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Female Abnormalities & Overall Health: A Case Study.

On September 1, 1999, a pleasant but distressed 42-year-old white female, 1-0-0-1, presented at this office complaining of a hormone imbalance and chronic TMJ pain which has been present for approximately four years. She brought three molds of upper and lower jaw impressions that demonstrated an alignment of the upper teeth directly on the teeth of the lower jaw. She stated that her symptoms were exacerbated with stress and anxiety -- without stress or anxiety a normal overbite was present. She reported that all of her symptoms were worse during the premenstruum. She also complained of episodic pain of the dorsum of the right great toe, as well as general aching in the feet. She also states that she is concerned that based on some of her reading she might have a problem with systemic candida yeast overgrowth.

Her past medical history revealed no surgeries and that she takes vitamin [B.sub.6], calcium, magnesium and a few other vitamins. She also reports occasional use of Xanax. She reports occasional heavy bleeding with her menstrual periods, as well as feeling bloated and irritable prior to her menstrual periods. She also has a past history of oral contraceptive use. Her last Pap smear was in July of 1999. She reports occasional headaches that are a tightness in nature and located in the suboccipital region of the head. These are relieved with aspirin. She reports occasional belching while eating, but this is relieved by a bowel movement. She reports intermittent tinnitus with associated ear pain.

An abdominal ultrasound dated 8/12/99, was reviewed and demonstrated a contracted gallbladder but was otherwise normal. A pelvic ultrasound performed on the same date was reviewed that demonstrated a retroverted uterus measuring 8.1 x 5.2 x 6.2 cm. The endometrial stripe measured 0.7 mm and a small amount of free fluid was noted in the cul-de-sac. The right ovary measured 3.2 x 1.6 x 2.4 cm and the left ovary measured 3.1 x 1.8 x 1.9 cm. Follicles were note bilaterally.

A dental occlusal analysis dated June 29, 1999, was reviewed that revealed myofascial pain dysfunction, bruxism, muscle spasm and inordinate occlusal awareness. An orthodontic evaluation dated August 24, 1999, was also reviewed that revealed upper and lower front teeth meeting edge to edge, less than ideal jaw joint function and bruxism.

Examination of the jaw revealed muscle splinting with guarding of the masseter. Palpation of the neck revealed splinting with guarding of the suboccipital musculature. The cervical lymph nodes were without tenderness or enlargement. Auscultation of the abdomen revealed normal bowel sounds in all four quadrants; no bruits or rubs were noted. Palpation revealed no masses or tenderness throughout.

Due to her complaint of a hormone imbalance, she was given a Female Hormone Panel to take home with instructions on how to perform the test over a one month period. She was also given a fecal microbiology kit to take home and perform in order to assess for intestinal candidiasis. Also, due to the severity of her TMJ complaints, it was elected not to perform manipulation at this time; instead she was referred to Dr. C. Robert Humphreys, a Board Certified Chiropractic Neurologist, for a functional neurological consult.

The fecal microbiology report was returned by the laboratory November 15, 1999, and upon review she was diagnosed with a 2+ candidiasis of the intestines. This particular species was sensitive to Uva ursi and Biocidin. The Uva ursi was prescribed as 200 mg t.i.d. and the Biocidin was prescribed as one tablet b.i.d.

Dr. Humphreys consulted with the patient on September 15, 1999, and found the following of significant concern:

1) Mildly elevated heart rate with normal B.P. and slightly decreased [O.sub.2]SAT.

2) Triceps muscle strength 4/5 on the left.

3) Biceps reflex 1/5 on the right.

4) Narrow based stance eyes open revealed a mild sway back and to the left.

5) Narrow based stance eyes closed - mild sway with falling forward to the left.

6) Optokinetic testing revealed dysfunction in stopping of the eyes with the tape proceeding left to right and right to left.

7) VA ratio 1.5:1 left; 2:1 right.

8) Direct and consensual papillary light reflexes non-responsive bilaterally.

9) Ocular hypermetria with gaze from up left to fixation and up right to fixation.

10) Medial rectus fatigue on the first attempt of repeated convergence on the right.

11) Superior oblique fatigue on the left on the third attempt of repeated down and in gaze with an increase in pain in the right eyebrow.

12) TMJ palpation revealed prominence on the right as the jaw deviated to the right on opening.

Based on these findings Dr. Humphreys suggested the following treatment protocol:

1) Manipulation of the toes of the left foot and ankle to provide increased proprioceptive input to the left cerebellum and right cortex.

2) Home exercises to include:

a) The left foot on a ball (about the size of an orange) moving it over the foot to provide novel input to the left cerebellum and right cortex to increase functioning.

b) Listen to Mozart with the left ear -- new selection until completion of two tapes or two CDs, and then repeat for 5-7 minutes, 2-3 times per day.

c) Consider comprehensive digestive stool analysis and a liver detoxification study with Dr. Strehl to evaluate population of bacteria in the bowel and intestinal permeability as well as dysfunction of the liver leading to toxic state.

On November 24, 1999, the results of the Female Hormone Panel were reviewed with the patient. She was informed of a significant deficiency of progesterone. Oral Progon B was prescribed as follows:

Days 13 -- 16: Two tablets b.i.d.

Days 17 -- 19: Three tablets t.i.d.

Days 20 -- 25: Two tablets b.i.d.

Days 25 -- 27: Two tablets QD.

Also, blood was drawn for a thyroid profile that revealed a [T.sub.3] uptake of 35.2, a total [T.sub.4] of 8.8 and a free [T.sub.4] of 3.1.

On November 29, 1999, she presented complaining of vaginal itching with a copious discharge and vulvar irritation. Examination revealed the external genitalia to be within normal limits, except for a small, crusted lesion measuring less than 1.0 mm in diameter inferior and lateral to the posterior commisure. The Bartholin's glands and Skene's glands were without lesion, as was the external urethral meatus. The vaginal support efficiency was good and the perineum was firm. Slight hyperemia of the inferior vaginal introitus was noted. Speculum examination revealed a pink vaginal mucosa; the cervix was without erosion, but a copious white discharge was noted on the cervix. Samples were taken of the cervix and the endocervical canal for a culture and sensitivity.

The culture and sensitivity revealed a 4+ Gamma strep, 4+ Staphylococcus aureus and a 4+ Candida albicans. Both bacteria were sensitive to Tanalbit and the Candida was sensitive to Uva ursi and Biocidin. As a result the following was prescribed:

1) Tanalbit: 1 t.i.d.

2) Tanafem: Douche QD.

3) Biocidin: 1 t.i.d.

4) Uva ursi: 1 t.i.d.

The patient was afraid to take the Uva ursi because a health food store employee informed her that it was a strong diuretic. She was also afraid to take the full dose of Biocidin, so she only took one a day.

On March 13, 2000, she returned for a follow up examination and culture to assess the progress of treatment. The external genitalia were within normal limits and the vulvar lesion inferior and lateral to the posterior commisure was gone. Slight hyperemia of the vaginal introitus was still present. The Bartholin's and Skene's glands were without lesion, as was the external urethral meatus. Speculum examination revealed a pink mucosa; the cervix was without erosion, but a copious white discharge was still present. Samples were taken of the cervix and endocervical canal for a culture and sensitivity. The culture and sensitivity revealed a 2+ Gamma Strep, 2+ Staphylococcus aureus and a 4+ Candida albicans. Both bacteria were again sensitive to Tanalbit and the Candida was sensitive to Biocidin, Tanalbit and Uva ursi. As a result, the following was prescribed:

1) Tanalbit: 1 t.i.d.

2) Tanafem: Douche QD.

3) Biocidin: 1 t.i.d.

4) Uva ursi: 1 t.i.d.

This time the patient agreed to take the full dose of Biocidin and Uva ursi (with considerable coaxing). At the time the culture and sensitivity were performed the patient was also given a fecal microbiology kit to assess for intestinal infection with these same organisms. The fecal microbiology revealed a 4+ Candida albicans that was sensitive to Uva ursi and Biocidin.

On June 28, 2000, the patient returned for a follow up evaluation with a vaginal culture and sensitivity as well as a repeat fecal microbiology. The external genitalia were within normal limits. The Bartholin's and Skene's glands were without lesion as was the external urethral meatus. Speculum examination revealed a pink mucosa and the cervix was without erosion or discharge. Samples were taken of the cervix and endocervical canal for a culture and sensitivity. This time the culture and sensitivity revealed a 4+ Alpha Strep, 3+ Coagulase Negative Staphylococcus and a 4+ E. coli. There was no candida seen on the Gram stain and the laboratory was unable to grow any yeast. All of the bacteria were sensitive to Tanalbit. As a result, the patient was again treated with the following:

1) Tanalbit: 1 t.i.d.

2) Tanafem: Douche QD.

The fecal microbiology revealed a persistent 2+ Candida albicans that was sensitive to Berberine, the active ingredient in Hydrastis canadensis (goldenseal). As a result, the product goldenseal was prescribed -- 1 t. i.d. (note: a word of caution should be offered at this time because not all companies are using Hydrastis canadensis as goldenseal [due to demand and cost] some are using Oregon grape which is not quite the same).

On November 29, 2000, the patient presented complaining of fatigue. Following some discussion it was determined that we would run an adrenocortex stress test. The results revealed normal cortisol levels and an 8 a.m. DHEA level of 0.67 (normal is 0.75-2.5). As a result she was given 25 mg of DHEA at night.

On December 7, 2000, she performed another fecal microbiology test that still revealed a 2+ Candida albicans. The sensitivity still revealed that the candida was mildly sensitive to berberine and she was instructed to continue with the Hydrastis canadensis.

On December 21, 2000, she received a blood test for a life insurance policy that revealed an ALT of 13, so she was given Lipotropic: 5 QD (methionine -- 1,000 mg; choline -- 2000 mg and inositol -- 650 mg) to aid her hepatic function.

On January 13, 2001, she presented for her annual physical and Pap stating that she hadn't felt this good in years and that if this office could help her feel this much better we would now be her primary physician. The examination revealed the following:

BP: 112/76 Lt. arm sitting.

Eyes: No icterus noted; fundi well demarcated.

Ears: Canals and pinnae were without tenderness or exudates; the tympanic membranes were WNL with good landmarks and good cone of light reflex. No erythema was noted.

L.N.'s: WNL; no lymphadenopathy or tenderness noted.

Thyroid: WNL; no thyromegaly or nodules noted.

Lungs: Clear bilaterally; no distress, wheezes, rhonchi or rales noted.

Murphy's: Negative bilaterally.

Heart: NSR, no murmurs, gallops, clicks or rubs noted.

Breasts: The breasts were examined in the sitting and supine positions. They were bilaterally symmetrical; the nipples and areolae were equal bilaterally, no discharge, dimpling, masses or tenderness was noted. The supraclavicular nodes were WNL. A sonomammogram was performed in our office as the patient refused a mammogram. The study was normal.

Abdomen: Normal bowel sounds were heard in all four quadrants; no bruits or rubs noted. Palpation revealed no tenderness throughout; no masses noted.

Pelvis: The external genitalia were WNL; the vaginal support efficiency was good and the perineum was firm. The Bartholin's and Skene's glands were WNL and without lesions. The external urethral meatus was without induration, tenderness or discharge. The labia were without erythema or lesions and no inguinal lymphadenopathy was noted. The speculum examination revealed a pink vaginal mucosa; no atrophic changes were noted and no lesions or remarkable discharge was noted. No cystocele or rectocele was noted. Samples were taken from the vagina, cervix and endocervical canal using a cytobrush and placing them in thin prep solution for a thin prep Pap smear. The bimanual examination revealed the uterus to be in the midline with no palpable enlargement, masses or tenderness; Chandelier's was negative. The adnexae revealed no masses, cysts or tenderness.

Discussion

Upon further dialogue with the patient it was learned that she had continued the exercises prescribed by Dr. Humphreys and that her TMJ symptoms were virtually gone. At this time it was also learned that initially she was attempting to mix allopathic treatment, as her family physician was treating her candida with Diflucan (unsuccessfully). As for the vaginal culture of June 28, 2000, that demonstrated remission of the Gamma strep and Staphylococcus aureus and the finding of Alpha strep, coagulase-negative Staphylococcus and E. coli, this author would propose that the monthly hormonal timing proposed by some microbiologists is not the etiology but rather previous errant therapy. Upon detecting a mildly abnormal Pap smear or the complaint of a vaginal infection, most allopathic physicians prescribe trimethoprim sulfa for a bacterial infection and Diflucan or Nystatin for a yeast infection. These may relieve the symptoms but are prescribed for too short a period of time to be curative and thus serve to "drive" the organism further into the body, allowing another organism to take its place on the surface of the cervix. As a result, treatment is progressive, eradicating the more superficial organisms, thus allowing the deeper organisms to migrate to the surface of the cervix.

About the Author

Dr. Frank Strehl is a graduate of National College of Chiropractic and a Diplomate of the American Board of Chiropractic Internists. Dr. Strehl hosts a radio show, "Doctor on Call" which can be heard in the Chicago metro area, as well as parts of Indiana and Wisconsin. His private practice is located in Wheaton, Illinois.
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Author:Strehl, Frank E.
Publication:Original Internist
Geographic Code:1USA
Date:Jun 1, 2001
Words:2411
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