Case Study from Book: Memory Loss and Fatigue (Dorothy)

Dorothy presented with memory loss issues and she appeared tired and depressed. She told me she had spent her childhood on a farm on the prairies where she was exposed to various pesticide and herbicide sprays. As a child she had multiple mercury amalgams placed in her teeth, but she had no root canals or crowns. She had all her wisdom teeth extracted under general anesthetic because they were impacted, and she was not aware of any complications from this procedure. She told me that when she was fourteen years old, her mother constructed a barometer, and Dorothy had played with the liquid mercury which it contained.

Dorothy became a registered nurse, and she told me that she was generally healthy before going to the Philippines at age 30 to work for a period of seven years with a Christian mission. Although the water she drank in the Philippines was filtered, she suspected that it contained pathogenic organisms because she had multiple episodes of dysentery. She also had dengue fever twice, and every six months she was treated with antihelminthic (anti-worm) medications. She also took medications to prevent malaria. She was constantly bitten by mosquitoes during the rainy season, and she was aware of the great amount of air pollution caused by large numbers of vehicles using leaded gasoline. Her last year in the Philippines was spent in Manila, where she found the air pollution unbearable. Her skin deteriorated and her hair began falling out; also and she suffered from extreme fatigue and insomnia. Her work was stressful and she began to develop problems with decision-making, partly because she had difficulty remembering and following instructions. Her hearing became hypersensitive and she began to react to various fumes and chemicals, for instance by developing a burning sensation in her mouth and feet. Her heart would pound when she was at rest and she would often experience a trembling sensation within her body.

Dorothy attended a psychiatrist in Manila and was placed on an antidepressant medication, which had the effect of making her feel highly agitated. After seven years, she returned to Canada and was placed on a series of antidepressants including Elavil, Prozac, Serzone, Zoloft, Paxil, and Effexor. She told me that she did not find any of these antidepressants to be helpful and that she was living a zombie-like existence. Several years went by and she went through menopause. She was then placed on synthetic hormone replacement therapy, but her health continued to deteriorate and out of desperation she traveled a great distance to attend an excellent naturopathic physician. Hair analysis was performed and showed elevated levels of lead, nickel, silver, and tin. She was placed on a large number of very expensive supplements and although she felt quite well on this program, if she discontinued the supplements, her symptom complex would return rapidly.

The naturopath discontinued Dorothy’s hormone replacement therapy and she developed severe hot flushes that interfered with her sleep. Furthermore, going off the hormone replacement therapy led to a deterioration of her cognitive function. At the time I met her she was working as a secretary at a university, and was finding it difficult to perform her job. She was forgetting to keep appointments and was able to perform only one task at a time. Word-finding was increasingly a problem and often when she spoke, the wrong word would come out. When she wrote by hand, she often omitted letters or reversed numbers.

Dorothy then attended a neurologist who ordered an MRI scan of her brain. The MRI found two small hyperintense areas in the white matter of the frontal lobes. The conclusion was that these hyperintense areas might be related to decreased blood flow to that part of the brain, or possibly to demyelination (breakdown of the protective layer around nerves). At the same time, she was adamant that she would never go back on antidepressant medication or hormone replacement therapy.

Dorothy had a conglomeration of other symptoms including marked increase in weight from the antidepressant medications. She would often overeat, and because of her weight gain, she snored (an overnight sleep study ruled out sleep apnea), and she often experienced restless legs during the night. She had a chronic intolerance to cold and found that her body temperature was often subnormal. She had no hypoglycemia, diabetes, or cardiovascular problems. She had very few symptoms related to the gastrointestinal tract, such as burping or bloating. Since menopause, the frequency of her headaches decreased significantly, and she had no further leg cramps during the night. Over the years, she gradually had mercury amalgams replaced with composite materials. Dorothy’s sister had developed Parkinson's with a dementia in her late 50s, and her maternal grandmother and maternal cousin both had breast cancer.

When I examined her, Dorothy’s blood pressure and pulse were normal. Her skin was very dry. She had two mercury amalgams present in her mouth. The membranes in her nasal passages were chronically swollen (implying allergies). She had tenderness above her left collarbone where the lymphatic vessels draining the head come together. She had very few tender points present throughout her musculoskeletal system (making the diagnosis of fibromyalgia less likely). The neurological exam was normal, except that she was unable to stand with one foot directly in front of the other with her eyes closed. Numerous blood tests, including serological tests for toxoplasmosis and Lyme disease, were unremarkable.

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