Saturday, January 15, 2011

Childhood-onset Schizoaffective - A Medical Doctor's Perspective of the Case

We are fortunate to have the following perspective about my daughter's case (and the book) from her General Practitioner, Dr. David Marwil, M.D.

Please note that Dr. Marwil is a traditional  doctor (not specializing in "alternative medicine" nor "complementary" or "naturopathic," etc.) He is a regular GP who goes the extra mile for his patients.

Jeanie Wolfson and her daughter Keri walked into my office several years ago, frustrated and discouraged. For many years, Keri had been experiencing profound fatigue, sleepiness, headaches, body pains, and hallucinations.

She had seen a long list of doctors, including endocrinologists, neurologists, and psychiatrists, and she was on an even longer list of medications. No diagnosis had ever been given that adequately explained her symptoms.

Jeanie was engaged in her daughter’s health care. When she wasn’t working at her full-time job, she occasionally spent time on the Internet looking for causes of Keri’s symptoms, where she encountered esoteric disorders never before heard of by Keri’s physicians.

Compiling a new history from the very beginning, I realized that poor sleep, excessive sleep, and REM-like (dream-like) hallucinations had plagued Keri from a very young age. Knowing the importance of sleep, I sent Keri for a sleep study, which surprisingly had never before been suggested.

Armed with the idea that sleep problems could be contributing to her daughter’s collection of problems, Jeanie ultimately came across the name of a cutting-edge endocrinologist in Nevada, who, after speaking with her, thought he might be able to help her daughter. Jeanie and Keri made the trip, and after exhaustive testing, the doctor found numerous anomalies in Keri’s blood, bone, and intestinal absorption. He came up with a theory about what could possibly be causing all her problems, and he began treatment in an attempt to help alleviate them. He also included me in the loop. As results of tests were compiled, I was able to review them to continue Keri’s care as her primary physician.

Keri seemed to feel a little better after starting medical treatment. She was by no means well, but some of her symptoms improved, such as low bone-density, pain, and frequent infections. Upon review of her test results, I noticed that her thyroid level was a little low. I didn’t think her level was low enough to cause even subtle symptoms, and yet she had florid symptoms of low thyroid, such as fatigue, sleepiness, depression, dry skin, brittle hair, lack of menstruation, body aches, and feeling cold. When we started her on thyroid hormone treatment, her low-thyroid symptoms dramatically improved. She was no longer as sleepy. She began to menstruate, her skin and hair improved, and her mood brightened. She could go to school, pay attention in class, and do her homework. I was amazed that something so subtle could cause such profound symptoms.

Keri exhibited other symptoms, including hallucinations and insomnia, which did not fit a diagnosis of low thyroid. Neither did these symptoms seem connected to other hormones on which Keri was low, including cortisol and progesterone. Yet these symptoms also partially improved with the introduction of additional hormones. Obviously, there was more to the puzzle.

I learned from research articles Jeanie brought in that certain vitamin and mineral deficiencies can affect the function of some of the brain’s chemical receptors. She found supplements that contained large amounts of these nutrients. Interestingly, Keri’s symptoms improved after starting these supplements and worsened when they were withheld. I developed a new respect for the role of nutrients and herbs in promoting health. I no longer looked at them as “alternative” medicine, but rather as “integrative” medicine.

My experience with Keri and Jeanie helped me to rethink how I practice medicine. I have always tried to take the approach I learned during training, which is to collect a list of symptoms from the patient, come up with a working diagnosis, then go back and elicit other symptoms to fit the diagnosis. If the patient’s symptoms did not fit my preferred diagnosis, I would dismiss them as confounding and irrelevant. Now I take the approach of collecting the symptoms, fitting them into diagnostic categories, and holding in reserve the unexplained symptoms. As in a crossword puzzle, if you don’t know the answer to a particular clue, you can go on to the next one. Once more boxes are filled in, you may eventually find the answer.

Our patients are giving us the clues, and every one of them is important. As physicians, we must keep our minds open and vigilant. There is much we don’t know. The paradigm has always been to follow prescribed diagnostic protocols and evidence-based treatment. Insurance companies have picked up on this paradigm and thus limit their coverage only to those particular protocols and treatments. The problem is, much of what we do is not evidence-based, so we must rely on critical thinking and intuition, that which we refer to as the art of medicine.

Jeanie’s dogged pursuit of a solution to Keri’s problem, coupled with our serendipitous discovery of abnormal blood tests, gave Keri back her life. God bless Jeanie for the sacrifice she made for her daughter, and God bless Keri for the suffering she endured. Now the time for suffering is over, but the time for a more comprehensive approach to patient care is just beginning.

Written by David Marwil, M.D.

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Property of Wolfson
Last Updated:
11 February 2011  (Links added)


Sarah Lamstein said...

What a beautiful, open response by Dr. David Marwil. To shift one's thinking from past teachings and paradigms deserves applause.

Unknown said...

schizoaffective disorder was once a big problem to my son, and he has severe changes in mood and some of the psychotic symptoms he was having are, hallucinations, delusions, and disorganized thinking. Poor appetite, Changes in sleeping patterns sleeping very little or a lot, excessive restlessness, Lack of energy, Loss of interest in usual activities, Feelings of worthlessness or hopelessness, Guilt or self-blame, Inability to think or concentrate, and he could not tell what is real from what is imagined.

Then i got help from Dr Benard,

He gave me the medication which i used to suppress the problem, now my son is living fine,he now have a lives like every other person, am very happy that my son can now talk to me in a good way

here is the contact of the doctor who helped me out