[INTERVIEW]
Ronda Nelson: Well, this case is going to be a heartbreaker, but I’m going to share it with you. I’m going to read you something that the patient recently wrote on his intake form. This is a quote: “I want to have the energy to pursue my goals in life — working or standing more than just a few hours at a time because I get so exhausted it’s difficult to stand, and I need to rest for one or two days afterwards. I’m so weak. I used to be an athlete. I love sports. I’ve been so slow to recover and prone to injury in recent years. I’ve had to stop doing many things I used to love to do. I’ve gotten so far away from myself, I can’t even recognize the person in the mirror. I don’t care about being rich. I don’t care about being famous or happy or even sad. I just want to be able to do the things that I choose to do.” When I read that, my heart broke for this young man.
And he came to me with severe digestive issues — reflux, an ulcer, bloating, undigested food in the stool. He’d been on PPIs for months. Nothing was working until I stopped and asked myself: “What if the problem isn’t his gut? What if the gut is just the loudest microphone, and it’s amplifying signals from a system that has lost its ability to regulate?” That question changed everything. I’m going to walk you through it.
Welcome to the Clinical Entrepreneur Podcast. I’m Ronda, your no-fluff, tell-it-like-it-is business bestie for wellness practitioners just like you who want to build a practice you love, make a bigger impact, and a little money while you’re at it. So if you’re ready to ditch the overwhelm, attract your dream ideal patients, and finally run your practice with complete confidence, you’re in the right place. Each week, we’re tackling things from programs to patient retention to marketing strategies that actually work — sprinkled, of course, with a little sass, a lot of heart, and the step-by-step strategies that will help you get there. So grab your cup of coffee, your notebook, or whatever keeps you going, and let’s build a practice you love — and a life you love — together.
Well, welcome back to the podcast. You can hear in my voice that I have a little bit more of a somber tone today because this particular clinical case is a really sad one for me. A very sad one. But it’s worth sharing because the information that I really hope you’re going to take away from this is going to change the way that you look at — let me say it like this — individuals that are broken. Okay? And I don’t mean broken like irreparable, but their perception is that they’re broken irreparably. They think that they are. I never believe that someone is.
But when this man came to me — and he was actually a referral — he was a former competitive JV athlete, and now he can barely stand without needing a couple days of rest. He just gets up, he does a little bit of activity, and then he’s just down. So on his intake form, everything was digestive. Everything he told me was digestive. He has ongoing reflux. It’s constant. It’s worse at night. He’s on an over-the-counter PPI, which is not working. His stomach is constantly burning — feels like it’s on fire — even if he eats or drinks anything. He’s nauseous in the morning. He’s nauseous during the day. He’s nauseous at night. He bloats immediately after eating anything — any kind of bread, any fatty foods, anything with fiber, or even dairy. He’d been previously diagnosed with ulcers, GERD, IBD, and SIBO.
He had some type of gastric surgery in the past. I couldn’t quite get that information out of him, but there was some gastric surgery in the past. It was not a gastric bypass. I do know that he can’t eliminate every day. But he doesn’t eat much because he can’t poop. So the poop isn’t going to be there, right? He’s not going to eliminate. He doesn’t have enough bulk. When he does go, the stool is really sticky. He’s crampy. It’s got undigested food in it. He has trapped gas that’s super painful, especially if he eats too much. And sometimes he said, “I will just eat because I know I’m so starving that I will eat,” knowing that I’m going to pay for it for hours afterwards. So he’s on Carafate, famotidine, calcium carbonate. There you go. DGL — deglycyrrhizinated licorice — and slippery elm.
So I always ask, “What are your priorities?” The patient is thinking, “Well, we’re going to go this route,” and then I’m over here going this route. Sometimes you lose them. And I felt like this young man was a bit fragile — his tone. I wish I could repeat the tone or convey it, but there was no life to his voice. Literally like someone had just sucked the life out of him. Very hopeless is probably the best way I could describe it. And my heart broke. He was referred by someone that I love and care about, and I really, really wanted to help this young man.
So he said that he’s had gut inflammation for three years — and I’m not sure how he knew that, but that’s what he said. And he knew that his limited diet doesn’t always work. So he already knew there were a lot of things he couldn’t eat, but it wasn’t working. He has posture problems. His posture, his mobility, his joints — he’s weak. He just feels frail. He said skin sensitivity. He’s sensitive to the sun. He gets moles. He bruises easily. He has slow wound healing. His energy is next to nothing. He has horrible anxiety, severe depression, and he literally just kind of felt hopeless. But you know, I never give up on anyone. I’m like, “Oh, well, we got this. I’m going to help you figure it out.” I don’t ever think there’s anyone that’s unfigure-out-able. So I was all in with him, but I lowered my tone and met him where he was. I didn’t run over the top of him.
But when I got on the call — when I heard the weak vocal energy, his presentation — he would hardly look at me. He wasn’t strong. He wasn’t confident. I knew he was feeling so badly. He also had insomnia. He said he’s had severe night sweats for many years. Those were his words. And he does not sleep in a dark room. He did have a history of mono. Do you see how deep this is getting? Are you guys feeling this? It’s deep. This is a deep, deep hole. Loss of motivation, decreased productivity. I think he had a job. He didn’t really talk about it much, but I’m not sure how he would have any gratification in the job because he certainly wasn’t gratified with his life. He said he was having weight gain, but he looked pretty thin. This was virtual, but he looked thin. Just very thin. He said, “I tend to be pretty irritable and angry, and then I get discouraged. And then because I lash out — or because I get irritable and angry — that makes me more depressed.” He said, “I have memory issues and I have very low libido.”
So where do you even start with that? What would you do? That’s a lot. That’s a lot to unpack. So I started asking some questions, and I asked my “never been well since” question. And he gave me three of them. The first one was when he had COVID in 2020. He said he did not have a vaccine, but he was very, very sick in 2020. The second moment was a bad breakup with a girlfriend in 2022. And then there was a very emotionally significant situation that he did not give me details about, but he said it was very emotional, very difficult, and it was in his primary family unit in 2023.
So I thought, okay, there’s definitely some emotional things that have gone on here — some really high stressors — plus we have an infection. So I asked him about the mono, and he said the mono happened before COVID — in 2019 — and he was really sick with the mono. Now notice: he did not tell me that. He did not identify that the mono was the “never been well since” moment. It didn’t even register until I started asking him about it. What he said was that being sick with COVID was the moment. But he had mono the year before, and he said, “I was down with mono for a month.” And then, “Before that, I was a competitive athlete.” It’s like, wow — this is kind of fast then.
So we go from competitive athlete through 2018. Then we get to 2019 and mono, and he said he was never the same. But there had to have been some level of functioning between the mono and the COVID because he said COVID was kind of like when the house fell apart. So he didn’t identify the mono as the house falling apart. It was COVID. So the mono started it, I believe, and then it was leading up, and then COVID just accelerated it — shined a light on it. So that’s kind of the real timeline, right? Mono in 2019, COVID in 2020, trauma in 2022, emotional trauma in 2023. Layer after layer after layer of trauma that never resolved, each one building on the other.
So I thought, all right, I got this. This is so hard for me, but I’m going to tell you what happened. So I thought, well, I know there’s an ulcer, and the ulcer is likely from the high stress. So I really have to start there. He was taking deglycyrrhizinated licorice, which is great for ulcers, and slippery elm is also great. But that wasn’t working. My question was: is this an ulceration because of an infection? Or is the ulcer because of high stress and we just need to decrease the stress response and improve the mucus barrier and let the stomach heal?
One of the fastest ways you can heal an ulcer — as a side note — is with cayenne. It is not pleasant, but it works. It’s old-time medicine. They would give somebody hot, hot, hot pepper — cayenne with high heat units. And what happens is it’s so irritating to the mucous lining — kind of like prolotherapy. You insert saline into the joint, it gets irritated and inflamed, and then it heals. Same idea. You put the hot into the stomach, the stomach goes into panic mode, and it starts to quickly release those mucins. The mucins lay down the mucous barrier, and once the barrier is down, the ulceration can heal. I had that fleeting thought — but it was very fleeting — because I knew there was no way he was going to be able to do this.
So I thought, all right, I’m going to start gently. I said, “Have you ever taken any bitters or anything like that? Do those bother you?” And he said, “No, not really.” He said, “I just always feel a lot of pressure up in that epigastric, xiphoid area.” I said, “Okay, well, let’s start with some bentonite clay and see if we can absorb some of that extra fluid in there. And let’s do a little bit — just a real little bit — of gallbladder support.” I was a little nervous about that, but I did it. And then I gave him something for stress — for anxiety. And a vitamin/mineral from Doctor’s Research, because I really like that one. And at the very end of our first call, I thought, I’m going to give him one more thing for mood. I’ve got to get him to see some sunshine. Just the tiniest little ray of sunshine. So I gave him a Nevaton because it has saffron in it. And I sent him off with that.
I said, “Chew your food thoroughly, and try to really be in a state of calm and relax when you’re eating. Keep taking the DGL. Keep taking the slippery elm.” The DGL was a good brand, so I wasn’t worried about that. And he said okay. I asked him to log his food and just pay attention to symptoms — how he was feeling — because I need to know what’s happening when he takes the supplements. It’s kind of like what I talked about last week on the podcast where I added GI Absorb and it caused darker thoughts. It tells me there’s something else in the gut. That was my thinking.
So this is what I get from him via text: “Logging my food and paying attention to these sensations is incredibly difficult for me because it’s been triggering my anxiety, which then exacerbates anything that I am feeling. I was on PPIs for so long and I was scared about getting a perforation or a bleed. My family really drilled that into me, so I stopped the PPI. But I have a new symptom now — painfully tingly tongue and a gum area towards the back that’s very raw on the right side. It feels bumpy and raw and sore.” He was tracking every single sensation, and every sensation was triggering more anxiety, which triggered more symptoms. I thought, okay. Tracking symptoms is not going to work for him.
So on our second appointment, the stomach burning was still bothering him. He wanted to go back on the PPI. I said, okay. He had told me initially that he didn’t think it was working. Now he said it is working. So he went back on it. He said he’s feeling nauseous and maybe some burning, but “I’m going to get back on the PPI,” which I didn’t quite understand. He forgot to order Calm Restore. He kept forgetting to take the Nevaton. I wasn’t getting the cooperation I needed because he was so in his head. Like I said last week, sometimes patients get real navel-gazy. They’re thinking about all the symptoms instead of looking up and thinking, “How can I get better?” All he’s thinking about is that he’s dying and all the horrible symptoms. He sent me a food log. I couldn’t make sense of it. No dates. Screenshots. I didn’t have the heart to ask him to redo it. He said now his skin is itchy — which makes me think gallbladder or histamines. He feels worse. Wheat and corn are causing loose bowels. Still undigested food in stool. So I stopped the gallbladder support.
And at this point, I’m grasping at straws. He’s so focused on symptoms that I can’t even get him to think about the possibility of getting better. I said, “All right. Let’s try aloe.” What can go wrong with aloe? It’s soothing. I said, “Think about when you get a sunburn. Aloe soothes and cools. It’s like a breath of fresh air.” So I had him take aloe orally. Then he started talking about ruminating thoughts. The ruminating thoughts made him not want to eat. And I’m thinking, I might be in over my head. If I could see him weekly in person, maybe. But every two to three weeks wasn’t working. I suggested High Pep — deglycyrrhizinated licorice, mastic, maybe chamomile — great for ulcers. I dialed in his protocol as best I could, walking on eggshells because I didn’t want to trigger more anxiety. And I kept thinking, what am I missing?
He texts me: “Nearly everything I have eaten has passed partially or completely undigested.” That stopped me. Like — does the whole piece of carrot come out intact? I struggled with that. “I’ve made four trips to the bathroom today. The days I take gallbladder support, things get more mobile but less digested. My body is still itching. I feel burning on the left stomach and in my throat. I’ve been having peripheral neuropathy on the left side of my body from head to toe.” Then the next day: “I went without gallbladder support. Ate clean. My stomach is gurgly all the time. Burning in my throat with no food. Pain in the upper left chest and stomach. I am not feeling good.”
Over the course of a week, multiple texts. And that’s when I stopped. Something is not right. Every time I changed something, he panicked. Gallbladder support changed motility. Bitters aggravated the ulcer. PPI worked and didn’t work. Calm Restore made him too sleepy. He was tracking symptoms faster than his body could adapt. And that’s when I realized — this is a neurological stress pattern. The symptoms were lateralizing — left-sided pain. Classic neurological stress pattern. I was treating the gut as the driver. But the gut wasn’t the driver. The gut was the microphone. The problem was his nervous system.
So I went back to the intake forms. Blank sheet of paper. Writing down everything that stood out. Epstein-Barr in 2019. Infection. COVID in 2020. Infection. Immune stress. Nervous system dysregulation. Then two significant emotional traumas. The apple cart crashed. He was pinned under it.
His central nervous system was completely unstable. He could not regulate. And I’m giving digestive support. He needs it — but he cannot regulate. He’s hyper-viscerally sensitive. Everything is magnified. And underneath it all is fear. “I’m dying. No one can fix me.” Six years of that. Low digestive signaling capacity. PPI. Stress. Ulcer. Probably not dropping hydrochloric acid. Reflux. Burning. Mast cell dysregulation. Traumas stored in the body. “Feelings buried alive never die.” Triggers. Anniversaries. Maybe carrot soup was tied to trauma. Every new intervention felt like a threat. Warning. Danger. Amplify. That’s why everything worked and didn’t work. I went too fast. I didn’t address the real problem. Every adjustment overwhelmed his nervous system. And I made him worse.
So I thought — phase it out. Protect digestion. PPI. Aloe. Maybe Gastrex midday. Slippery elm at night. A little Calm Restore. Chamomile tea. Not fixing. Just settling. No analyzing. No symptom tracking. No stool checking. No Google. Boring. Safe. Predictable. His nervous system needs to stop bracing. Then we can layer in targeted support. Hyperbaric. PEMF. Reset first.
I never heard back from him. That’s the saddest part. I lost him. And I wanted so badly to help him. The lesson? The loudest symptom isn’t always the real problem. Some patients need stabilization first. Tracking symptoms can amplify dysregulation. Post-viral issues are real. Going too fast is a clinical mistake. The answer wasn’t try harder. The answer was slow down. Create safety. Let the body heal.
In hindsight, hyperbaric or PEMF might have been better first steps. This one was hard. I’m hoping I get another chance. If I do, I’m going after the nervous system first. Settle. Calm. Safety. Outside therapies. Deep trauma work. Because talk therapy alone probably won’t touch it. So there’s my hard, sad case. Don’t you have those sometimes? The ones you wish you hadn’t missed? I’m praying I get another chance. I’m glad you’re here.
[CLOSING]
Ronda Nelson: Next week we wrap up the series. If you haven’t downloaded the clinical thinking resource, go to rondanelson.com/6principles. And if you want more clinical help, join me in Clinical Academy. Although today wasn’t the best commercial, was it? That’s all right. I do know what I’m doing. This was just a hard case. Thanks for hanging out with me. I’ll be back next week. Take care. Have a great week.
[END]