I have a 58 yo F with a PMH of anxiety, mild hypothyroidism who was Dx with locally advanced rectal cancer T3N+M0, low-grade rectal adenocarcinoma in 2017 s/p neoadjuvant FOLFOX and chemoRT and LAR, with some post chemo neuropathy. Now 8 years out and scans are negative, she has a colostomy, she came to me 2 months ago with profound fatigue for past few years (checked tick borne panel as we live in Massachusetts (neg), Vit D a bit low in the 30s, ESR in the 20s, hsCRP 12, homocysteine 19, FT3 and FT4 not optimal but normal), shes already on Zepbound but had to reduce dose from 10 to 7.5 due to worsening fatigue, now back up to 10 mg. GIMAP shows some dysbiosis and low Akkermansia (due to colectomy?) and some low pancreatic enzymes, zonulin + but not high (137). She’s postmenopausal but we don’t have hormones levels yet.
Her endo won’t let me adjust her thyroid meds so I put her on thyroid support vitamins, Akkermansia probiotic, methylated B vitamin complex, GI Revive, alpha lipoic acid. I wanted BPC157 but she is afraid of cancer regrowth given VEGF stimulation. She’s open to peptides to help with recovery but also still very fatigued (better over last 6 weeks, went from 3 naps a day to one) but also planning on traveling out of the country for the next 3 months starting in December. I was thinking of SS31 to help with energy but thought I should probably work on her immune system first with TA1 and maybe TB4, but didn’t want to change protocols midway through her time out of the country and concerned about long term use of these. Also thinking Selank to help with mental clarity and anxiety.
Open to any thoughts/ideas. She’s anxious and tired and fearful of the rectal cancer returning.
thank you
Dave
