Tales from the Fringe: System Failure

Janet, a 49-year-old woman came in for an initial visit somewhat frustrated by her ongoing medical problems. She had been followed by five medical specialists in Boston for a number of years.

Many of Janet’s symptoms related to the gastrointestinal (GI) system. She had chronic nausea, gas, bloating and loose stools going back to childhood. She had severe esophageal reflux out of proportion to her lifestyle.

She avoided cigarettes, alcohol and caffeine. To keep the heartburn under control, she required double the typical dose of Protonix (a proton pump inhibitor, generally the strongest type of pharmaceutical used for acid suppression) and quadruple the typical dose of ranitidine (an H2 blocker also used to artificially suppress acid in the stomach).

Janet had me review some of her extensive test results before our visit. These included more than 20 pages of labs plus MRI of the abdomen, ultrasound of the abdomen, a gastric emptying study and others.

In addition to the GI problems, she had chronic joints pains. The rheumatologist diagnosed her with “seronegative rheumatoid arthritis” with mean the rheumatoid factor (RF) blood test was normal, but based on the pattern on joint inflammation, rheumatoid arthritis, to the specialist, was still the likely diagnosis. Janet was maintained on three very potent anti-rheumatologic agents: remicade, methotrexate and plaquenil. In my 20 or so years in medicine, I have never seen any patient on all three of those medications and she still had some degree of joint pain.

Is it a coincidence that she has severe GI problems requiring megadoses of acid medication and severe ill-defined joint problems requiring megadoses of pharmaceuticals. She, like many, likely requires a holistic global approach to her issues rather than a fragmented system-by-system approach.

In addition to the above, Janet had fatty liver, ovarian cysts, uterine fibroids, breast cysts, cold intolerance, ocular migraines, fatigue, recurrent hives, emotional irritability, intense cravings for sugar (but still managed to lose 35 pounds through force of will), and sores to her scalp.

Is she struggling because her group of medical specialists from well-respected medical establishments aren’t dedicated enough or smart enough? Of course not.

She is unserved because we have a system failure in healthcare. The providers that see her were not trained to sort out her problems and lack the curiosity to break free and seek alternative solutions.

Ten years ago, I wouldn’t have had much to offer her. Now, I have so much to offer her, I wasn’t sure where to start.

Based on her collection of symptoms and issues, I could say there was high probability of food sensitivities, dysbiosis (disrupted bowel flora), thyroid dysfunction, magnesium deficiency and iodine deficiency.

After the first visit, the plan was to:








In the next blog, I will give an update on how Janet is doing.

Andrew Lenhardt, MD

  1. Check labs including RBC magnesium and some thyroid levels that hadn’t been ordered

  2. Stop all wheat in her diet

  3. Start a digestive enzyme like Digest Gold at least twice a day before a meal

  4. Order iodineplus2 so we could do an iodine loading test

  5. Start Epsom salt baths once or twice a week to raise magnesium levels and 6. Have her do some research on methylation cycle issues. I was considering starting a T4/T3 thyroid supplement, but was going to wait on some of the test results.

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