THE BLOG
12/27/2013 06:23 pm ET Updated Feb 26, 2014

Feeling Tired and Achy? Here's Another Perspective to Think About

If there are two symptoms that I can say that I see the most in my clinic, it would be "fatigue" and "pain." It seems that no matter what the initial presenting symptom the patient came in to see me for, whether it be for thyroid disease, hair loss, weight gain, insomnia or any other medley of presenting complaints, inevitably, during the review of symptoms, the patients usually come up positive for fatigue and pain of some sort.

In my patient population, when these patients come in with these two common symptoms, the cause is usually related to the endocrine system, autoimmune disease, adrenal fatigue, or major food sensitivities. So, typically, tests are done for all these categories and fortunately, most of my patients seem to improve dramatically once we address these categories of issues.

So, imagine my surprise and frustration, when one of these patients walked into my clinic and after evaluation and treatment of these major categories, the patient did not improve in her symptoms of fatigue and generalized muscle aches and pains.

Let me first start by telling you a little bit about her history...

She is a 43-year-old Asian female who had been generally healthy her entire life until she started developing significant fatigue and myofascial pain, with some occasional seemingly transient feelings of numbness and tingling in her hands and feet about two years before she started seeing me. She had been seeing her primary-care doctor but she was ruled out for heart disease, lung disease, thyroid disease, diabetes and Addison's disease. She found me herself and decided she needed to be evaluated for food sensitivities and vitamin levels. She also wanted to be treated with acupuncture to see if it might help her.

She reports that there was nothing out of the ordinary around the time of the onset of symptoms. She rather felt as though it just started to sneak up on her one day. She reported no foreign travel and no exposure to areas where she might have picked up parasites or obscure infections.

Since her history seemed relatively uneventful and benign, we started doing testing for some of the common causes of fatigue and non-specific generalized pain in her body. During that time period, she was also sent by her primary care doctor to a neurologist and had a normal spine and brain MRI.

Her labs came back negative for thyroid disease and autoimmune disease but she was positive for gluten and dairy sensitivity in her labs. She wanted to forgo heavy-metal testing due to potential costs and because she didn't take any vitamins and wasn't exposed to any blatant sources of heavy metal according to the patient. But she had prior lab testing two years ago that showed she had mild adrenal fatigue so she wanted to go ahead with treatment now since the fatigue was getting worse.

Since she did not have hypertension or renal disease, we decided to first start with a treatment regimen for the adrenal fatigue and with vitamins and minerals she was found to be low on her labs. She also wanted weekly acupuncture therapy for her symptoms. She worked with a dietitian on her diet and removed her food sensitivity items from her diet altogether.

After three months of the therapy, she reported that she felt mildly better but she still occasionally had symptoms of the tingling and she still felt fatigued and achy. She did say that she was about 40 percent less achy and fatigued but she said that she "still didn't feel like myself."

At this point, I suggested that she get a nerve conduction study done and revisit the neurologist about her symptoms. I also highly recommended the heavy-metal testing to be done. The patient relented to the evaluation and labs since she still was not feeling as well as she would like. However, during this time, she also relayed to me that she would be moving to another state and would need to know how to follow up with the test results when they came back since she probably wouldn't have enough time to follow through with the treatment with me.

When the results came back, they were positive for several heavy metals and her nerve conduction study was consistent with that as well.

At this point, I went over with the patient more in detail her daily environment and food sources and after extensive discussion, she brought up the fact that her family members from Asia had been bringing her teas and dried foods from Asia in the last three years. She really enjoyed the foods and teas and since she had been using them for a while, she had not thought to mention them.

Once we identified the potential risk of these items from Asia, she decided to stop eating or drinking from these items. She confessed that she didn't know where the items were purchased from but that she would ask her relatives. We had time for one other lab test before she moved and so we rechecked the heavy metal levels after a week off the food items and the levels were indeed lowering.

The patient searched through the national holistic boards and associations and was able to find an integrative practitioner where she was moving to. She then had her integrative practitioner there perform chelation therapy and she continued to refrain from those food items.

When she returned this year for a visit with friends, she stopped by my clinic and reported that her pain, fatigue and tingling were gone and that her recent labs were all normal for heavy metals. She reports that she is just starting to feel more like herself and that the healing process had taken quite a bit of time for her to start to feel "normal" again.

She has maintained her vitamins and minerals as well as her diet that is free of gluten and dairy while she was working with her other integrative practitioner. She reported that the entire experience helped her to realize how important foods and her environment is to the level of her health status and that she is helping her friends and family to re-evaluate these factors in their life as well.

This patient is a great example of a few concepts that I believe makes all the difference in patient care. So, I'll leave you with these concepts that I think is important for patients and practitioners alike to keep in mind when assessing disease and symptoms.

One is that our food and environment are indeed very important to our health, so delving in deeply with patients about these aspects of their life is crucial to ascertaining what needs to be treated.

Second, that despite how common the symptoms seem, there is no such thing as cookie-cutter medicine and that each patient needs to be evaluated as though each case is in fact different, even if the symptoms seem common.

Lastly, that even when symptoms improve, if symptoms still persist, it pays off to dig deeper to try to get rid of as much of the problem as possible, because had we stopped looking at 40-percent improvement, we would never have dug up her problem with heavy metal toxicity.