antecedents are factors, genetic or acquired, that ...  · definitions: antecedents, triggers,

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  • Definitions:Antecedents, Triggers, and Mediators

    Antecedents are factors, genetic or acquired, that predispose individual to an illness or pattern

    Triggers are factors that provoke the symptoms and signs of illness

    Mediators/mediation are factors, biochemical or psychosocial, that contribute to pathological changes and dysfunctional responses

  • 2015 The Institute for Functional Medicine

    Mediators cytokines, prostanoids, nitric oxide,

    kinins, hormones, neurotransmitters, free radicals

    Antecedents genetics, experiences, past illness, occupational exposure, nutrition,

    lifestyle

    Triggers microbes, allergens, trauma, toxins,

    etc.

    Feed-forward

    cycle

  • 2015 The Institute for Functional Medicine

    Antecedents, Triggers, and MediatorsAntecedents

    Congenital

    Demographic

    Dietary

    Habitual

    Environmental

    Occupational

    Learned

    Traumatic

    Disease-induced

    Drug-induced

    Triggers

    Trauma

    Microbes

    Antigens

    Environmental Toxins

    Radiation

    Social Interactions

    Memories

    Diverse Sensory Stimuli

    Mediators

    Hormones, Cytokines, etc.

    Ions

    ROS

    Metabolites

    Thoughts

    Beliefs

    Social Reinforcement

    Classical Conditioning

  • 2013 The Institute for Functional Medicine

    CurrentConcerns

    TriggersorTriggeringEvents

    Signs,SymptomsorDiseasesReported

    Birth

    Antecedents

  • Antecedents

  • Precon

    ception

    CurrentConcerns

    TriggersorTriggeringEvents

    Signs,SymptomsorDiseasesReported

    Pren

    atal

    Birth

    AntecedentsFamily history (genetic predisposition), trauma, toxicity,

    intrauterine history, sexual abuse, intestinal permeability, infection, dietary insufficiencies, drug use

  • Precon

    ception

    CurrentConcerns

    Antecedents

    TriggersorTriggeringEvents

    Signs,SymptomsorDiseasesReported

    Pren

    atal

    Birth

  • Triggers

  • Precon

    ception

    CurrentConcerns

    Antecedents

    TriggersorTriggeringEvents

    Signs,SymptomsorDiseasesReported

    Pren

    atal

    Birth

    Physicalorpsychictrauma,microbes,toxins,memories,stressfulevent,surgery,infection,etc.

  • 2015 The Institute for Functional Medicine

    Inflammatorycytokines,ongoingpsychologicalstress,ongoingexposuretoenvironmentalinsultsi.e.mold,chronicsleepdeprivation.

    Mediators/Perpetuators

  • 2015 The Institute for Functional Medicine

    Ask Unexpected Questions

    What life events occurred just before or around the onset of your illness?

    When were you last well? If you could erase 3 problems with a magic

    wand, what would they be? What do you think caused or might be

    contributing to your illness?

  • 2015 The Institute for Functional Medicine

    MicrobesToxinsAllergensFoodsStress

    The Timeline of the Lifespan Metabolic Stress-Nutrient Requirement Changes

    Timeline for methylation stress

    Preconception>First Month

    Pregnancy

    12-18 monthsB Vitamin Stores decrease

    6-7 yearsEFA change

    30-50s GlucoseIntolerance

    Cognitive changesLatency diseases

    ParenthoodPregnancy

    Job/EconomicStress

    Latency Diseases

    10-18 yrsTanner ChangesAndrogenation

    18-30 Social Habits

  • 2015 The Institute for Functional Medicine

    Childhood

    Childhood Nutrition and Stress Levels

    Adolescence Adult Life

    Nutrition Influences at Various Life

    Stages

    Gen

    erat

    iona

    l Inf

    luen

    ces

  • 2015 The Institute for Functional Medicine

    Prec

    onc

    eptio

    n

    Current Concerns

    Antecedents

    Triggers or Triggering Events

    Signs, Symptoms or Diseases Reported

    Pren

    ata

    l

    Birth

    FUNCTIONAL MEDICINE TIMELINE

    Mediators/Perpetuators

    Name: ______________________________ Date: __________________ CC: _____________ @2014 Institute for Functional Medicine

    Gas & Bloating,Frequent non-bloody stools, sensitive stomach,Feeling of incomplete voiding, low energy, depressed mood.

    44

    Fam Hx of IBS, Diverticulitis

    Abdominal Pain Missed

    school GI eval, no

    scopes

    Dx as lactose intolerance partial

    improvement.

    10Vag Birth

    prolongedABX dt

    membrane rupture

    Solid foods at 6 months

    Bottle fed @ 4wks

    Colic @ 6 weeks

    Tonsillectomy @4yo

    3-5 bouts of OM treated with ABX

    3 4

    Vag Delivery

    Vag Delivery

    Weight gain in college

    History of DepressionPostpartum

    depressionaftereach;notreatment

    Weighthascontinuedtocreepupoverthe

    years

    27 29

    Parents divorced

    Mother Remarried

    7 9

    MarriedMarried

    25

  • 2013 The Institute for Functional Medicine

    Precon

    ception

    CurrentConcerns

    Antecedents

    TriggersorTriggeringEvents

    Signs,SymptomsorDiseasesReported

    Pren

    atal

    Birth 411517 20 3432 36 38

    SleepDeprivation Rightleg&hippain Dryscalp Neckpain/stiffness Rightjawache Brokentooth

    2129

    Highstressyears

    Remarriedbestfriend

    1500flights/radiationMaternalCVD,Anxiety,Arthritis,MTHFR

    PaternalCVD,MetSyn,Obesity,Anxiety,EtOHism

    GlassesinKindergarten

    PCOSWeightGainTrunk

  • 2014 The Institute for Functional Medicine

    20montholdmale

    Prenatal

    42mo.oldmale0

    MultipleAntibioticsOM,SkinInfections

    poorweightgain,face,cheeks,earswitheczema,impetigo;OM;Rx:Augmentin>>exacerbationofrash

    DevelopmentalDelay:Speech,Hearing

    DX:MixedIgEIgGReaction,Dysbiosis,Malabsorption

    MultipleepisodesofOtitisMedia;txantibiotics

    BreastFeeding/mixed/OnlyBreast Limitedpalatereducedfoods

    RestrictiveDiet,SevereEliminationDiet

    MultipleallergiesduringPregnancy,OralSteroids

    severerefluxrequiringPPI

    MomG3P2AB1historyofallergytofoodsandrashesspecifictofoods,asthmaFather withatopicdermatitis

    ContinuedMaternalAllergies,Depression,Fear

    Rash,scalyskin,severecolic

    Diarrhea

    Undernutrition

    CaseAtopy,MixedIgE,IgGReactions,sIGAdeficiency,Dysbiosis,Malnutrition PMStone

    Dysbiosis

    308931.5

  • 2015 The Institute for Functional Medicine

    Precon

    ception

    CurrentConcerns

    Antecedents

    TriggersorTriggeringEvents

    Signs,SymptomsorDiseasesReported

    Pren

    atal

    Birth

    57 62 65 73

    Chronicdebilitatingfatigue Multiplegastrointestinal

    symptoms Rashonchest

    SystemicMastocytosisHashimotosThyroiditis

    BreastCancer

    CFSInbedfor5

    years

    NotbreastfedPotentialmethylationissues(SNPs)?Potentialglutathioneissues(SNPSandnutrition)

    53

    IBSstartedinearly20s

    DiagnosisofFM

    IntegrativeMD:significantnutritionalsupplementation

    withoutbenefit

    Childhood 20s

    ChemicalsensitivitiesaschildmultipletripstoER

  • 2013 The Institute for Functional Medicine

    Precon

    ception

    CurrentConcerns

    Antecedents

    TriggersorTriggeringEvents

    Signs,SymptomsorDiseasesReported

    Pren

    atal

    Birth

    9 21 46

    Headaches Migraines ChronicFatigue(comesandgoes). Depression Osteoarthritis

    IBS

    Fibromyalgia Psoriasis Asthma

    4226

    LatexAllergy Hypoglycemia Hypothyroidism Bulimia&

    Anorexia BingeEating

    Disorder

    38

    SleepApnea

    36

    ChronicSinusitis FoodAllergies ChronicPain

    (24years)

    4331

    PolycysticOvarianSyndrome

    4039

    Gout

    KidneyStones

    EnvironmentalallergiesHypertension

  • 2013 The Institute for Functional Medicine

    Precon

    ception

    CurrentConcerns

    Antecedents

    TriggersorTriggeringEvents

    Signs,SymptomsorDiseasesReported

    Pren

    atal

    Birth

    710

    Asthma,SOB,&Insomnia

    1315

    SevereAsthma&DOE

    3054

    Asthma;ShortnessofBreathInsomniaandFatigueResistantWeightLossHeadaches

    48

    AsthmaReturnedRx;HeavyexposureBronchitiscyclicallyforyrsSevereFatigueDeveloped

    ChronicAntibioticuseforyears;2wksofeverymonthandahalf

    3Childrenborn;atagesof25,27,29

    2529

    Dx:Dyslipidemia&Hypothyroidism

    LMP

    52

  • 2014 The Institute for Functional Medicine

    Prec

    onc

    eptio

    n

    Current Concerns

    Antecedents

    Triggers or Triggering Events

    Signs, Symptoms or Diseases Reported

    Pren

    ata

    l

    Birth

    FUNCTIONAL MEDICINE TIMELINE

    Mediators/Perpetuators

    Name: ______________________________ Date: __________________ CC: _____________ @2014 Institute for Functional Medicine

    34

    Ear infxn

    1 2

    Roseolla

    Induced wt Pit. Post srom; Apgar 9-10

    7 15

    15 ABX Tx 1-2/year

    Bouts of Bronchitis/

    Sinusitis

    3

    Violaceousspots on her toes wt. pn

    3318 19

    Periods with Cramping

    12

    Chicken Pox

    Otitis Media & Bronchitis

    Conjunctivitis/Strep throat/Sinusitis

    Migraines began

    23 27

    Both elective C-section; bl tubal ligation after 2nd child

    30-31

    Pustularacne with sinusitis, allergic

    rhinitis. UTI.

    Nodular acne; Raynauds

    Vitamin D deficiency

    32

    PUPP

    Recurrent Yeast infxn Migratory

    polyarthritis, Raynauds, MS injuries to neck, low back, radicular Sx

    Father with Ulcerative Colitis

    Dx: Lupus

    Thanksgiving /no water at home; high stress

    Thanksgiving /