Successful treatment for environmental illnesses requires holistic approach
UPdate Summer 2007
Dr. Jennifer Armstrong, an Ottawa physician specializing in Environmental Medicine, presented the 2007 Elliott Lecture in Halifax on April 14. Dr. Armstrong spoke to a packed room on diagnosis and treatment of environmentally ill patients at the Ottawa Environmental Health Clinic. Dr. Armstrong focused her talk on the case study of a severely ill patient at her Ottawa Clinic. The 26 year old woman had multiple health problems including Raynaudís, myalgia, swollen veins, dyspnea, irritable bowel, iron deficiency and weak kidney function. She also had low blood pressure, white tongue and white spots on nails, and an itchy scalp. She had been a hyperactive child. The young woman had seen 9 doctors, who all agreed that she was very ill, but could not determine the cause. In desperation, her mother took her to the Mayo Clinic in the US. Doctors there also agreed that she was very ill, but could not make a diagnosis.
On her return to Ottawa in January, she began seeing Dr. Armstrong at the Ottawa Environmental Health Clinic. Dr. Armstrong discussed the impact of environmental factors in the patientís life such as renovations in the home, living in a mouldy house, and working in a sick government building. With changes to of the environmental factors, along with other treatments, the patientís health began to improve.
In her presentation, Dr. Armstrong outlined a number of diagnostic tests which she used with the patient including testing for arsenic by hair analysis, testing for Lyme disease, urine tests for mycotoxins (mould), and genetic tests which revealed several altered polymorphisms (genetic defects) which are associated with multiple health problems.
Dr. Armstrong discussed the high numbers of people of Irish or Scottish background who have the gene for celiac disease. Research has revealed that the gene for celiac can be triggered by exposure to mould. She discussed a National Institutes of Health study (2004) that revealed far higher rates of celiac disease than previously believed.
Traditional blood tests for celiac may have up to 30% false negatives, according to Dr. Armstrong, because patients have to be quite sick with leaky gut for the antibodies to get into the blood and show up on the test. Other tests are available which can determine if a patient has celiac disease or the celiac gene. Armstrong recommends that patients who may be celiac can test this by changing their diet to eliminate dairy and soy as well as glutens, found in many grains including wheat, spelt and kamut.
The audience included local doctors who practice environmental medicine, naturopathic doctors, and many environmentally ill patients. The discussion highlighted a desperate need in Nova Scotia for more doctors who are able diagnose and treat patients with environmental illnesses, and the lack of medical education and training for physicians about how to treat environmental illnesses.
Discussion pointed out how difficult it is to correctly diagnose and treat environmental illnesses when doctors only allow patients to discuss one problem per appointment. Dr. Armstrong related the story of another patient with multiple environmentally related health problems who commented that if she had followed this rule it would have taken her 10 years just to inform her doctor about what her problems were. The ďone problem per appointmentĒ policy works against doctors looking at the whole picture, and leads to treating symptoms without understanding possible underlying causes, according to both doctors and patients in the audience. Dr. Armstrong pointed out the importance of getting a complete picture of a patientís symptoms as well as the patientís environment in order to determine the underlying causes in cases of environmentally related illnesses in order to treat them successfully.