we can get her to stop crying all the time, stop being so emotional, and get her back. So if she feels better and we get her out of the sympathetic stress response, then certainly she’ll start feeling better. Her energy’s gonna come up. So I’m in my mind kind of making my protocol, thinking, okay, this is how this is gonna go.
But here’s where the high point of the conversation happened. At the very end of the conversation — very end. I mean, we’re an hour in now — and I’ve asked every question that I know to ask. Every question I know. And all of a sudden, she says out of the blue, “Well, you know, I’m not sure if this matters, but I did have a weird thing happen with my tooth a few months ago.” And I said, “Really? Tell me more.”
So here’s what happened. This was an incidental finding for her. She just dropped it. “Oh, well, you know…” Maybe in the summer. Had nothing to do with her vacation plans. In the summer, she had her teeth cleaned. Everybody gets their teeth cleaned. No big deal. Two weeks later, she has a horrific nightmare — and she’s not prone to nightmares. I mean, really bad nightmare. And she woke up with an incredible amount of pain in her mouth, and she had a cracked tooth. It had cracked. And she said, “I just thought that I was probably so stressed from the dream that I was clenching down so hard that I cracked the tooth.”
So she goes, they pull the tooth. They pull it when she goes on vacation. No problem. Comes back, not sick, everything’s great. The site where they pulled the tooth, it all healed. So now they’re gonna put a post in for the new tooth they’re gonna put on. They put the post in, and she has it placed, and 24 hours after she has it placed, she said, “I just didn’t feel right. I felt — it’s just weird. I don’t know. I just felt weird, almost like I had the flu.” And then it was like a little low-grade fever, and then 24 hours or a short amount of time later, the fever kind of broke, and then she was fine.
And I was like, slap in the forehead. Oh my gosh. This is the infection. This is what’s happening. And as soon as she described that moment where she had the fever and it kind of broke, all the little pieces start to fall into place.
So here’s what happened. The tooth that was cracked probably wasn’t healthy to start with. So there was probably some kind of cavitation, or there was a previous filling or something. But a nightmare — people have nightmares. Not everyone that has a nightmare wakes up in the morning with a cracked tooth. So I think there’s two plausible explanations here. One is that the tooth was already compromised, and that could very well be. The second one is that, as a result of the tooth cleaning that she had, around that tooth there may have been some kind of bacteria that got dislodged and then got down inside that tooth. And then two weeks later she had the nightmare. The nightmare could have been caused by the bacteria. I mean, that’s very, very possible. So it’s one of those two things, right? The cleaning could have released the bacteria, or she could have just had a weak tooth already.
So she wakes up, cracked tooth, horrible pain in her mouth. They pull the tooth. Nobody thought that there was an underlying infection. You just go, “Oh, you have a cracked tooth. We’re gonna pull it.” Okay. No problem. And then when the dental post was placed months later, it likely disturbed that pocket of infection again, which is why she had that 24-hour fever. And so now all this time — I mean, we’re six months into this now or more — this infection has been festering. And as it festers and festers and festers, how it was manifesting was all of that emotional dysregulation. It wasn’t an adrenal dysfunction, but the infection made her body not feel well.
And she said she was ready — as we were talking about it — she’s like, “That makes total sense because in March I was feeling the best that I had felt in a really long time, and I was ready to go do some competitions — weightlifting or whatever she’s into.” And she said, “Like someone pulled the plug. I have no energy. Nothing.” That’s why, because her body’s fighting an infection.
So this is why I always say, yes, you always have to ask that “never been well since.” You have to ask that question every time. But even when the symptoms don’t add up — which for her, it was not adding up for me. I could not figure it out — I just kept asking and asking and asking. And I kind of was out of askings, and then she dropped the little nugget: “This might not mean anything, but I did have a tooth pulled.”
So now that I knew what we were dealing with, here’s what I did. First, I said, “Well, we’ve got to clear up that infection.” So my go-to always is the stealth pathogen protocol. Always. And that’s from Standard Process. If you’re not familiar with it, you should be, because it is amazing. So I explained to her what the stealth pathogen protocol was, and I said, “Here’s how we’re gonna do it. Four days on these two supplements, 10 days on these two supplements. You’re gonna keep going. I want you to do it for three, maybe four, months. Don’t skip. Don’t skip. Just keep rolling.” There’s a two-week cycle. And again, if you’re listening and you’re not familiar with what that is, you can message me and I will send you the little one-sheet that I give to patients that kind of explains how to use it.
I then had her — I said, “Let’s get you some herbal throat spray.” I just use the one from Standard Process MediHerb called Herbal Throat Spray. And I wanted her to spray it in her mouth where the tooth was, where the post is, because the post is in there now. I don’t know if it’s gonna get through the tissue down into the gums. I don’t know. But it’s got all kinds of antibacterial — myrrh, cloves, echinacea, all the things in there. It doesn’t taste real great, but at this point, we do not care. I said, “Let’s get the antimicrobial support right at the source.”
Then, once we kind of have that secondary sort of support — and we sort of agreed on a little bit of a compromise so that I wasn’t giving her too many supplements — I said, “Let’s just start with something that’s gonna give you some emotional balance.” I don’t think we’re gonna get rid of the emotional piece until we get rid of the infection, because the infection is the “never been well since” moment. That’s where all this came from. So now what we wanna do is get in and start to stabilize the symptom. But now I know it’s not the emotions that are the problem — it’s the infection that’s causing the dysregulation in the emotion.
So I chose Nevaton from Standard Process. I love that product. But I could have also chosen Emotional Balance from Gaia — that’s a good one — or even Ashwagandha Forte would have worked. All of those would be fine. And I gave her a dose of four per day. I said, “You don’t need much, just two in the morning, two at night. You’re gonna be fine.” And then because her hormones were a little bit wonky, I probably would have just done chaste tree. Maybe some Ovex. Again, these are Standard Process products, but you could use Doctor’s Research Complete Female — there’s several different things you could use. But the female support was kind of secondary for me.
What was primary was: one, infection; two, getting the emotional symptoms calmed down; and then three, addressing the inflammation. Because I knew that there was some inflammation — obviously, that CRP is high. The first thing I’m gonna think of if it’s not in a joint or the lungs, I’m gonna think about turmeric. So I use Turmeric Forte from Standard Process, but there’s lots of other good turmeric out there. That’s just the one that I used. And then because her fibrinogen was high, I had her get on nattokinase. The nattokinase that I love is from Doctor’s Research because it’s a food-based natto, so I like that one. And I told her to get a little bit of a probiotic — just pick your probiotic — just so we kind of covered that gut issue. Just a good probiotic.
So really, her protocol’s pretty simple. Let’s recap. Stealth pathogen protocol and the herbal throat spray in the mouth. Then I gave her one thing for her emotional symptoms, just to see if we could settle that a little bit. I gave her something for the inflammation, something for the clotting — the high fibrinogen — and then a probiotic. See, my protocol is pretty small. It’s pretty small. But she’s gonna feel so much better.
So notice what I did not do. I did not throw a whole bunch of supplements at her. And I did not order a bazillion dollars in testing. Because I knew what the problem was — I don’t need all those tests to tell me where to go. The dental post situation isn’t gonna be completed for another three months, which is great, because now I’ve got three months. What I don’t want is that tooth placed on that post until we get the infection gone. So we’ve got time to work on it. The infection is the number one priority.
I think I’ve learned this over 20 years of experience — if I don’t have good follow-through, this is where I’m gonna drop off with this patient. So I now have her on a time-sensitive protocol, and I’m watching. The very first thing I know I’m gonna think through? I wanna retest. I wanna see what the CRP is doing. I wanna see what the fibrinogen is doing. And I definitely want a CBC. Not really worried about her blood sugar right now — that’s a later conversation. Her hormones are gonna be fine, but I know that I need to retest. My thought is, I’m gonna retest in probably three months when she’s done with that stealth pathogen protocol.
But I know myself, and I know that my tendency — if I don’t have some kind of structure in the follow-through to make sure that follow-up test gets ordered — I’m gonna miss it and forget, because I’m doing 100 other things. If you listened to last week’s podcast, you’ll know this follow-through thing is like — I’m doing all of the work right now, and I have to be good about the tactical business side of it to do the follow-through. So I made a note. I use Practice Better. I made a task in there to order the retest for her — the blood retest — because I wanna see what’s happening with the CRP, the CBC, the neutrophils, and lymphocytes. They’ll respond pretty quickly, and the CRP should go down nicely as well.
Got the supplements all ordered for her, and I wrote up the protocol in Practice Better — and it’s also in Fullscript. I have all of those resources loaded in Practice Better, so I just assigned that resource to her about how to do the stealth pathogen protocol, made sure that all my tasks were in place, and then I can wipe my hands. She’s got the supplements coming her way, and she’s gonna be just fine. She was so thankful, and I was too, because I was scratching my head. Where is this infection coming from? I was thinking it’s gotta be in the gut. And then I’m thinking, okay, I’m gonna have to do a parasite cleanse — CellCore. That wasn’t it at all. It was in her mouth. Good grief.
So here’s what I want you to take away from this — Clinical Thinking, episode one. Number one, I find more often now that the obvious answer is not always the right one. There’s a rule they call the 30/30/30 rule. And the 30/30/30 rule doesn’t add up to 100, but just pretend it does. Thirty percent of the time, the first answer isn’t gonna be right. The second 30% of your thinking is gonna uncover some version of the first one, just a different variation. The third 30% of your thinking is gonna really be where the answer is. And that’s really what happened. I’m like, well, this has got to be for sure, it’s a slam-dunk endocrine issue. She’s crying all the time and she’s tired. For sure. Endocrine. Her thyroid numbers looked good too. I ruled that out. But it wasn’t. The second third of my thinking is like, okay, well maybe it’s gut. Maybe there’s a parasite that’s affecting her emotions. And then finally we get to it at the end.
I would have gone down a whole other rabbit hole had she not dropped that little nugget. So keep asking. If something is not adding up, you do not need to order more tests. I just had to keep asking. Keep asking, keep asking. And something that I said made her say, “Wait a minute. This might not mean anything, but this is what happened.” So if you don’t have in your intake forms a dental section, you might want to. You may wanna add something that just says, “What is your dental history?” And had she filled that out, I would have known. So guess what I did? Went and added that to my intake form. So now I’m asking about dental history. It used to be there. No one ever filled it out because they were like, “I don’t know what tooth it was.” So I took it out. Well, here we go. I should have left it in. So there you go. There’s the first Clinical Thinking case, episode one. We’ve got five more weeks of this.
But before we go, I really want you to know — if you’re thinking through these cases or not knowing where to start, this is what I hear all the time from practitioners — if you want to learn how to think like I think and walk through these cases, a step or two at a time instead of just relying on a protocol from a book — back in the day, we had these CRGs from Standard Process and they were full of protocols, and that’s how I cut my teeth. But if we had it on a scale of good, better, and best, they’re on the good side, and maybe underneath good, because they’re cookie cutter, and a cookie-cutter protocol never works. What I teach inside Clinical Academy is the way that I think, the way that I process through a test, the way that I’m asking questions and digging a little deeper and thinking, “Oh, well, it must be this. Wait a minute, it’s not that. Well, if it’s not that, then what must it be?” And I’ll teach you how to do that. That’s why there are dozens and hundreds and hundreds and hundreds of different conditions that you’re gonna see every day, every week, every year in your clinical practice. If you need help thinking through those, I would love it if you would join me inside Clinical Academy. Go click the link in the show notes. You can find me at rondanelson.com/clinicalacademy.
[CLOSING]
Ronda Nelson: Hey, listen, friend — before you go — if you want to follow me along on this Clinical Thinking series, I put together a one-page guide called The 6 Principles of Clinical Thinking. This is the exact framework I use to work through every single case. It’s the questions I ask, the order I think them in, and the mistakes that I’ve learned to avoid. So grab it for free: rondanelson.com/6principles. The “6” is the number 6, and then principles. This will help you get so much more out of these episodes, and honestly, it’ll help you with every single patient case that you work with. So grab it. It’s free. Go get it. Next week, I’ll be back with another case that I’ve solved — a different patient, different puzzle, and a whole different approach. I’ll show you how I solved it. So take care, have a great week, and I’ll see you then.
[END]