September 2004

Plagued by fatigue

by Dr. Howard Loomis

Every once in a while a patient comes along that baffles even the best diagnostician. I have had my share of these patients, and I guarantee you that the treatment will become obvious if you can find the source of the stress that is causing the patient's symptoms.

Yet, most doctors collect signs and symptoms under a syndrome name and follow a course of treatment that works for some people with similar symptoms. What do you do, however, when the signs and symptoms defy categorization? Where do you start, how do you proceed, and how do you judge improvement?

Richard W. McBride, DC of Willow Grove, Pennsylvania, was recently confronted with just such a case and sent me the following for inclusion in this column.

Chief complaint

A 44‑year‑old married female with three children presented with a chief complaint of severe fatigue since 1990, evidenced by her belief that she would not live much longer. She also complained of carpal tunnel syndrome and generalized aching in her body and legs. Almost as an afterthought, the patient mentioned that she wished she had better skin. Apparently, she has suffered from continual formation of blackheads on her face since puberty.

She was 5'6'' and weighed 135 pounds. She did not smoke or use alcohol and used coffee only twice a week. She had one‑to‑ two bowel movements per day and to that point was not a user of antacids or laxatives. She felt she was in good health overall but recent blood tests revealed that she suffered from an underactive thyroid. As for work, she was self‑employed cleaning both residential and commercial properties.

Case history

The patient had undergone the following surgical procedures: pyloric stenosis as an infant and tonsillectomy at age 7; wisdom teeth removed at age 29 and tubal ligation at age 30; and an appendectomy performed at age 32. In addition, there was a long history of falls and injuries associated with horseback riding, including a fractured tailbone at age 39.

There was a past history of severe depression, but the patient described herself as being happy and well‑adjusted. Realizing that this patient's source of stress could be coming from a structural, functional, or emotional cause (or any combination thereof), Dr. McBride requested a dietary survey and a 24‑hour urinalysis collection before his physical examination.

Dietary preferences

This patient's diet was remarkably well‑balanced. It was perhaps slightly tilted toward protein and shortchanged on whole grains, but she denied following a specific dietary plan. Be that as it may, among her lesser complaints were cold hands and feet and menstrual cramps, suggesting protein deficiency.

Signs and symptoms survey

Once her symptoms were categorized according to organ system, they indicated a deficiency of carbohydrate and protein, poor carbohydrate digestion, general endocrine imbalance, especially hypoadrenal function associated with alkaline mineral deficiency. All of these are consistent with poor energy production from carbohydrate sources.

24‑hour urinalysis findings

The urine sample contained traces of blood and white blood cells, which was associated with menstruation. Other than that, there was no suggestion of pathology. The urinary sediment suggested poor protein and fat assimilation accompanied by excessive simple carbohydrate intake. While this is not consistent with her stated dietary preferences, it does suggest that her simple carbohydrate intake is more than her body can process efficiently. In addition, there was excessive calcium excretion accompanied by an acid pH. This again is consistent with poor carbohydrate assimilation and energy production.

Physical examination

One of the unique assets every chiropractor possesses is the ability to palpate and relate abnormal muscle tension (contraction) and soreness to either mechanical or visceral causes. Dr. McBride did not report any gross structural abnormalities or findings.

Subsequently, he conducted a palpatory examination of the patient in a fasting state.

Next, he gave the patient a tablespoon of specially designed powdered test meal, mixed in water, that consists of protein, carbohydrate, fat, and fiber. He waited 45 minutes and re‑palpated in order to determine the effects of food and digestion on the patient. The results were quite revealing.

Areas involved in preprandial state only

******  Submandibular muscle contraction and soreness BEFORE the test meal was gone after the test meal! This suggested that there was adequate nutrition in the test meal to nourish these muscles and related organs, thereby relieving the muscle contraction. Areas involved in both pre‑ and postprandial states

******  Pronounced contraction was found within the masseter, erector spinae and the quadratus lumborum muscles as well as the muscles covering the upper posterior rib cage.

******  Significant muscle soreness was noted at the base of the skull and within the temporalis muscle bilaterally.

Areas involved in postprandial state only

A Pottenger's saucer (so‑called "anterior dorsals") appeared AFTER the test meal but not before! This suggested stress to the organs of digestion. The epigastric area and upper right abdominal quadrant were of particular interest. Prior to the test meal there was some palpatory soreness but this soreness worsened after eating.

Treatment recommendations

Because of the very obvious soreness and pain involved over the epigastrium, Dr. McBride suggested a digestive enzyme formula that supports the mucosal membrane of the digestive tract before meals and also two hours after eating. He also suggested supplementation designed to supply alkaline minerals for the adrenal glands and sympathetic nervous system. Finally, he made recommendations aimed at relieving toxic and immune stress to the liver and spleen.

Clinical outcome

Results in this case are best reported in the patient's own words: "...(A)fter three weeks I feel so much stronger and can face the future with confidence. I had no pain connected with my period this month and I feel better emotionally." She concluded by saying, "The best part is, the skin on my face is getting better!" Congratulations, Dr. McBride!

(Dr. Loomis welcomes input on the subjects covered in this column. To make a comment or ask a question, write to him at 6421 Enterprise Lane, Madison, WI 53719. Visit www.loomisenzymes.com online or call 800‑662‑2630 for information on upcoming Loomis Institute seminars.)

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