Terry

Terry is a 19 year-old female who I started seeing when she was 16. Her diagnoses when initially seen by me included allergies, Bi-Polar disorder, fatigue, headaches, Hypothyroidism, allergic cough, Irritable Bowel Syndrome, history of recurrent ear infections, Premenstrual Syndrome, and possible Tourette's Syndrome.

At the initial visit, Terry was taking four very strong medications (Prozac, Depakote, Tegretol, and Klonipin) to control her perceived depression, anxiety, and presumed Tourette's Syndrome. She was also taking Synthroid for hypothyroidism.

Terry's ear infections started at age five and antibiotic frequency was two to six per year, but she had six ear infections at age 15. She also complained of frequent sore throats that radiated to the ears and chest.

Tics were noted at age eight and were described as "head flipping, spinning around, touching herself." Terry was diagnosed with Tourette's Syndrome at age nine, and she was started on Haldol, which had to be stopped because of side effects. Another medication for tics called Catapres was used but had to be discontinued also because of an adverse reaction. At age 14 Terry was diagnosed with a Bi-Polar disorder. Lithium was prescribed, which did not help, and it also caused a number of side effects. She was also on a number of other strong medications including Mellaril, Navane, and Prolixin, all of which were poorly tolerated and had to be discontinued. Thyroid blood tests became elevated after Lithium, and thyroid medication was started appropriately at that time. Depakote was being used for approximately 1-1/2 years as a "mood stabilizer." Klonipin was started approximately six months before her initial visit to my office to decrease insomnia and anxiety, and Tegretol was started five months prior to her first visit with me to decrease mood swings (which was thought to be helping).

This medical regimen of Prozac, Depakote, Tegretol, and Klonipin was considered to be helpful, and in Terry's words, "was the first time she had been feeling better for over 2-1/2 years." Side effects on this medical regimen included fatigue and easy bruising. She had been hospitalized in December 1994 in a "manic phase." Tics involved primarily the neck and hands and were considered much better compared to the initial concern at age eight.

Medical complaints involved increased nasal symptoms, especially from March to August, for the previous six years; a history of dark circles since infancy; Tinnitus (ear ringing for several years); severe sore throat attributed to post-nasal drip; cough ("I always cough"); gastrointestinal complaints for over eight years; increased rashes, especially on the legs, for the past year; headaches, described as daily and lasting minutes to all day, for over five years; and fatigue with an energy level considered to be 40 to 50% of normal. Also, fatigue was increased on the medication regimen. Premenstrual Syndrome included depression, irritability, and suicidal ideation one day before and the day of menses.

A major concern is that Terry was an excellent student, but because of her health problems was unable to attend high school for the 10th and 11th grades.

At a follow-up visit in October 1995 after two months of allergy testing and treatment, Terry was being treated for allergies to 10 foods, 13 molds, and 25 inhalant/pollens. Her largest skin reactions were to coffee, beef, and potato, and medical symptoms developed while allergy testing these products.

At this follow-up visit, Terry noted that she did not feel as sick, and that her ear, throat, and gastrointestinal complaints were markedly decreased. In addition, improvement was noted with sore throats, nasal complaints (sneezing, itching, and drainage), eye itching and redness, coughing, heartburn or cramping, rashes, headaches, concentration, and an energy level that had improved up to 60 to 70% of normal.

Over the past two years, Terry has continued to do beautifully. For her high school senior year she was able to attend school and participate fully in high school activities. Her diet included restricting wheat, beef, coffee, potato, sugar, and mild. Klonipin was discontinued four months after starting immunotherapy followed by stopping Tegretol six months after beginning allergy treatment.

After one year on treatment, at her most recent follow-up visit two years after starting immunotherapy and dietary changes, Terry has continued to do well. All medications had been discontinued by August 1996. Two years later Terry was doing well in college and feeling very healthy; her only complaints were tics occurring only with marked fatigue, some nausea after meals, and occasional fatigue. The only medications she is currently taking are Synthroid, vitamin supplementation, and allergy immunotherapy.

Terry represents an excellent example of a patient with multiple medical complaints including having been diagnosed with Bi-Polar disorder and Tourette's Syndrome. After seeing her rapid improvement and, more importantly her continued progress over two years, it is my opinion that her multiple medical complaints certainly appeared to be of an emotional basis but were primarily physical and aggravated by the stress of feeling so poorly.

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