Dr. Levine did fasting bloodwork, a urinalysis and spirometry. Although she found the results unremarkable, my own later scrutiny of the test results showed abnormal findings. However seemingly insignificant, these abnormal results were signs of conditions that became more prominent over time. The urinalysis showed specific gravity with a positive reading of 1.024 and non-hemolyzed traces of blood in the urine. Spirometry revealed mild hypoxemia with oxygen saturation at 94%. Hypoxemia (deficiency of dissolved oxygen in arterial blood) is a sign of an underlying disease, usually related to the lungs and is marked by a reduction in red blood cells due to hemorrhage or anemia. Its main symptom is shortness of breath.
From my research I found that high specific gravity may indicate significant dehydration and/or interstitial nephritis (inflammation that affects the kidneys' ability to filter waste due to infection or drugs) marked by an enlarged kidney. It also indicates glucosuria (glucose in the urine) which could indicate diabetes, jaundice or liver disease. Blood in the urine is also a symptom of interstitial nephritis. I had been hospitalized with an infection of the right kidney in 1977.
In her notes, Dr. Levine assumed the blood traces occurred due to spotting between menstrual periods. She didn't know the significance of high specific gravity or didn't think the finding significant, so glossed over it. She was aware that my other doctors had recommended that I see a pulmonary cardiologist for my coughing and shortness of breath, so she too recommended I see a pulmonologist for further evaluation. She prescribed Clarinex, Flonase and an Albuterol inhaler.
Feeling as ill as I felt with post nasal drip mucus production so excessive I woke up choking every few hours at night, it was difficult for me to accept doctors' contentions that because they didn't see anything, this condition must be normal for me, or something common, so deal with it. They didn't understand why I seemed frustrated and anxious at their not finding the cause of my symptoms. They didn't understand that my lack of sleep was affecting my demeanor and ability to focus, and this change was becoming exceedingly apparent at work.
This was a Thursday afternoon. I went home to bed following the appointment completely drained. The next morning I awoke at about 6 am and had trouble walking a straight line to the bathroom. My balance was terribly off. I felt much the same as I had felt in 1983 just before I collapsed with gastrointestinal bleeding, so I called a co-worker and asked her to drive me to Inova Fairfax Hospital ER.
Sept. 12, 2003. I called my primary care physicians to let them know I was headed to the ER. Dr. Ignacio warned me not to expect much from my ER visit. She was right. I spent most of the day on a cot just inside triage waiting to be seen along with loads of other patients. Those with visible signs of bleeding from stabbings, gun shots or auto accidents took priority. An acquaintance later told me that she lost a fetus from a miscarriage while she waited four hours to be seen at Inova Fairfax Hospital ER. I suppose it didn't help that the triage receptionist had indicated "insomnia" as the reason for my visit on my admittance paperwork. I wondered how she was able to fill in my paperwork while simultaneously talking on the phone and addressing another patient that had walked up in front of her desk during my interview.
I arrived at approximately 10 am. I was seen eight hours later in the evening. Attendants completed a urinalysis, CBC, and chest x-ray as tests for my complaints of internal bleeding and excessive mucus production. I was told all tests came out negative, although I was showing signs of being dehydrated. When I asked for a unit of vitamin and electrolyte enriched saline or for what is known as a "banana bag," I was told that only drunks got banana bags.
It was only upon discharge that I was able to obtain a copy of the test results that indicated the following. The urinalysis showed trace ketones, which typically indicates dehydration or ketoacidosis, a sign of type 1diabetes. Microscopic analysis of the urine sample revealed squamous epithelial cells in the sediment, which typically indicates that the specimen is contaminated and needs to be redone. Hematology revealed a low RBC count of 3.99 and a high MCH of 32.7. This finding is indicative of a couple of things. One is the existence of pernicious anemia (PA), a blood disorder caused by a lack of vitamin B12 due to a lack of intrinsic factor (the substance in the stomach that allows the body to absorb B12). Treatment with vitamin B12 has to be administered by injection because people with PA cannot absorb vitamin B12 taken by mouth. The second is the possibility of internal bleeding.
Bleeding, depending upon how rapid it is, leads to two basic derangements. One is a drop in blood pressure, resulting in shock. The other is the development of anemia, in which the RBC count is so low, the ability of the body to transport oxygen is reduced. Signs of shock due to blood loss include shortness of breath, weakness, dizziness, chills, thirst and as it progresses, confusion, disorientation, sleepiness, the possibility of coma and eventually death.
In addition, anemia is a symptom of various diseases. It is the first detectable sign of arthritis, infection and certain major illnesses.
The fact I had two independent reports indicating dehydration and a lack of oxygen due to anemia fazed neither the ER doctors nor my primary care physicians, who were provided a copy of the test results. Only after repeated requests did the attending ER physician, Dr. Judith Mechanick, infuse a unit of saline for my dehydration just before discharging me around 1 am. There was no other treatment. No B12 injection. Not even a diagnosis.
The discharge instructions stated: "Get mold testing in home as soon as possible." I can only surmise the comment arose from my expressed apprehension over possibly inhaling some mold spores while cleaning mold off HVAC ductwork in my home and Dr. Mechanick's conclusion that my ailment was an allergic reaction.
Sept. 17, 2003 Appointment with Dr. Ferrer for my annual physical. Blood tests and urinalysis were unremarkable. The pap test result noted the presence of endometrial cells, which the report stated, "If present in a woman over age 40, could be associated with benign endometrium, hormonal alterations or, less commonly, endometrial abnormality." Dr. Ferrer recommended clinical correlation with Dr. Frederick Helmkamp, a gynecological oncologist.
Oct. 20, 2003. Appointment with Dr. Helmkamp. There's actually not much to say about the appointment. I was surprised at how old Dr. Helmkamp, a tall man with stark white hair, appeared. He explained that I would be examined by colposcopy, and if he saw anything noteworthy, he would perform a biopsy that would be sent to a pathologist for evaluation. However, during the exam, he said of what he could see he saw nothing unusual and didn't recommend doing a biopsy. He seemed puzzled about why I had been referred to him in the first place.
Oct. 27, 2003. Persistent cough and yellow phlegm brought me again to Dr. Ferrer's office. She diagnosed bronchitis and wrote a prescription for Amoxicillin and Tannic-12 (cough and cold medicine). She also wrote out a second referral for pulmonary function testing by Dr. Michael Tsun, as I hadn't used the previous referral.
"I wash my hands of it." Dr. Rosario Ferrer's reaction upon hearing that the gynecological oncologist she referred me to did not perform a biopsy she thought was needed.As we were standing at the front counter after the exam, Dr. Ferrer asked me how my appointment with Dr. Helmkamp went. When I told her that he did not see anything that would indicate the need for a biopsy, she became perturbed. She turned, and as she began walking away, she threw up her hands and stated, "I wash my hands of it. That's between you and him."
How odd, I thought, that the primary care physician, who is charged by the medical insurance company with the responsibility of quarterbacking and coordinating my health care among the various specialists, would suddenly count herself out. If she felt that strongly about something, why didn't she just refer another specialist? And what's all this unspoken concern about anyway? When Dr. Helmkamp asked me why Dr. Ferrer had referred me, all I could point to was the statement on the pap test result paper recommending further correlation due to the presence of endometrial cells. I felt like something was going on that I should but didn't know, and there was no one around to ask.
On Nov. 11, 2003, the day after my appointment for pulmonary function testing with Dr. Tsun, I received a letter from my medical insurer, Cigna Healthcare, notifying me that my primary care physician had enrolled me in the Well Aware program for people with asthma. At first I thought it a bit curious that I would be receiving information for managing a disease not yet confirmed through diagnostic testing results. Then I figured Dr. Ferrer probably needed to provide Cigna with a Dx code for asthma to justify the referral to a pulmonary cardiologist. However, the second referral to Dr. Tsun listed the Dx as bronchitis.
As it turned out, the pulmonary function test showed normal gas exchange. Dr. Tsun's letter to Dr. Ferrer dated Nov. 17, 2003 regarding the Nov. 10th exam noted that prior to testing, I had completed a course of Augmentin, which temporarily quelled my chronic symptoms of nasal congestion, cough, flu-like symptoms and burning sensation in the throat and lungs. Although he did not specifically indicate whether the Augmentin affected test results, his letter recounting my recent medical history set forth an unfortunate pattern of my being ill, receiving a prescription for antibiotics from my PCP which was completed during the lag time prior to specialist consultation. No wonder I wasn't symptomatic by the time I got to see the specialist. It's as if we're testing antibiotic efficacy.
In fact, we now know that antibiotics and other medications, such as cortisone and estrogen, as well as a diet high in sugar and processed foods bring on fungal yeast infections, which are integral in cancer and other chronic illnesses. Studies show antibiotics lead to pathogen overgrowth through indiscriminate annihilation of all bacteria including the bacteria needed to maintain the balance of normal flora required to keep the body healthy. When antibiotics alter the body's internal ecological balance, then yeast, which is part of the normal flora of the body, begins to overgrow and hyper proliferates causing far reaching toxic symptoms. And asthma-like symptoms are characteristic of yeast and fungal infections.
Candida usually manifests in the gastrointestinal tract but can occur throughout every part of the body. Candida infiltrates the intestinal mucosa (the lining of the stomach and intestines), making the intestinal lining more permeable to harmful toxins and undigested food particles. "Leaky gut syndrome" or intestinal permeability occurs when undigested particles pass into the bloodstream and are attacked as foreign invaders by the immune system. Gradually over decades of a life, this yeast overgrowth complex adversely impacts the liver, the brain, the thyroid and the adrenal glands. When the liver is unable to properly dispose of toxins, dysfunction and degeneration of body tissues occur. Yeast overgrowth may be the dominant factor in the rise of degenerative and proliferating autoimmune diseases plaguing our aging population.
Among other symptoms accompanying candidiasis are chronic fatigue, fibromyalgia, allergy, sensitivities, brain fog, nasal congestion, sore throats, cough, ringworm, heartburn, gas, bloating, irritable bowel syndrome, chest tightness, blurred vision, spots in front of the eyes (floaters or specs of decomposing tissue) and recurrent skin, nasal, sinus, throat, ear, bronchial, lung, vaginal, prostate or urinary infections. Along with a depleted immune system, those affected are deficient in nutrients such as iron, magnesium, vitamins A, B6, B12 and essential fatty acids.
In recent years, studies linked heavy antibiotic use to inflammatory bowel disorder, Crohn's disease, asthma and other respiratory tract infections as well as diabetes, autism and other neurological diseases. A 2005 study implicated the antibiotic Augmentin TM in the formation of autism and ammonia poisoning. Arizona State University medical scientists found that antibiotic induced alteration of gut flora almost completely inhibited excretion of mercury in rats. Heavy metals bind to yeasts, making elimination of either substance from the system extremely difficult. Subclinical colonization with yeast in the body may persist unrecognized for many years.
In his letter to Dr. Ferrer, Dr. Tsun recommended a methacholine challenge test to rule out subclinical asthma, which could not be determined through lung function testing. He also recommended a fungal serology, a hypersensitivity pneumonitis profile, and CBC to rule out eosinophilia.
Based upon my own research, my symptoms and inconclusive test results, my gut instinct was telling me that my health woes were more likely caused by some internal fungal infection than as a result of asthma. Asthma-like breathing difficulties are symptomatic of fungal infections. An educated hunch was telling me the methacholine challenge test would be a waste of time and money. Plus I was apprehensive about taking the recommended test based on the adverse reaction I'd had after the lung function test, which left me noticeably nauseated. I suspected the testing equipment hadn't been adequately disinfected. Let me elaborate.
Once I had filled out the requisite paperwork at my Nov.10, 2003 office visit with Dr. Tsun, I was escorted to seating within view of the patient testing area. There was a few minutes wait as another patient completed a test using the same equipment upon which I would be tested. I watched the tester simply wipe the exterior of the breathing tube with a dampened cloth and insert a new disposable mouthpiece guard. Even if the cloth was soaked with alcohol, alcohol does not sterilize prions (proteins thought to cause a number of diseases, including Creutzfeldt-Jakob disease, the human form of mad cow disease). To be properly sterilized inside and out, the breathing tube would need to be steam cleaned. Who knew what airborne microbes lurked within the walls of the tube into which I would inhale and exhale? Lung function equipment I had been tested on previously in the mid-80s had been wrapped in cellophane prior to use. Shortly after leaving the office post test, I became severely nauseated. Upon returning to work that afternoon, office colleagues with whom I was meeting remarked about my pale appearance.
Nov. 17, 2003. Second visit with Dr. Tsun. A sputum study tested positive for Candida albicans. Fungal serologies for histoplasmosis and aspergillus were negative after culturing only four days. (Fungal cultures typically take two to three weeks to grow.) From doctors' notes, the Candida finding was chalked up as just common oral thrush. In a letter to Dr. Ferrer dated Dec. 18, 2003, Dr. Tsun wrote: "Candida growth in the sputum most likely represents colonization. There is no evidence of active oral candidiasis by examination. I doubt she has a systemic fungal infection at this time." Unfortunately, tests conducted a year later by another doctor found systemic Candida growth rampant. Dr. Tsun's impression of my ailment: "chronic allergic rhinitis with postnasal drip." He recommended treatment with Flonase and non-sedating antihistamines, such as Claritin, and a nasal saline wash. To ease my breathing difficulties, Dr. Tsun prescribed Combivent inhalant at my request, even though he states in a letter to Dr. Ferrer, "I gave her a prescription for this even though I am not sure if she truly has asthma..." I later learned that the corticosteroids in such inhalants encourage fungal yeast growth.
Dr. Tsun is a very self assured physician with many years of experience and a reputation among patients and fellow medical professionals for being abrasive. He epitomizes those who view medicine as a science rather than an art and is skeptical of claims unless proven by a double-blind study. This view sets up inherent patient-doctor conflict with the doctor challenging everything the patient says. To illustrate my premise, I offer the following examples from our meetings.
"You can print out the whole internet. I'm not changing my opinion." Dr. Michael Tsun's response when I tried to give him back up information from the internet to justify my request for a specific serum test.
One of my two birds was being evaluated for infection based on a positive gram stain test. At the urging of my veterinarian whose husband had once caught a Cryptococcus infection from their pet birds, I asked Dr. Tsun to complete a serology for chlamydial pneumonia. He refused. Based on his looking at me in my street clothes from a few feet away and the tests conducted while I was taking antibiotics, he concluded that I did not "have any signs or symptoms of psittacotic pneumonia." I brought in printouts on relevant zoonotic diseases from the web as back up in case he balked at the request. His response: "You can print out the whole internet. I'm not changing my opinion." This same doctor started answering his own yes-no symptom questions when I took more than two seconds to answer. A couple of times we chimed opposing answers simultaneously. I had to restrain myself from jumping up to see if we could mimic the Three Stooges/Marx Brothers mirror image pantomine that ends with a move fake and a two-eye poke.
When I asked him about repercussions from post nasal drip getting into the lungs, he said as a pulmonologist, his responsibilities "stop at the neck." He said he could not answer since the source of the post nasal drip was in the head. I found it curious that Healthgrades lists three specialties for Dr. Tsun, including internal medicine, which covers the body from head to toe. I suppose if I'd asked him about the repercussions from acid refluxed into the windpipe from the esophagus, he would have told me to consult a gastroenterologist. However, when I later asked my gastroenterologist about the repercussions from intestinal permeability, he said he could not answer because once a substance leaves the gastrointestinal tract, it's out of his realm.
When I told Dr. Aliza Levine that I had a referral from another physician to see Dr. Tsun, she suggested I see another "less abrasive" specialist in his office and wrote a referral for a female doctor. When I arrived at Dr. Tsun's office, however, he insisted that he sees all new patients. I was surprised to read in his report to Dr. Ferrer that I was being seen by him because I was "exposed to black mold spores while cleaning the ventilator system" in my house. When I told him I may have inhaled mold spores while removing them from HVAC ductwork in my utility room using a Clorox soaked rag, he flat out said he didn't believe me. He also told me I was, in essence, lying after I conceded to spitting up the equivalent of 100 tablespoons of white sputum per day in response to his pressing me to quantify my mucus production.
Dr. Tsun's two letter reports to Dr. Ferrer regarding my office visits are among the most detailed I've seen. Nonetheless, a case could be made in favor of patient proofreading doctor write-ups prior to dissemination based on misstated facts. For instance, I take issue with his contention that "there are no occupational exposures to toxic fumes, chemicals or asbestos." Among my work responsibilities was oversight of commercial tenant build outs, which entailed multiple visits to and meetings in premises under construction. Results from urine tests later administered by another doctor were positive for elevated lead and possible exposure to the chemical solvent, toluene, which may be absorbed from outgassing of new carpets and other building materials.
He states "she denies significant dyspepsia or reflux." I was hospitalized for bleeding ulcers in 1983 and have been taking Tagamet and Zantac daily ever since to quell the bouts of heartburn I experience after eating most anything. He also states "there is no history of diabetes, hypertension or coronary artery disease." I was never tested for these conditions. The closest assessment I'd received was typical cholesterol related blood work, which doesn't measure arterial plaque build-up.
Dec. 5, 2003 Dr. Ignacio called in response to my concern over testing positive for Candida albicans. She said she spoke with Dr. David Yoho, an infectious diseases specialist, who said it is not uncommon to find Candida in the sputum and not to worry. To ease my mind I suppose, she declared, "Everyone has Candida."
But I was worried. The entire time my doctors were telling me the tests show that I am ok, my deteriorating physical health was negatively impacting my work performance and my mental well being. Everything I was reading heralded dire health consequences from failing to address Candida fungal infection. My next door neighbor who was a supervisor in the Arlington lab at Virginia Hospital Center was telling me that she was seeing a lot of yeast coming up in the hospital lab tests post 9/11/01. It was obvious something was terribly wrong with me to my friends, co-workers and customers. My wheezing and asthmatic-like breathing coupled with excessive post nasal drip phlegm was making sleep nearly impossible. As incredulous as it seems, I was waking up every hour or two to spit. The sleep deprivation was manifesting during the day in uncontrolled anger outbursts and noticeable brain fog. I was put on notice that my job was in jeopardy.
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