7/18/2013 5:54:34 AM
Good morning all,
I am new to functional medicine and this is only my 3rd or 4th case. This patient is a 48 yo female patient who first presented to me with mild HTN, new onset vertigo, anxiety/panic disorder, nightmares, Hashimoto's, polycyctic ovarian syndrome, obesity, fatigue, poor sleep, brain fog, recurrent sinus congestion without overt sinusitis since sinus surgery and IBS characterized by bloating, cramps and alternating constipation/diarrhea, but more of a tendency to constipation. She had been in an MVA which left her with chronic neck and back pain which limited her ability to exercise. She divorced a few years ago after an abusive marriage. She moved back east to a good job and is now living with a boyfriend with whom she describes a good relationship. Initial medications included Metformin for the PCOS, HCTZ for HTN, Levothyroxine and pulmicort solution which she used prn for her nasal congestion. Her exam was unremarkable aside for a modestly elevated BP and obesity.
For a variety of reasons I could only order conventional testing on this patient. CBC, CMP were normal. Her TSH was mildly elevated at 5.29. The celiac panel was negative however she did test + for a celiac gene pair. I felt that the vertigo was a self-limited vestibular neuronitis, but that she was undertreated for her thyroid, had adrenal fatigue and at a minimum gluten intolerance. I adjusted her thyroid medication, put her on a dairy free/gluten free diet with the exception of kefir and started her on ashwaghanda as well. We discussed her finding a form of exercise that she could tolerate and we started some simple meditative breathing exercises.
At follow up a month later she had improved a lot. The vertigo indeed resolved a day or so after I saw her. Her energy was much better and brain fog had resolved, as had her nightmares and her anxiety had improved significantly, though it had not resolved entirely, and the episodic panic attacks were gone. Interestingly when she tried twice to return to gluten she noted that within a couple of hours she got abdominal pain which then resulted in a panic attack!
Her BP had improved with the addition of a low dose of lisinopril, but we discussed tapering off the BP meds as her overall health improved.
My concern is that about 2 months after she started to develop ovarian cysts which she had not had in 20 years. They were very large and painful and resulted in severe uterine bleeding. Reviewing everything, the only thing we could come up with was that perhaps the ashwaganda had disturbed the adrenal endocrine pathways in the patient with underlying PCOS. At this point we stopped the ashwaghanda and so far she has not had a recurrence of the ovarian cysts after another 2 months. Has anyone heard of this (I could find nothing in the literature)? If so, could you explain the mechanism for it?
Thanks for your input.