Dear Readers,

Our case study this month could be anyone’s child. Ms. November is the perfect example of the state of medical care for her generation. This month’s case study is about a young and talented young woman who has received the best medical care that traditional medicine has to offer. Unfortunately, she is now dealing with the consequences of that treatment. With that said, let’s begin.

Here is the disclaimer. This case study is for educational purposes only. I am using it to show you how a typical patient presents and the things I consider when I make a diagnosis. The patient’s name has been changed to protect her identity. I practice integrative/alternative medicine and my recommendations for treatment are often considered outside traditional practice. It is not my intent to criticize or denounce traditional medicine. I am merely providing an alternative opinion. Most importantly, the information provided here should not be used as a substitute for an examination and/or treatment by a licensed health care provider.

Presenting illness: Patient is a 20 year old white female who presents for an alternative medicine consultation. Ms. November reports that she has problems with joint pain, fatigue and panic attacks. She states that the problems with her joints and panic attacks began when she was 10 years old.

Past medical history: Ms. November was able to provide a fairly comprehensive medical history. She states that when she was 10 months old (1990) she underwent surgical correction of her eye muscles for strabismus (crossed eyes). In 1992, Ms. November had multiple eye infections which required multiple courses of antibiotics. After a course of vancomycin, she developed a persistent diarrhea. In 1993-1994, Ms. November again had recurrent episodes of eye infections, ear infections and tonsillitis requiring approximately 12 different courses of antibiotics. In 1999, Ms. November had a severe case of strep throat followed by a sinus infection, both requiring treatment with antibiotics. In 2000 (age 10 years), Ms. November began having problems with pain in her joints. Over the course of the next few years, 2000-2003, Ms. November was seen by several doctors including an orthopedic and pediatric orthopedic surgeons and a pediatric rheumatologist. One of her doctors told her that the “strep had settled in her joints.” Another told her that she had sero-negative rheumatoid arthritis. Ms. November was treated with Celebrex (NSAID). In reviewing her medical records from 2005-2009, I have noted that Ms. November was seen at least eight times for recurrent sinusitis which was treated with antibiotics. She also received several courses of oral steroids (once for hives, once for sinusitis). In 2008, Ms. November began an antifungal diet and noticed that, when she avoided sugar and grains, her joints stopped hurting. She was able to get her primary care practitioner (PCP) to prescribe Diflucan for two weeks and did well. Based on her response, her PCP gave her a script for Diflucan. She attempted to stop the Diflucan for 3 ½ weeks but started having terrible symptoms and joint pain. At the time of our consultation Ms. November reports that she has been on 9 ½ months of Diflucan.

Past surgical history: Ms. November had her wisdom teeth removed approximately 5 years ago.

Medications: Ms. November is taking Diflucan and Zyrtec for allergies.

Supplements: Ms. November is taking probiotics and vitamin C. She takes Alleve and Tylenol as needed for pain.

Allergies: Ms. November reports allergies to Ceclor (antibiotic) and ibuprofen. She also states that she has reactions to grapes, peanuts and turkey, “things with yeast” and sugar.

Social history: Ms. November grew up in an agricultural area in Kansas but is attending college in Texas. Ms. November is not married and does not have any children. She lives with her sister at college and they cook their own meals. Ms. November does not smoke or drink alcohol. When she is feeling well she does Pilates and walks for exercise. She states that she has been trying to follow the “caveman’s diet” for the last 2 months and has recently added wheat, kamut (an ancient relative of modern durum wheat) and spelt (another ancient grain similar to wheat that also contains gluten) to her diet.

Family history: Ms. November’s mother has multiple sclerosis. Her sister was diagnosed with Hodgkin’s disease in 2007 and underwent chemotherapy for six months. Her maternal grandfather had prostate cancer and her maternal grandmother had ovarian cancer and leukemia.

Ms. November’s father “is allergic to everything.” Of note is the fact that Ms. November’s mother was raised in the same area of Kansas. Ms. November reports that their 16 year old neighbor (in Kansas) has recently been diagnosed with acute lymphocytic leukemia.

Review of systems: In addition to the presenting illness, Ms. November reports a history of allergies and recurrent sinus infections. She occasionally notices some “palpitations." Ms. November says that she has headaches and began having migraines for the first time last year. She suffers from irritable bowel syndrome especially after eating. She reports sleeping problems and fatigue. Her menstrual cycles occur monthly but she has severe cramping. Ms. November suffers from premenstrual syndrome with increased irritability and crying. She reports that she finds it difficult to concentrate at times and that this occurs unpredictably. Ms. November does not have any root canals. The remainder of her review of systems is unremarkable.

Physical exam:

Blood pressure: 123/66 Pulse: 70 Height 5’4” Weight: 126 lbs

Examination of her external ocular muscles reveals a slight weakness in her right eye.

Her tongue reveals mild scalloping.

She has beta-carotenemia (yellow color) of the soles of her feet bilaterally.

Her cervical, thoracic and lumbar spinal muscles reveal some spasm.

The remainder of her physical exam is unremarkable.

Discussion: As I stated earlier, Ms. November is a perfect example of the state of medical care for her generation. What do I mean by that? The children of her generation were born into a society where multiple trips to the doctor became the norm for any ailment. Parents expected to get a prescription for an antibiotic if they brought their children in for a “cold.” Doctors began to believe this as well. Why bother to explain that the child may actually have a virus (in which case the antibiotic won’t work). “It takes too much time” and “it’s almost impossible to tell the difference” or “if I don’t give them an antibiotic now, they’ll be back in a day or two.” I don’t mean to put it all on the doctors; the patients bear some of the blame as well. We live in a society that does not have the patience or time to wait for nature to run its course. We have forgotten commonsense and put too much faith in magic bullets (medications).

Before you think that I am on a soapbox again, I am stating fact. I just returned from a “sanctioned” Family Practice conference. This is a real problem. Did you know that 80% of the otitis media (common middle ear infection) cases will resolve on their own without medication?

Okay, let’s talk about Ms. November. Ms. November clearly has ongoing problems with chronic fungal infection and, based on her examination, she has problems with thyroid metabolism. This is not surprising. It has been my experience that chronic fungal infections and abnormal thyroid metabolism go hand in hand. Which came first? I think that I could make a strong case for either.

We know that if you undergo a stress such as surgery, severe illness or childbirth, your body may slow your thyroid metabolism down as a protective, survival mechanism. In some individuals, this never goes back to normal. If your thyroid is not working optimally, you are at increased risk for developing future infections. We also know that fungi produce chemicals called mycotoxins, some of which can suppress your immune system and make you more susceptible to infection and cancer.

In many cases, this becomes a vicious cycle with decreased thyroid function and decreased immune function. In Ms. November’s case, we are going to have to address both the chronic fungal infection and her decreased thyroid metabolism.

Ms. November’s family history is significant for immune system disorders. Why do I say that? Her mother has multiple sclerosis, which is considered an autoimmune disease. Her sister is currently in remission from Hodgkin’s disease, which again is an immune system disease (cancer of the immune system). Does this mean that Ms. November will develop an immune disorder? Not necessarily, but it certainly increases her risk.

Here is what I believe. There are no papers on this so I cannot give you a reference to read. There are many discussions about “nature vs. nurture.” I think it is a combination of both. Based on her family history, Ms. November may have inherited a genetic tendency towards immune system dysfunction. How this “tendency” expresses itself is variable since everyone is different (except identical twins). It is also dependent on other things, including environmental exposure to toxins, including medications, pesticides, etc. I had the benefit of having been able to talk with both Ms. November’s mom and sister. Her mom grew up in the same town as both Ms. November and her sister. Although they lived in town, they live in an agricultural area. I believe that this increased their risk of exposure to pesticides from the surrounding farms. Add exposure to mycotoxins in foods (corn, grains and peanuts) and antibiotics and you have a perfect recipe for immune system dysfunction.

Why didn’t she develop a malignancy of the immune system as her sister did? For this I do not have an answer. As I said earlier, how a genetic tendency expresses itself is variable. I believe that she was helped by starting the initial phase diet and convincing her primary care physician to give her Diflucan.

Since it came up in the history, let’s briefly discuss the “Caveman diet.”

Experts call this the Paleolithic diet, a menu plan based on what our hunting and gathering ancestors probably consumed 40,000 years ago. You are not allowed to eat any grains (no rice, wheat or corn). No sugar or dairy products including butter, milk and cheese and no starchy root vegetables are allowed. If it needs to be cooked then you don’t eat it. No beets, peanuts or legumes are allowed. On the plus side, you can eat meat, eggs, fish and other vegetables and fruits. Raw. Thanks, but I will stick with the initial phase diet.

So here is what I recommended and prescribed for Ms. November. I started her on a systemic antifungal, ketoconazole for three months. I also started her on Nystatin and daily probiotics. We needed to address her decreased thyroid metabolism, so I started her on an iodine supplement as well as Armour thyroid. For her immune system, I recommended that she start on Vitamin D3 as well as some other supplements. Diet is going to be essential for her. It all starts in the gastrointestinal tract. Remember that eighty percent of your immune system is located there.

Update: Ms. November’s first visit was five months ago. I received an email from her and she states that she is doing much better. She is still having a few headaches but usually this is when she is exposed to strong chemicals or paint. Her stomach aches are gone, her nausea is gone, joint pain is gone, fatigue is gone and her energy is back. In her own words, “I feel like my old self again and it is wonderful.”

We all have things that we are thankful for. I am thankful for my family and friends. Life is that much sweeter with people you care about. I want to thank Doug for all of the work he has done and continues to do. This information, “the fungal link to chronic medical disease” has completely changed the way I practice medicine. It is an honor to write for this newsletter. I also want to thank all the readers for “reading the rest of the article” and the patients that inspire them. Happy Thanksgiving!

Blessings,

Lynn Jennings, M.D.