host posted on January 01, 2009 12:47
Dear Readers,
One of the greatest gifts we can give ourselves is time; time to enjoy life, family and friends. As I continue to grow older, I have come to understand the adage “time flies.” Each minute, hour, day or week brings multiple opportunities for change. We often forget this with our busy lives. We become comfortable with our old routines and habits. The beginning of a new year is an excellent time to reflect on the past. It is also a great time for resolutions to change your life; to erase the board and start with a clean slate. I think that this month’s case study will show it’s never too late to change for the better. I spoke with the subject of this month’s case study and she was agreeable to being presented. I told her that I would not use her real name and I suggested the alias Mrs. January. She said “I’d much rather be called Mrs. America.” So would I. It never hurts to have a great sense of humor. We settled on Mrs. January America.
With that said I must give this 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: This month’s patient is a 60 year old, married female who presented to the clinic with a 20 year history of rheumatoid arthritis. Mrs. January America (JA for short) was interested in treatment with intravenous sodium bicarbonate to see if this would reduce her pain. “It just keeps getting worse.” Her primary care doctor started her on a six day regimen of oral steroids, “otherwise I would never have been able to make the trip here.”
Past medical history: In addition to her rheumatoid arthritis, Mrs. JA has hypothyroidism. In 2004, she was diagnosed with Crohn's disease. Mrs. JA was recently diagnosed with anemia which required treatment with a blood transfusion. She has a history of tachycardia (rapid heart beat) of unknown cause.
Past surgical history: Mrs. JA has a history of goiter which was treated with a partial removal of her thyroid when she was 14 years of age. She has undergone a right hip replacement and surgery to correct hammertoes on one of her feet. She has undergone a breast biopsy and a liver biopsy, both of which were benign.
Medications: Mrs. JA is on multiple medications: Synthroid, Verapamil, Humira, Protonix and Tramadol. She has a prescription for cephalexin (antibiotic) which she takes prior to having dental work. She is currently on a six day course of steroids.
Vitamins/Supplements: Mrs. JA is on several supplements which she takes on a regular basis, including omega 3 fish oil, a multivitamin/mineral supplement and probiotics. She takes olive leaf extract, when she remembers, and a BC powder occasionally.
Social History: As noted above, Mrs. JA is married. She is retired due to disability. She quit smoking 18 years ago, rarely drinks alcohol and does not have a formal exercise program. She is able to do all of her housework. She states that she has been on and off diets all of her life. Mrs. JA states that she followed an antifungal diet for one year but then she just stopped. She only uses artificial sweeteners when she drinks a rare diet soda.
Family history: Mrs. JA has a family history of hypertension, coronary artery disease, cerebrovascular disease (stroke), thyroid disease, irritable bowel syndrome, diabetes, arthritis and cancer.
Review of Systems: Mrs. JA denies any history of lung problems. She has a history of recurrent sinus infections for which she has taken multiple courses of antibiotics. In addition, Mrs. JA must take antibiotics whenever she has surgery or dental work to prevent infection in her prosthetic hip. She has had a work-up for her rapid heart rate but no cause has been found. She does not have a history of heart attack or heart failure. In addition to her Crohn’s disease, Mrs. JA has a history of gastro-esophageal reflux disease and gallstones. She had jaundice when she was younger but could not tell me more about this. She has no idea why the liver biopsy was performed. She does not have any history of diabetes although she has been told the use of steroids can cause problems with elevated blood sugars. As noted previously, she was recently treated for anemia with a blood transfusion. Mrs. JA reports problems with sleep and fatigue. She has a root canal that was put in over twenty years ago. She has been on multiple medications for her rheumatoid arthritis which have an affect on her immune system. In addition to the surgery to remove part of her thyroid, Mrs. JA reports that she received a “radiation shot” for her thyroid. The remainder of review of systems is unremarkable.
Physical exam: Blood pressure: 165/95 Pulse: 108 Height: 5’5”
Weight: 156 lbs
Patient’s tongue reveals indentations on the sides of her tongue from the pressure of her teeth. The right side of her neck appears larger than the left although there are no obvious masses or enlargement of her remaining thyroid. She has prominent varicose veins on both of her lower extremities. She has some yellow discoloration of the soles of her feet and dry skin on her heels. The remainder of her physical exam is essentially normal.
Assessment/Plan: Let’s start with a little crash course on autoimmune disease. Rheumatoid arthritis is a chronic, systemic inflammatory disease that is thought to occur as a result of an overactive immune system (autoimmune disease). It has a predilection for joint involvement (knees, elbows, ankles, shoulders, etc) with resulting pain, swelling and deformity. It also can have manifestations outside of the joints such as neuropathy, enlargement of the spleen and pericarditis (inflammation of the sac around the heart). There is no known or universally accepted reason for the development of this autoimmune reaction.
Crohn’s disease is a chronic, inflammatory disease involving the entire gastrointestinal tract, resulting in diarrhea, weight loss, abdominal pain, malabsorption and fever. It can also manifest with arthritis, peripheral neuropathy, inflammation of the eyes and mouth ulcers. There is no known or universally accepted reason for the development of this disease although it is considered to be as a result of an autoimmune reaction. Sound familiar?
Mrs. JA had a goiter (enlarged thyroid) when she was a teenager. From her history, I cannot determine whether it was thought to be due to an iodine deficiency, or an autoimmune disorder. Autoimmune disorder, there’s that term again.
Traditional medicine holds the belief that autoimmune diseases arise from an overactive immune system. It is believed that the immune system mistakes the body's own cells for invaders and attacks them, resulting in destruction of normal tissue. The immune system via the B cells begins to produce antibodies against proteins in the normal cell, such as DNA and RNA, causing an inflammatory response.
It is a strongly held (and funded) belief that the immune system has “gone haywire” and most of the research has gone into finding ways to shut down the immune response. The current treatment of autoimmune disorders is to use medications that alter or block the effects of a certain substance (tumor necrosis factor) on the body. These medications do not cure the problem, they only treat the symptoms. Unfortunately, they also come with a host of side effects including an increased susceptibility to infection such as pneumonia, neurological “events,” disorders of the blood (anemia) and cancer.
Now let’s talk about fungus. In The Fungus Link Volume 2, Doug Kaufmann makes a compelling case for fungi as the cause of the autoimmune response. It is clear that the mycotoxins produced by fungi have the ability to alter DNA and the expression of proteins by our DNA. We know that fungi have the ability to invade our cells and go virtually undetected. What we believe is that, in autoimmune disease, the immune system is attacking cells that have been altered by fungus. It doesn’t make sense that the immune system, which protects us from birth, would suddenly “go haywire” and start attacking us. We believe that the immune system is “cleaning house” and is able to detect a change in these cells. They are no longer “normal” and pose a threat (fungus) to the body.
So why do these diseases seem to occur in families? I believe that there can be a genetic component, such as an inherited tendency to develop certain diseases given the environmental exposure to toxins, viruses, bacteria or fungi. Families tend to share common environmental exposures (moldy house) as well common learned habits such as diet. Eating foods that tend to be highly contaminated with fungus will have the same effect as taking antibiotics chronically.
It is clear that Mrs. JA has chronic fungal disease as manifested by her rheumatoid arthritis, Crohn’s disease and recurrent sinusitis. I started her on ketoconazole (systemic antifungal), nystatin and daily probiotics. She is aware that she needs to follow a strict antifungal diet.
Although Mrs. JA is on synthroid for her hypothyroid disease, she still shows obvious clinical signs of thyroid disease. I have yet to see a patient with fungal disease who does not have some form of thyroid metabolism dysfunction. I have asked her to take her temperature three times a day for the next month and record them. This will give me the best information on how well her thyroid replacement is working.
Mrs. JA also has chronic malabsorption as a result of chronic fungal overgrowth in her intestines as well as Crohn’s disease. Chronic fungal disease of the intestinal tract (dysbiosis) interferes with absorption of nutrients and vitamins from foods and supplements. It is fairly certain that Mrs. JA has vitamin and mineral deficiencies which can cause irregular heart rhythms. For this reason, I have advised her to receive intravenous vitamins once a week for a few months. I have also started Mrs. JA on a few supplements to support healthy heart function.
Mrs. JA has a root canal that was placed over twenty years ago and predates her development of rheumatoid arthritis. I have given her the name of a holistic dentist in her area and I have urged her to get this root canal removed. Mrs. JA is agreeable to making all of the above changes.
Mrs. JA is a perfect example of someone who is trying to take charge of her health. Traditional medicine has failed her. I am not certain that we will be able to reverse the destruction she has already undergone but I am optimistic tha,t with these changes, she can optimize her current state of health. Chronic fungal disease causes chronic medical disease. Fungal disease is a silent killer. The best defense is pre-emptive. If you are healthy, don’t take it for granted. Make the changes in your diet, exercise and smell the roses.
For those of you who are interested in learning more about the fungal link to chronic medical disease, I recommend: The Fungus Link Volumes 1-3 by Doug Kaufmann.
It’s time to make a resolution for a healthier new you!
Blessings,
Lynn Jennings, MD
Champions Clinic