I hope this case report will help shed light on how a biomedical and environmental approach to a serious tic disorder can be useful.
Personal History: MC is a 13-year-old girl.
Background Information: This patient began seeing me approximately three years ago. She had been seen by a neurologist and psychiatrist and her condition had received a diagnosis of TS, as well as one of obsessive-compulsive behavior. She also had a number of other physical symptoms, including nosebleeds, bedwetting, itching, and headaches.
The patient had a history of frequent ear infections, with a treatment history that included tubes in the ears, and frequent rounds of antibiotics. She also had a history of frequent stomachaches and yeast infections as an infant. Her mother was very concerned; MC also had significant gastrointestinal symptoms, including diarrhea, abdominal gas, belching, and rectal itching.
Her neurologist had noted paroxysmal episodes of blacking out but basically kept to a diagnosis of a tic-like disorder. Her tic-like disorder included eye blinking, head shaking, sniffing, and a smelling type of aberration. She also licked her fingers and had behavioral difficlties.
Past Medical History: Her past medical history included a parasitic infection, Cryptosporidium, in 1998.
Environmental History: The family lived in a farm-like area. They lived surrounded by many types of animals, including dogs, cats, cows, horses, chickens, and rabbits—all of them outdoors.
Medications: MC had been on a regimen of many medications to control her symptoms, including: (1) Topamax; (2) Prozac; (3) Provigil; and (4) a number of other psychopharmacologic agents, including Geodon and Risperdal.
Allergy history and testing: MC was tested and found to be allergic to pollens, dusts, molds, and some foods, including cow’s milk. She had significant sensitivities to 18 allergens. She had never been allergy tested before coming to my office. We were required to wait until she was out of school for summer vacation to take her off psychiatric medications in order for her to be appropriately allergy skin tested.
Laboratory testing results: The results of her stool study indicated that she had a 4+ (highest level) yeast infection in the gut.
- We placed her on antifungal medications to treat a rash under her arms.
- We began use of antifungal creams and initiated a low-yeast diet to treat rectal itching.
- We placed her on vitamin K daily to treat the nosebleeds.
- She was advised to avoid fabric softeners and other scented products.
- We took her off psychiatric medications.
- We advised her family to have MC avoid milk.
- We placed her on natural antifungal medications, including acidophilus to treat the yeast infection in the gut, which seemed to help. We also started her on a program of Diflucan and Nystatin, which are medications for fungal infections.
Treatment results: We were gradually able to take her off psychotropic medications and onto a full course of allergy immunotherapy, environmental controls, nutritional supplementation, and appropriate antifungal medications. She remains on Prozac only. Originally, she was getting sinus infections approximately every other month. Within 1 year of treatment with allergy immunotherapy, her sinus infections were completely under control. Within approximately 6 months of receiving allergy immunotherapy, most of MC’s tic disorder was gone and most of her other symptoms had also completely subsided.
Summary: Once MC began allergy immunotherapy and was weaned off the psychotropic medicines, most of MC’s symptoms were relieved by 6 months. Also, appropriate nutritional supplements and environmental controls may have played a major role immunologically. (We treated her as we did patients who are chemically sensitive, advising the family to avoid the use of fabric softeners, and all fragranced and toxic products for home and personal use.)
All of these improved environmental factors brought MC to below her threshold of (tic) reactivity. She was having much less respiratory, neurologic, gastrointestinal, and skin symptoms. MC’s regimen, once completely in place, included a comprehensive environmental approach:
- allergy immunotherapy, including injections twice weekly for pollens, dust, molds, animal danders, and foods;
- avoidance of allergen triggers, including highly allergic foods, animals, and chemicals;
- environmental controls to reduce allergens in her bedroom;
- nutritional supplements based on her biochemistry;
- medication and natural supplements to treat a hidden yeast infection that affected her immune system;
- education in understanding the environmental medicine approach to her complex multisystem tic disorder, with individualized attention, periodical fine-tuning, and care of the whole person.
As a result of treatment, her symptoms were controlled without the need for standard symptom-relieving medications.
The family’s account of MC’s recovery
Sheila J Rogers, Director ACN, interviewed MC and her mother for this account
MC had such severe neuropsychiatric symptoms that the parents were told she should be hospitalized. The symptoms began when she was being potty trained as a toddler. She began withholding her stools and required treatment with three different stool softeners. At age 3 years, MC started the behavior of sniffing her food. Sniffing the food actually seemed more important to her than eating it. She also began making little noises, sometimes letting out a high-pitched scream. As MC was well-behaved, social, and bright, little was made of these behaviors; she “seemed to just be playing around.”
At age 3 years, MC had some speech articulation difficulties and received occupational therapy. In second grade, the teacher noted the beginning of MC’s academic difficulties and the abnormally long time it took MC to complete written work.
As MC’s behavior continued to change, meals soon became a battle; MC wouldn’t eat anything that had the “wrong” texture, preferring everything soft. She would wear only old clothes that felt smooth on her skin. She wore the same set of clothes for 2 years, because the feel of new clothes bothered her. Wearing shoes drove her crazy, and socks had to be seamless.
Ritalin and more problems
In fourth grade, MC was evaluated and found to be gifted but a learning disability was also revealed. A neurologist suggested that MC had attention deficit hyperactivity disorder and started her on Ritalin, though she didn’t seem hyperactive to her parents. Within 6 weeks, MC became verbally hyper, began banging her head on surfaces, and was on such “overload” that she would lie down on the floor at school to shut things out. She began withdrawing, and her tics worsened. She had already shown mild signs of obsessive compulsive behavior, but now it was much worse. Every time MC got in or out of the family van, she had to close and open the door a certain number of times and make special steps while walking. She also had trouble concentrating. Things were quickly spiraling downward. MC was taken off Ritalin, but the tics remained. She began to space out—particularly when exposed to fluorescent lights. She would describe this by saying, “My lights are going out.” She was evaluated and found not to have epilepsy.
Further medicating: MC’s mother shares
We made the rounds to doctors for work-ups—gastroenterologists, neurologists, psychiatrists; she underwent MRIs and other numerous tests. We ended up with a diagnosis of TS from one specialist and a severe tic disorder from another. MC was put on trials of medications, sometimes three at a time. She was repeating words, speaking rapidly, and making noises. Eye squints and head jerks were frequent. The mediations included Prozac, Clonidine, Zyprexa, Seroquil, Topamax, and others. We actually reached a point where we were treating the reactions to the medications! MC was often so sleepy that she had to be removed from the classroom in a wheelchair.
Although the tics were reduced, the cost of the side effects was too high. She was in therapy, but I never thought that was an answer. A school psychologist suggested that I quit teaching and keep her at home. A psychiatrist concluded that MC needed to be admitted to a psychiatric hospital! I refused their advice and tried not to let MC know how scared I was.
During the last significant drug trials in which MC was a participant, a couple of years ago, MC was put on Provigil, which resulted in major sedation and angry, defiant behavior. When a doctor observed her anger, he advised the family to have MC hospitalized. MC’s mother insisted that the anger was a reaction to the drug and began weaning her off of it. The anger ceased. However, at this point, MC was so distracted and spacey that she had to be dressed every morning. Everything became a major effort. She began not leaving the house, even to see a movie. The family couldn’t imagine what her future would be or how they would find the help they needed. (At this time they learned of environmental medicine and reached the office of Dr. Albert Robbins.)
In middle school, MC had to dictate answers to her school work to a parent, who would write them down.
“I got my sweet daughter back!”
According to MC’s mother, dietary changes, supplements, and treatment for Candida yeast overgrowth made a big difference in MC’s behavior. Allergy therapy was started and was very successful. MC is now only taking Prozac. MC’s mother added, “She’s doing fantastically. It’s been 3 years of restored health and I can’t believe it—I got my sweet daughter back! MC is 14 years old now, doing well in advanced classes in school, and working independently. She is socially adjusted and happy once more. She takes the recommended supplements and allergy injections without complaining. We stopped the psychotherapy because now that she’s off the drugs she doesn’t need it. When I look back I can’t believe the awful experience we all went through—all because of a Candida infection and allergies.”
Editor: ACN asked MC for a comment on her recovery. She said that she used to think giving up dairy was difficult but she’s used to it now. She added, “Tell other kids that a special diet isn’t that bad if it helps you. And the allergy shots don’t hurt that much. It’s all worth it.” Her name and image are withheld at the family’s request.