Concussion Care 2023

Frances Meredith, MD

Concussion is so much more common than we realize, a frequent occurrence in kids and teens, especially athletes, and increasing frequency in the elderly and unstable of gait.  The fact that memory loss can be associated creates a scenario where concussions are simply not recalled, but can lead to long lasting symptoms and deterioration in quality of life.   Most people do not seek care, and when they do, they are usually given out dated advice unless seen at a dedicated concussion center or provider. Sadly, most medical professionals, even in an urgent care or ER, are not trained in current cutting edge acute concussion care. Concussion centers have only come into existence since 2000, and active research has been lacking until recently.

What is very clear is that with any symptoms suggestive of concussion (including loss of consciousness, dizziness, or feeling “detached”, vision changes, headache, nausea), physical activity must stop immediately. Theon field symptom that best predicts a longer recovery is dizziness followed by “fogginess”. Estimates according to Dr Michael Collins, head of the concussion center at UPMC University of Pittsburgh Medical Center, are that for every minute a player is back on the field, his/her recovery time is lengthened by7-8 days (1). The average recovery time for a mild concussion is 18 days, with15 minutes back on the field prolonging this to 44 days.  What is not widely recognized is that immediate evaluation, a graded exercise and brain rehab plan, and supplement support can greatly speed recovery.   
           
EVALUATION

An evaluation by a doctor familiar with concussion is essential after head trauma. Assuming the doctor feels you can be monitored at home, someone should stay with you and check on you for at least 24 hours to make sure symptoms are not worsening. This should be followed be evaluation by a true concussion expert as soon as possible. Evaluation should include an assessment of the mechanism of injury itself(video very helpful if available), vestibular ocular motor screening, balance and autonomic nervous system testing, and can include more sophisticated testing including a qEEG brain scan and Right Eye testing. An assessment of preconcussion risk factors which might delay recovery is important as well as a determination of the type of concussion. There are, according to current research, six types of concussion: cognitive fatigue, vestibular, ocular, migraine, anxiety, and neck based. These can overlap, and these different types are treated with different therapeutic modalities guided by testing.

MANAGEMENT

Mental rest and eye rest are essential in the early days after concussion. How long you’ll need to rest your brain and body will depend on the severity of your concussion and rapidity of resolution of symptoms. Your concussion specialist will help you to create a plan to allow the brain to heal. This will include lots of rest, optimizing hydration, and initially completely avoiding activities requiring mental concentration including homework, watching TV, playing video games, texting and using computers. These activities should be avoided for at least the first 48 hours after concussion, then gradually brought back incrementally as tolerated. Physical activity should also be limited in the first few days to mild activity such as walking that does not trigger symptoms. At that time exercise becomes essential in the healing process. Previously recommended complete bedrest, in darkness avoiding all stimuli, is no longer recommended.  A structured, gradually progressing exercise plan should be created with your concussion specialist. Exercise programs after concussion often consist of 45-90 min daily of intense activity to increase blood flow to brain. Exercise is the best way to increase Brain Derived Neurotrophic Factor (BDNF), essential in neuroplasticity and brain healing.  Optimal sleep is essential, with experts recommending at least 8 hours nightly with consistent bedtime and awakening times, taking only short naps when needed during the day in order to ensure optimal nighttime sleep. Your doctor may recommend, as screentime and mentally focused activities are reintroduced, a lightened work/school schedule, and spacing out screentime such as homework in short blocks. Your doctor will likely recommend other modalities to “rebab” the brain including a combination of exercises for vision and balance, Neurofeedback, autonomic nervous system retraining, and laser therapy. Often chiropractic care will be advised to reestablish alignment in the neck as misalignment in the neck gives the brain incorrect information about where you are in space.  For pain relief discuss with your doctor whether Tylenol is right for you as NSAIDS such as Ibuprofen or Aspirin can increase risk of bleeding and actually prolong inflammation. As the brain is working hard to clear out damage, it is essential to abstain from other toxins to the brain such as alcohol, and lay off cigarettes if you smoke.

   “Energy Crisis”

Optimal nutrient support at the onset of concussion may have an impact on speed of recovery.  To understand why, it is key to understand what is happening in the brain in the minutes after concussion. The brain depends on glucose for energy.

Following concussion, an “energetic crisis” occurs in the first 24 hours after injury where the brain can no longer easily metabolize glucose. Just when the brain needs more energy to heal, it has much less. This is followed by neuroinflammation at the site of injury that can further impair metabolism and energy production in the brain. Neuronal damage is also accompanied by vascular damage in which the pumps that keep nerves stable begin to fail. Then glutamate, a neurotransmitter toxic when in high amounts, can leak out and create inflammation and cell death. The goal is to decrease energetic demands on the brain and provide an alternate source of fuel other than glucose: ketones. Ketones serve as an alternate fuel source for the brain, typically created from fat stores while fasting. There is limited research in this area but animal studies are supportive and human studies are ongoing.  The mechanisms of injury above guide treatment options that can be helpful in the hours to days after concussion. These can include:

 –Ketogenic diet: Ketones created in a low carbohydrate “ketogenic diet” support brain energy and can be supported by “exogenous ketones” in powder form.  Studies in rodents show therapeutic benefit(4,5); studies in humans are lacking and ongoing but safety of ketogenic diet has been established.

Anti-inflammatory nutrients and anti-inflammatory diet:  Nutrients such as fish oil, DHA, Vitamin D,NAC, Vit C, and curcumin have growing research to support their therapeutic benefit.

Phospholipid Support: Phospholipids, the main component of cell membranes, are made up of fats and phosphate. Studies suggest phospholipid support can help repair a damaged blood brain barrier and reduce tissue damage with traumatic brain injury (TBI)(8,9)

Hyperbaric oxygen treatment: Research suggests hyperbaric oxygen may be beneficial in both acute and chronic concussion or CTE (chronic traumatic encephalopathy) (6,7) however more research is needed.
 
As the research grows, our approach to concussion will be fine tuned in the years to come.

Please spread this information to family and friends as this knowledge can be the difference between return to play with speedy recovery and a lifetime of frustrating neurologic and psychologic symptoms that can be the result of poorly managed concussion. With expert management, top practitioners in the field firmly believe that complete healing is possible.

Your Partner In Health,
Frances T. Meredith, MD

Dining Out With Kids

 

It’s tricky enough to find restaurants with healthy options for grown-ups. Here are a few suggestions for dining out with the whole family.  

Cowfish Sushi Burger Bar- With locations in Raleigh, Charlotte and Orlando, Cowfish melds the deliciousness of sushi and burgers to make sure there is something for everyone on the menu. Cowfish makes special occasions fun with their playful ambiance and noisy gong birthday song!  

With most kids’ meals priced at $8, it’s affordable for a regular dinner out, too. Their kitchen takes care to accommodate a variety of allergies. The kids’ menu is made up of Bento Boxes with main dishes including California rolls, grilled nuggets, PB&J Sushi Roll and more. Each one comes with two sides and a rice crispy dessert. Healthy side options include oranges, carrots, edamame, apples and sweet potato fries. For the grown-ups, gluten sensitive and vegetarian options are clearly marked. Try the Double Salmon Roll and the Tuna & Avocado-Tini.  

Firebirds – Okay, confession time. I am guilty of ordering from the kids’ menu at Firebirds. It’s tough to beat grilled salmon with two sides and a drink for less than $11. In my defense, I do tip generously when I go this route.  

Firebirds is a chain with locations around the country – including Raleigh, Durham, Morrisville, Winston-Salem and Charlotte. The dining room is nice enough for a special occasion dinner. 

For healthy kids’ options, try the grilled chicken breast, salmon or steak with broccoli, fresh veggies and/or fresh fruit and 1% milk or an Honest Juice Box to drink. They also have mocktails for fun, non-alcoholic drink options for the whole crew. Food allergies? Ask to see a manager to ensure your food is prepared in a way that is safe for you and your family.   

Chipotle- For a quicker meal on the go, Chipotle offers vegetarian, vegan, paleo, Whole30, gluten-free, dairy-free, soy-free and even sulphite-free options. They do not use eggs, mustard, peanuts, tree nuts, sesame, shellfish or fish as ingredients. Kids meals are less than $6 and include a fruit side and organic milk as healthy side/drink options – and I admit to ordering the kids’ meals here, too. I still tip like a grown-up, though. This is a fantastic option for tired grown-ups in the middle of a Whole30. 

Your partner in health,

Erica Nelson, MSPH, NBC-HWC

Back To School Checklist

Blair Cuneo, PA-C

While the family is enjoying the downtime from school break, the upcoming school year is in the back of my mind. I’m slowly starting to make lists for updating lunch boxes, checking clothing sizes, gathering school supply items, all the while wondering what the next grade level will be like for my kids. 

“Preparation clears a pathway for success.”  ~ Ron Kaufman

As a pediatric functional medicine provider, I recognize that each child has unique needs to optimize their mental and physical wellness. However, there are several general recommendations from which many children and families can benefit.

Specific to academic performance, here are some fundamentals for your “Back to School” checklist:

– Honor the importance of sleep for body and brain.

Lack of sleep impacts production of neurotransmitters like dopamine, crucial for its role in attention and focus. School aged children should be getting 10-12 hours of restorative sleep. Restless sleep, teeth grinding, snoring, and waking up tired after adequate hours, are all signs that the sleeping hours are not “quality”. Without quality sleep, the body has not had the restorative opportunity to repair, heal and learn.

– Check in on screen time.

Prolonged screen time is associated with increased difficulty in attention, focus, emotional regulation and anxiety. Take into account screen time needed for school and set boundaries for when and what type of screen time is allowed in the home.

– Clean up the pantry, stock the fridge.

Artificial foods and dyes have a direct, negative relationship to behavioral health and cognitive performance. When hungry, go the fridge first, aim for rainbow whole foods, read labels and avoid eating what you can’t pronounce.

Many patients and families notice improvement in mood, energy, digestion, pain and school performance by integrating the above considerations.  If needed, there are more areas to investigate with a pediatric functional medicine provider.

In the functional medicine approach, we evaluate metabolic, nutritional, environmental and genetic contributors to your child’s symptoms or medical conditions. We want to understand “root cause” and not rely solely on band-aids to suppress or mitigate symptoms. We want to support the body and mind in need, while also shifting towards fundamental healing and prevention.

Some major contributors to impaired school performance include nutrient needs, like zinc and magnesium. If nutritional needs are found, we can directly support, but let’s also consider why the needs are there! Is the diet lacking? Does the digestive system have trouble absorbing nutrients adequately?

Speaking of the digestive system, the gut-brain axis is a recognized, bidirectional communication mechanism between the gut and brain. The gut microbiota affect the production and breakdown of neurotransmitters like dopamine, serotonin and GABA. These neurotransmitters are responsible for mood and academic performance. Dopamine is a key neurotransmitter for attention and focus.

When the body is under stress, dopamine production is hindered. Areas of stress include poor sleep, inflammatory foods/chemicals, food sensitivities, nutritional needs, yeast overgrowth, inflammatory bacteria.

Objective testing can be helpful in creating a personalized plan for our young patients. Less guessing, with more targeted interventions and support, can help you and your child experience enjoyment and success in their academic programs.

Call Carolina Total Wellness to schedule with our pediatric functional medicine provider.

Your Partner In Health!

Blair Cuneo, PA-C

PEDIATRIC COVID-19 Vaccination Prep

 Supporting Resiliency for Children 5 years – 11 years

The Centers for Disease Control (CDC) and American Academy of Pediatrics (AAP) have announced recommendations for COVID-19 vaccination in children 5 years and older, who do not have contraindications.

At Carolina Total Wellness (CTW), we seek to empower our patients and their families with up to date information and provide medical recommendations through our personalized approach.

If you have questions regarding vaccinations, please reach out to your established medical provider.
 
PEDIATRIC COVID-19 Vaccination prep:
Supporting resiliency for children 5 years – 11 years
 
Start 2 weeks BEFORE and continue for 1 week AFTER vaccination:
 
1. Clean water: ½ body weight in ounces
2. Vitamin C: 125-500mg two times a day
3. Daily Multivitamin (ActivNutrients chewables)
4. Daily Probiotic (Ther-biotic complete chewables)
5. Vitamin D: 1000IU per 25 lbs, daily (CTW Liquid D3)
6. Zinc 7.5mg daily (Zinc Drink liquid)
7. SPM Active 1 caps daily: cut/puncture the softgel and squeeze out contents onto spoon, ok to take/mix with food.
 
In the days leading up to your vaccination, fuel your child’s immune system with healthy, organic colorful foods that are nutrient dense. Avoid pro-inflammatory junk foods and sugary foods. Stick to sleep schedules/healthy sleep hygiene and aim for quality sleep the two nights before the vaccination.
 
*Day of and day after vaccination, add extra C to above protocol:
Vitamin C: 500mg two times a day
 
After your vaccination, think muscle, immune and lymphatic system support:
 
Engage your deltoid! This is the shoulder muscle which received the vaccine. Movement and engagement of the muscle will reduce the tenderness and soreness which can start setting in a few hours later. Example exercises include arm circles, push-ups, patty-cake!
 
Run around! Walk, run, play after the vaccination to provide a healthy stimulus for the immune system for optimal response and reduce side effects.
 
Stimulate lymphatic system! After the vaccine, you can begin gentle skin brushing of the vaccinated arm. When able, incorporate whole body lymph support with options like whole body dry skin brushing, gentle rebounding (jumping, hopping), or deep breathing (blowing bubbles, square breath). 
  
AAP statement:
https://www.aap.org/en/pages/covid-19-vaccines-in-children-and-adolescents-policy/
 
CDC statement:
https://www.cdc.gov/vaccines/covid-19/planning/children.html

  
Please contact our office for an appointment to further support and personalize your path to wellness.
 

Your Partner In Health!

Blair Cuneo, PA-C

Tips for Healthy Eating for Busy Families

Does the back-to-school season of busy weeknights filled with extracurricular activities have you relying on take out for dinners?  Here are some tips to keep meals at home that are healthy and easy. 

TIP #1
~ Keep freezer stocked with proteins to limit daily trips to the store.  Grass fed beef, organic ground turkey, organic chicken breasts, wild caught salmon, and Aidell’s chicken sausage.  Instacart has been a time saver for my family and Costco will deliver all of these protein options. 

TIP #2
~ Keep the pantry stocked with staples. Beans, GF Pasta (we love Jovial,) Tomato sauce (Rao’s,) Chicken and Bone broth, rice, quinoa, nut butter.

TIP #3
~ Use a crockpot or instant pot to cook meals and/or meat ahead of time.  One great way to cook chicken is to add a few chicken breasts, taco seasoning and a few scoops of your favorite salsa.  Cook for 3 hours in the crockpot.  This chicken can be used for many meals!

BONUS TIP
~ CHANGE YOUR MINDSET TO MAKE SIMPLE, HEALTHY DINNERS
This might be the most powerful secret of all. The best way to make simple, healthy dinners is to change your thinking on what dinner should look like. This means that not everything is gourmet, but the upside is now meals are much simpler while still being healthy.

TWO easy “on the go” meals:

1) Burrito Bowls or Taco salad in a Jar
~ Chopped up greens as the base
~optional rice, black beans, chicken, beef or turkey, guacamole, salsa, sour cream or Tessemae’s Avocado Ranch dressing. 
~ Prepare in a bowl or in jars to take in the car. 

2) Aidells Chicken Sausage & Roasted Vegetables

~ Aidells Chicken sausage – sliced
~ Broccoli, zucchini, mushrooms, potatoes or sweet potatoes, or whatever else you have on hand.
~Roast in the oven and enjoy!

For more tips on how to conquer healthy eating during the busy school season, contact our office at 919.999.0831 to schedule an appointment with one of our Health Coaches. 

Your Partner in Health!
Caroline Wilson, M.Ed., FMHC

Kids and Mindfulness

Caroline Wilson, M.Ed., FMHC
 You may be thinking that kids and mindfulness are not two things that naturally go together. But as anxiety continues to become an epidemic for our children and teens, we must find ways to help them make mindfulness a part of their lives.

So, what is mindfulness? 

A great definition by Jon Kabat-Zinn, the founder of Mindfulness-Based Stress Reduction describes it well:

 Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally. 

Stopping, paying attention, and noticing what’s happening around you, and everything you’re feeling, thinking and doing in that particular moment with honesty and without judgment is being mindful.  Sounds easy enough, right?

Actually, this Harvard study found that we spend almost 50% of our time thinking about something else and NOT what we’re actually doing!

Here are just a few of the health benefits of mindfulness that have been researched:
Increased focus and attention
Improved memory and learning
Less anxiety and depression
Better emotional self-regulation
Stronger immune system
Reduced inflammation 

Here are a couple of my favorite mindfulness exercises that you can do with your kids:
 
STOP, LOOK, and LISTEN
 
You and your kids can practice mindfulness anywhere and anytime.  A great way for kids to learn how to be mindful is by using the STOP, LOOK, and LISTEN method.  This involves, STOPPING what you are doing, LOOKING around you and using all 5 senses (what are you seeing, hearing, feeling, smelling, and even tasting) and LISTENING (listen to your body and mind and how it feels in that moment).

THE FIVE SENSES EXERCISE

Another quick exercise that can be done anywhere is the 5 senses exercise.  Notice 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell, and 1 thing you can taste.  This exercise can bring you to a mindful state quickly.
These are just a couple of examples of how you can practice mindfulness with your kids.   

Your Partner in Health!
Caroline Wilson, M.Ed., FMHC

COVID-19 UPDATED

Blair Cuneo, PA-C
While there are questions and uncertainties in our evolving understanding of COVID-19, its variants and vaccination options, there are many things we have learned. We continue to see reduced severity of COVID-19 illness in patients with less chronic inflammation and with healthy immune support.

The CDC website reviewing preventative recommendations for vaccinated and unvaccinated patients is below, including guidelines for mask wearing, social distancing and information on vaccinations.

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html

In addition to those guidelines, the providers at Carolina Total Wellness recommend the following lifestyle and supplement supports to optimize immune function, decrease viral transmission, reduce viral activity in the body and support the body’s immune response.

LIFESTYLE:
For adults and children, focus on eating foods that are organic and rich in antioxidants.  Try to eat 5 to 7 servings of vegetables and 2 to 3 servings of fruit every day.  Drink filtered water, avoiding plastics as much as possible. Improve ventilation, air flow and utilize quality air filters indoors, including home and work. Ensure adequate sleep for healthy immune and detox response.
Integrate mindfulness and stress lowering practices each and every day.
 
SUPPLEMENTS: (Bold items are available in online patient portal supplement store)

Adult Prevention Supplement Options:
1. Vitamin C: 500-1000mg daily to twice a day (Complete Vitamin C)
2. Vitamin D: 2000IU -5000 IU per day (Liquid D3, Vitamin D3, Ortho Force)
3. Zinc: 15-30mg daily (Zinc glycinate or Zinc Drink)
4. Quercetin 400 mg daily (Allergy Ease, BetaQ Immune, D-Hist Jr)
5. Melatonin 3-6 mg at bedtime (Melatonin CR or Quick Dissolve Melatonin)
6. Biocidin LSF mix 10 pumps into Xlear or a bottle of over the counter nasal saline spray: 2 sprays per nostril after possible exposures to virus.  
Additional options to discuss with your provider include curcumin, NAC, Andrographis, Vitamin A, Resveratrol and Immune Adaptogenic Mushrooms.
 
Pediatric Prevention Supplement Options:

1. Vitamin C (CTW Complete Vitamin C), Seeking Health Liposomal Vitamin C (liquid):3-5 years: 125-250 mg daily6-12 years: 250-500 mg daily 
2. Vitamin D (CTW Liquid D3 or CTW Vitamin D3):3-6 years: 1,000 IU daily7-12 years: 2,000-3,000 IU daily 
3. Zinc (Zinc Drink, Zinc Glycinate):3 years: 5-10 mg daily4-12 years 10-25 mg daily 
4. Quercetin (CTW Allergy Ease, D-Hist Jr chewables):3-4 years: 50-100 mg daily4-8 years: 100 mg daily8-12 years: 100-200 mg daily 
5. Xlear nasal spray: 1-2 sprays per nostril daily and after potential exposures. 
6. Elderberry:<7yo: 250mg daily>7yo: 500mg daily 
Additional options to discuss with your provider include curcumin and glutathione
 
The following therapeutic options are started at first signs of illness, positive exposure, and/or positive testing. Please notify your provider so that we can further personalize support.

Adult Therapeutic Supplement Options:

Vitamin C: increase to 1000mg four times a day. Reduce dosage to 500mg if loose bowels. (Complete Vitamin C)

Vitamin D: 2000-5000IU per day (Liquid D3, Vitamin D3, Ortho Force

Zinc liquid or lozenges: 15-20mg four times a day. Swish liquid before swallowing. If using lozenge, do not chew, instead suck on lozenge until done. (Zinc Drink)

Quercetin:  800 mg two times a day (Allergy Ease, BetaQ Immune, D-Hist Jr

Melatonin 3-6 mg at bedtime (Melatonin CR or Quick Dissolve Melatonin

Biocidin LSF mix 10 pumps into Xlear or a bottle of over the counter nasal saline spray: 2 sprays per nostril two times a day. 

Curcumin 500-1000 mg four times a day (Meriva or Turmero liquid) N-acetylcysteine: 600mg twice a day (CTW Liver Support or Trizomal glutathione

Andrographis: 375 mg twice daily (Viragraphis

Pediatric Therapeutic Supplement Options:

1. Vitamin C (CTW Complete Vitamin C), Seeking Health Liposomal Vitamin C (liquid)3-5 years: 125-250 mg four times a day, reduce dose if loose bowel movements.6-12 years: 250-500 mg four times a day, reduce dose if loose bowel movements. 
2. Vitamin D (CTW Liquid D3 or CTW Vitamin D3):3-6 years: 1,000 IU daily7-12 years: 2,000-3,000 IU daily 
3. Zinc liquid or lozenges (Zinc Drink or Zinc Glycinate)3 years: 5-10 mg four times a day4-12 years: 10-15 mg four times a day 
4. Quercetin (CTW Allergy Ease caps or D Hist Jr chewables):3-4 years: 50-100 mg two times a day4-8 years: 100 mg two times a day8-12 years: 100-200 mg two times a day 
5. Melatonin (Quick Dissolve Melatonin 3mg) or Source Naturals Melatonin lozenge, 1mg3-5 years: 1mg at bedtime6-12: 3mg at bedtime 
6. Biocidin LSF: 5 pumps into Xlear or nasal saline spray: 1-2 sprays per nostril two times a day.
 
7. Curcumin (Meriva or Turmero liquid)3-4 years: 125 mg three times a day4-8 years: three times a day8-12 years: 325 mg three times a day 
8. Glutathione (Trizomal Glutathione):3-5 years: 50mg two times a day6-12 years: 100mg twice a day


   
 

ADULT COVID-19 Vaccination prep: supporting resiliency
 
Start 2 weeks BEFORE and continue for 1 week AFTER vaccination:
 
1. Clean water: 8–10 glasses a day or ½ body weight in ounces
2. CTW Complete Vitamin C: 1 cap (500mg) two times a day
3. CTW Daily Multivitamin or MitoCore 2 caps two times a day
4. Daily Probiotic
5. Vitamin D3 4000IU daily
6. Zinc Glycinate 15mg daily
7. SPM Active 2 caps daily
 
In the days leading up to your vaccination, fuel your immune system with healthy, organic colorful foods that are nutrient dense. Avoid pro-inflammatory junk foods and sugary foods. Rest when you need to rest and aim for quality sleep the two nights before the vaccination.
 
*Day of and day after vaccination, increase vitamin C:
CTW Vitamin C: 2 caps (1000mg) twice a day
 
After your vaccination, think muscle, immune and lymphatic system support:
 
Engage your deltoid, the shoulder muscle which received the vaccine. Movement and engagement of the muscle will reduce the tenderness and soreness which can start setting in a few hours later. Example exercises include arm circles, push-ups, resistance shoulder pressing exercises.
 
Go on a walk! Perform some light cardio and exercise after your vaccination to provide a healthy stimulus for your immune system for optimal response and reduce side effects.
 
Stimulate your lymphatic system! Right after the vaccine, begin gentle skin brushing of the vaccinated arm, encouraging lymphatic flow toward center of body. Whole body lymph support options: whole body dry skin brushing, gentle rebounding, deep breathing. 
 
   

PEDIATRIC COVID-19 Vaccination prep:
 supporting resiliency for children 12 years and older
 
Start 2 weeks BEFORE and continue for 1 week AFTER vaccination:
 
1. Clean water: ½ body weight in ounces
2. Vitamin C: 250-500mg two times a day (CTW Complete Vitamin C caps, Seeking Health Liposomal Vitamin C (liquid)
3. Daily Multivitamin (ActivNutrients chewables or CTW Daily Multivitamin caps)
4. Daily Probiotic (Ther-biotic complete chewables or CTW Daily Probiotic)
5. Vitamin D 2,000IU – 4,000IU daily (CTW Liquid D3 or CTW Vitamin D3)
6. Zinc 15mg daily (Zinc Drink liquid, Zinc Glycinate caps)
7. SPM Active 2 caps daily
 
In the days leading up to your vaccination, fuel your child’s immune system with healthy, organic colorful foods that are nutrient dense. Avoid pro-inflammatory junk foods and sugary foods. Stick to sleep schedules/healthy sleep hygiene and aim for quality sleep the two nights before the vaccination.
 
*Day of and day after vaccination, add extra C to above protocol:
Vitamin C: 1000mg two times a day
 
After your vaccination, think muscle, immune and lymphatic system support, refer to instructions above.
  
Please contact our office for an appointment to further support and personalize your path to wellness.
 

Your Partner In Health!
Blair Cuneo, PA-C
 

References:
https://www.drkarafitzgerald.com/2020/03/16/covid19-traditional-chinese-medicine-and-western-options-for-the-non-tcm-trained-clinician/?mc_cid=1cd528a9bd&mc_eid=fb7826b1c3
https://healthykidshappykids.com/2020/02/27/coronavirus-covid-19/
https://www.drkarafitzgerald.com/2020/03/12/covid-19-preserving-your-familys-health-and-sanity-in-the-face-of-a-pandemic/?mc_cid=1cd528a9bd&mc_eid=fb7826b1c3
https://www.sciencedirect.com/science/article/pii/S1550830720301130?fbclid=IwAR0ZjInhMGulFrfnMHVL_uITY5EYuGNccwRII03as8NSVn_EeqRGvi8DgXY
https://healthykidshappykids.com/2020/04/04/pediatricians-pandemic-immune-support-plan/
https://info.ifm.org/covid-19?utm_campaign=covid-19&utm_source=website&utm_medium=popup&utm_content=resources_learn_more
https://covid19criticalcare.com/covid-19-protocols/i-mask-plus-protocol/
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/your-vaccination.html
 
 

 

Tips for Picky Eaters

By: Caroline Wilson, M.Ed., FMHC       

Do you have a picky eater?

Picky eating often begins early in life for our kids and is often one of the top concerns reported in our practice.  It’s not about perfection, it’s about creating a love of food and how it fuels our mental and physical health. 

Healthy eating habits start at home. With a few changes and persistence, we help patients go from eating chicken nuggets and white pasta meals to filling their plates with more colorful fruits and vegetables.

Here are a few of my favorite tips for picky eaters:

#1 Lead by example.  If you want your children to add more colorful and healthy foods to their plate, then you must eat them too.  Help them understand why it’s important to eat healthy.  “Because we want to feel good and have energy.”

#2 Make food FUN and Accessible.  We eat with our eyes so access and presentation are key.  For example, put healthy food at eye level in the refrigerator or create a vegetable tray and set it out on the counter.  Cut food into fun shapes or arrange the snacks in a mini muffin tin for something different. 

#3 Timed Snacking. Endless snacking does not allow time for kids to get hungry and eat what is prepared for meals.  One idea to help guide snack choices is to set out the veggie/fruit tray at designated snack times and “close” the kitchen soon after.  If you prefer them to choose their snacks, a great rule is to pick something from the fridge before the pantry. 

These are just a few tips to help you get started with creating more colorful plates that your kids will want to eat.  Our pediatric team has experience and more ideas to handle the pickiest eaters.  Every child is different and learns to eat new foods and make healthy changes at a different pace.  With a little persistence, patience, and fun, positive changes can happen.  

Contact our office for an appointment to get started with our Pediatric Team

919-999-8031

Pediatric Guidelines for “Colds”

Blair Cuneo

By: Blair Cuneo, PA-C

Pediatric Supplement Prevention Options:

1. Annual Vitamin A “flu” shot (Seeking Health liquid vitamin A, CTW Vitamin A caps): • 150,000 IU vitamin A once

2. Vitamin C (CTW Complete Vitamin C):

• 3-5 years: 125-250 mg daily

• 6-12 years: 250-500 mg daily

3. Vitamin D (CTW Liquid D3 or CTW Vitamin D3):

• 3-6 years: 1,000 IU daily

• 7-12 years: 2,000-3,000 IU daily

• 13-18 years: 3,000-4,000 IU daily

4. Zinc (Zinc Drink, Zinc Glycinate):

• 3 years: 5-10 mg daily

• 4-12 years 10-25 mg daily

5. Probiotics (Ther-biotic Chewables, CTW Daily Probiotic, CTW S. boulardii):

• All ages: 1 a day

6. Omega 3 (Nordic Naturals DHA (strawberry), Nordic Naturals CLO (orange), CTW Omega 3s):

• 4-12 years: 2000 mg daily

7. Elderberry: • <7yo: 250mg daily • >7yo: 500mg daily

8. Boiron Oscillococcinum (homeopathy):

• 1 vial once a week

Pediatric Supplement Therapeutic options: Start at first signs of upper respiratory illness.

1. Vitamin C (CTW Complete Vitamin C)

• 3-5 years: 125-250 mg dosed every hour, reducing if loose bowel movements

• 6-12 years: 250-500 mg dosed every hour, reducing if loose bowel movements

2. Zinc liquid or lozenges (Zinc Drink or Zinc Glycinate)

• 3 years: 5-10 mg every 6 hours

• 4-12 years: 10-15 mg every 6 hours

3. Elderberry:

• Kids: 1-2 tsp 3-4 times a day

• Teens and Adults: 1 TBL 3-4 times a day

Homeopathy options begun at symptom onset:

1. Boiron Oscillococcinum

• One vial 3xday for 24 hours

2. Boiron ColdCalm

• Ages 3+: 2 tabs under tongue every 15 min for 1 hour; then 3xday until symptoms resolve.

3. Umcka ColdCare/Cough/Cold+Flu (ages 12 and older) and Umcka ColdCare Kids (ages 6 and older)

• Use as directed

Carolina Total Wellness also carries “Viracid” and “Viragraphis”, combination formulas to combat viral illness, in capsule form. Ask your provider for more information on dosing.

Healthy foods and restorative sleep are fundamental, especially when sick. Bone broth daily, minimum 5 servings of fruits and vegetables daily.

Restorative Sleep guidelines from AAP:

Children 3-5 years old: 10-13 hours of sleep every 24 hours (including naps)

Children 6-12 years old: 9-12 hours of sleep every 24 hours

Children 13-18 years old: 8-10 hours of sleep every 24 hours.

Blair Cuneo
Pediatric Team Lead

A Note From Blair Cuneo PA-C Lead Pediatric Team Care Provider

Blair Cuneo
Pediatric Team Lead

Thinking back to my childhood, it was difficult to list many friends or classmates with multiple medical conditions that decreased their quality of life. Fast forward to working as a family practice PA-C, I saw not only the list of medical conditions and medications increasing for my adult patients, but also those of my pediatric ones. These included severe food or environmental allergies, difficult to treat eczema or asthma, overwhelming anxiety, sleep difficulties, chronic or recurrent pain with migraines, menstrual cycles, joints. I did as I was well trained to do, prescribe, and refer; prescribe and refer. I felt confident in suppressing their symptoms but not genuinely appreciating the cycle we were all in.
Traditional visits to family care or pediatric providers do not allow the time to truly sit down with a family and understand where their child is, how and why they got there, and where they want to be. Pediatric functional medicine appreciates this thorough discussion, as it will powerfully impact the creation of an individualized plan of action. Pediatric functional medicine works to understand root cause of symptoms and diagnoses. We implement medical and lifestyle therapies that will change the momentum of chronic illness and improve quality of life.

Your pediatric functional medicine team includes a medical provider and health coach certified through the Institute of Functional medicine. We work with families to target nutrient needs, understand inflammatory triggers inside and outside of the body, diversify and increase colorful, anti-inflammatory whole foods and address lifestyle balance. We work to increase the resiliency of these young bodies who are under increasing pressure to detox from stressors on their systems.

Every BODY can benefit from a functional medicine approach to wellness. Lists of medicines and medical concerns have become normalized in our society, but it is not normal and it’s definitely not optimal.
Call or go online to learn more how Carolina Total Wellness pediatric functional medicine team can optimize health for the special children in your life.