Case Study - Polymyalgia Rheumatica to Remission

Case Study – From Sickness to Health

Severe form Polymyalgia Rheumatica to Remission in 9 months of Treatment

Abstract 

Background: Polymyalgia rheumatica is categorized as an inflammatory disorder. Muscle pain and stiffness, especially in the neck, shoulders, arms and hips, buttocks, thighs, wrists, hands, and in extreme cases, the lower extremities. Symptoms may also include intermittent fevers, fatigue, general malaise, loss of appetite, depression and more. More uncategorized symptoms associated with other autoimmune presentations commonly present as well. Polymyalgia rheumatica generally presents in people older than 65 and rarely affects people younger than 50. According to Medline and the general perception of Western medical diagnostics, the cause of polymyalgia rheumatica is unknown.¹

Objectives: This case study provides a holistic treatment approach to polymyalgia rheumatica using Chinese medicine.

Methods: A male in his 60s (exact age protected) was treated with Chinese medicine while accompanying other holistic methods for 9 months, to decrease, eliminate, place symptoms associated with polymyalgia rheumatica in remission, with the intention of sustained remission.

Results: The patient reported gradual improvements month by month. He reported he was completely symptom free by 7 months. He continued treatment until 9.5 months before being released to best assure sustained remission.

Background

Before experiencing chronic symptoms, this 60+ year old male patient was an active and healthy man who experienced no chronic symptoms.

This patient reported that he experienced global chronic pain with other chronic immune reactions (listed below), with severe anxiety, depression, and with the inability to sleep any more than 3 hours per night for 4 years. He was not taking any medications or supplements at the time of his first intake.

Upon inquiry of pathogenic exposure due to the abundant immune related symptoms, the patient reported having these symptoms for 4 years, after living in a home that “smelled funny”. He stated the ice dams on the roof caused the roof to leak into the house. Black mold came through the sheetrock at the area of the leak. The patient also reported living next to a canal for many years. Mosquitos were a burden for almost half of the year to which he had obtained hundreds of bites from them over the years. Bartonella is a pathogen known to be abundant in the area, carried by mosquitos and other vectors; specifically near water and marshy areas.

Case History

Diagnosis and Physical Appearance

A 60+ year old male came into Dr. Lynch’s clinic and stated he had been diagnosed with Polymyalgia Rheumatica 4 years prior. His appearance looked like a combination of extreme vulnerability, weakness, sadness, anger, frustration, depression, fatigue and fragilility. He appeared to experience difficulty walking as he came into the clinic to sit down; as well, was he appeared to be uncomfortable sitting throughout the appointment.

Symptoms

Pain – Global

Onset of symptoms began 4 years prior. His symptoms began with pain. The pain began in his shoulders, then migrated to his hips, then spread to the rest of his body. This man reported that he currently had severe pain and cramping in his feet, ankles, calves, thighs, knees, hips, ribs, all regions of the back, sides and back of the neck. The sensations on bottom of his feet alternated between numbness and burning pain. He experienced severe cramping in the calves, hands ribs and chest. He could not make a fist with his hands. The patient reported that walking around was a real struggle. His balance was compromised; everything had to be very purposeful, and he frequently fell. His jaw had chronic pain, making it difficult to chew. The patient reported having sharp shooting electrical like pain in the back and hip as well as overall global muscle weakness and muscle atrophy. The patient reported only being able to sleep a few hours per night due to the global pain and cramping and he never felt rested. He reported having regular drenching night sweats and nightmares. He also reported teeth and gum sensitivity. He could not work physically let alone get around without falling on a regular basis due to the burning pain in the legs and feet and not being able to feel his feet. This patient also experienced intermittent episodes of severe gout flares.

Other Symptoms

The patient reported having chronic sinusitis, a chronic cough, a sore throat to which he was clearing his throat all the time and reported his throat would just lock up at times as if he was feeling like he was being “choked out”.

The patient reported having chronic brain fog, short term memory loss, severe anxiety, and frequent depressive episodes.

Western Medical Approach

This patient had seen a medical doctor, specializing in autoimmune disorders. He reported to her that his chronic pain symptoms began with shoulder pain, and eventually moved throughout his body. He had reported to the doctor his feet would be in so much pain he could not walk.

The doctor then had blood labs drawn. The blood lab results indicated elevated cholesterol levels, low white blood cell count, elevated ESR, elevated CRP and elevated hematocrit.

Based on laboratory data, the patient exhibited signs of infection(s). Based on symptoms, the patient exhibited signs of infection(s). The doctor gave him a diagnosis of polymyalgia rheumatica and gave him a prescription of prednisone to help manage pain and help him function. The patient reported very little, if any, help from the prescription.

Holistic Medical Approach

Laboratory and Clinical Diagnostics

Generally speaking, with Western medical awareness, an elevated white blood cell count can be indicative of an active acute infection. However, a low white blood cell count can also be indicative of a chronic infection. A low WBC is just not an effective response by the body to fight an infection. Elevated ESR and CRP also point toward inflammatory processes, which is indicative of immune related activity.

Clinical data suggests chronic immune related symptoms; based on inflammation, pain, and histamine reactions. Immune related symptoms or reactions correlate with the immune system. One of the jobs of the immune system is to help keep pathogenic microbes under control. When there are chronic immune reactions, a chronic infection should be considered.

We know the patient has a history of living near a canal and obtaining many mosquito bites for many years, as well, lived in an environment with significant mold exposure. According to clinical diagnostics based on Dr. Richard Horowitz MD PhD, this patient presented with symptoms associated with a strong potential for having babesia, bartonella pathogens, as well the sensible potential for mold.

Laboratory data, clinical data and environmental exposure point toward the possibility of infection(s) being the cause of this patient’s symptoms. Based on studies of laboratory findings in relation to symptoms, this patient’s infections point toward the likelihood of babesia, bartonella and mold infections with the likelihood of others.  

Holistic Medical Approach

Treatment

This patient’s treatment began in March and ended January. It was 10 months long. The treatment consisted of Dr. Patrick Lynch’s dietary modifications, 400mg of s-acetyl glutathione twice per day, Spiro-Clear and Intra-Cell products from Trillium Health Solutions, other pulsed antimicrobial supplements such as Trace Brand 30ppm colloidal silver at specific times, Argentyn 23 nasal spray pulsed at different times, cardiovascular supplements such as hesperidin, a bulk herbal formula and few other secrets. No pharmaceutical medications were taken by the patient at the time of treatment. No vitamins, folate, B12 or other nourishing supplements or compounds were taken at the time of treatment.

Beginning Treatment – Month 1

The patient began with Dr. Lynch’s dietary modifications and 400mg of s-acetyl glutathione twice per day for 7 days. This part of the treatment is designed to stop giving strength to the infections as well, help support detoxification, as detoxification had been compromised for several reasons. Juicing celery and greens, as well, taking s-acetyl glutathione are optimal for that. Other binders such as activated charcoal and zeolite have limited effectiveness at best without s-acetyl glutathione.

After 7 days with the diet and s-acetyl glutathione, the patient began taking Spiro-Clear I; a full spectrum antimicrobial product from Trillium Health Solutions. The patient began at a very low dose and carefully reached a full dose of 5 capsules twice per day within the first month. The herbs used in this full spectrum antimicrobial product are the best herbs chosen for all categories of unwanted microbes. They are supported by research studies found in medical databases.

The patient included 30ppm Trace Brand colloidal silver intranasal spray at 5 sprays in each nostril 5 times per day for 30 days only. The idea of this is to kill unwanted microbes such as mold and bacteria in the nasal and sinus passage. This prevents continuous systemic reinfection when mucus is swallowed.

Outcome Month 1

Upon the first 5 week check in, the patient felt confident he was doing the right thing but felt as if he did not feel better. The patient remained impeccable with Dr. Lynch’s dietary modifications and the recommended treatment protocol. He reported that he felt slightly more fatigue and more headaches as he increased dosage each time of the Spiro-Clear I; however, he felt as if he increased at the right time, so the reactions were tolerable.

After comparing the patient’s symptom presentation from his initial appointment 5 weeks prior, it was evident the patient did have a significant decrease in some of his symptoms. When reviewing the initial symptoms presentation, no previously reported symptoms were worse, and no new symptoms were reported when asked during the appointment. His anxiety that he had experienced daily was gone, he was sleeping better, his neck had less pain, his sinusitis had decreased, night sweats were gone, he had slight feeling return to his hands and feet which were completely numb with no feeling before. The patient then acknowledged there had been some improvement during the first 5 weeks, however, without reviewing the initial symptom presentation, he would say he would not have noticed a difference.

The patient appeared to have made slight improvement. He was more present, upright, confident and appeared slightly less vulnerable. He was still frustrated, vulnerable and in a significant amount of pain.

Beginning Treatment – Month 2

The patient discontinued the 30ppm colloidal silver nasal spray and included Intra-Cell I at a low dose to begin. He worked his way up to a full dose of this formula within 2 weeks. At this time, he was taking a full dose of both Intra-Cell I and Spiro-Clear I. Intra-Cell I is designed to help penetrate inside the red blood cells to help neutralize pathogens that Spiro-Clear I cannot reach. The reason why both formulas are not initially used is due to the excessive die-off reactions that can occur when both products are initially used. That said, Spiro-Clear I is used with the intention initially to help clean the plasma and keep it clean before using Intra-Cell I to clean and keep the red blood cells clean. Intra-Cell I is considered the co-infection formula. When both products are taken, then all categories of pathogens are being addressed in a safe manner before picking up aggressiveness again when the body is ready.

Outcome Month 2

At the 10-week check in the patient reported feeling slightly better. He reported he was still in pain, still felt horrible and was frustrated at the amount of time it takes to feel better. He acknowledged and understood it was going to take time after being reminded that based on the amount of time he had been down, that it was going to take some time to get better. All his previous symptoms that had completely diminished after the previous check in were still gone. Less pain was observed over all; he still had to be very mindful how walked, but less; his feeling was still coming back in his hands and feet; the muscle cramping was less; the itchy feet was gone; the electrical sharp shooting pains were 50% less; the difficulty swallowing and feeling like he was being choked out was gone; the neck pain was 50% less; the nightmares were gone; the brain fog and short term memory loss had improved; the cramps in the ribs and chest were 50% improved; the feet feeling like they were on fire had decreased by 50%, and more. After reviewing the initial chronic symptoms at this second check-in, he realized he had made significant progress. However, he still felt as if he would not have recognized that much progress unless we had that check-in.

Month 3-5 Treatment

At the beginning of month 3, Intra-Cell I was rotated out for Intra-Cell II, to offset the potential for resistance that pathogens develop during treatment. Co-infections such as babesia, bartonella, mycoplasma, and more develop resistance to antimicrobial properties, as well antibiotics. So, by rotating herbs with the same type of properties, but different biochemical properties, then a thorough neutralization of pathogens can effectively resume.

At month 3, the patient reported feeling much better. Increasing aggressiveness with treatment is considered as one turns a corner and feels considerably better, according to Dr. Lynch’s protocol. Other things were then added to this gentleman’s regimen to increase aggressiveness. When aggressiveness was increased, the patient felt a temporary decrease in energy and had some intermittent headaches. This increased die-off and leveled out over the month.

At month 5, one of the herbal formulas (Spiro-Clear I) was permanently rotated out with another formula (Spiro-Clear II) to go deeper into the body. This formula is used to dissolve biofilms and open cystic formations; areas where pathogen hide. This formula is used only when the patient is feeling considerably better. If this formula is used too soon, then the hidden pathogen would be let out of hiding too soon, thus adding to the existing pathogenic load which would only increase the severity and frequency of the symptoms and could lead to harmful events. Therefore, it is very important to wait until the pathogenic load presents in a way that is has likely significantly decreased, so that the temporary increase of symptoms can be more tolerable.

Improvements

During month 3, specifically on week 10, the patient reported having increased aches and pain, moderate but manageable depression, increased fatigue, and headaches. Based on the type of symptoms this man was having, he was experiencing his first Herxheimer reaction. The increase of symptoms lasted for 5 days. On the 6^th day, he reported feeling much better. The depression had ceased, his energy returned and stabilized, the aches and pains had decreased, and the headaches diminished.

At the end of month 3, the gentleman reported being “out of the woods”. He still felt very compromised, but he noticed that he had felt much better. The pain had significantly decreased, and in many areas diminished. He reported his anxiety was gone, depression was gone, his memory was returning, and brain fog was less. The shoulder pain he had been experiencing was 75% less; he reported the shortness of breath was significantly less; it was easier to walk; neck flexibility increased by 75%; the esophagus had not been locking up anymore; muscle cramping had ceased completely; the coughing and runny nose was gone, the cramping on the chest region was gone; night sweats had ceased; he reported having an increased amount of energy and his sleep had been better than it has in years. He reported not quite seeing the light at the end of the tunnel, however he acknowledged what he had been doing was working.

Still Yet to Improve

The numbness of his hands and feet had improved 50%. He was dropping things less, but the numbness and lack of sensation was still an issue. The neck pain had improved by 50% and reported much progress is still needed there. His hips were still sore with 20% improvement. Muscle fatigue is still an issue; walking and using his body still needs to be purposeful.

Month 6-9 Treatment

By now, there are longer windows of having increased energy and almost complete cessation of symptoms, treatment continued to pick up aggressiveness. One thing added to treatment at this time was hesperidin. This has been shown to clean the vascular plaques off the interior lining of the blood vessels. Cholesterol buildup in the vessels is common for systemic infections, as well, pathogens hide behind plaques. A research study shows that within an 8-week period that 150mg of hesperidin/kg of bodyweight when consumed orally, have dissolved all cholesterol plaques from cholesterol impacted carotid arteries.  Again, this is not something to take too early on, rather than toward the end of treatment. Otherwise, an increase in severity and frequency of symptoms can present from clearing pathogenic hide-outs, exposing them to the blood supply thus triggering the immune system to respond differently and potentially causing an increase of immune reactions.  

To best assure mold gets knocked out, other things were implemented during this month, as well, strong antimicrobial substances to help kill microbes when they come out of hiding from the use of hesperidin and the cyst/biofilm herbal formula.

The last month of treatment consisted of a Chinese medicine bulk herb formulation named “Big Guns”. This is not a traditional formulation, but a formulation created by Dr. Lynch. There have been variations of this formula based on individual need, however, the main function of the formula is to get into the most difficult areas of the body, where blood supply is limited, to root out hidden pathogen. This Chinese medicine formula also uses very aggressive Chinese herbs to break down biofilm and cysts. One cup of tea of this formula can break and has broken open a cyst inside the body. It is not a formula to mess round with. Using this formula without knowing how to use it, or using it at the wrong time, or dosing it incorrectly can lead to very bad outcomes. We want to use this formula, at the very end to root out things that Spiro-Clear II did not. When treatment is done correctly, the physician feels the patient has been compliant, and symptoms have completely ceased, there should be little to nothing left enough to cause a die-off reaction. This formula is to best assure the body is sufficiently cleaned out so that the patient can remain in a sustained remission.

Once the body is in remission, then one can resume a normal lifestyle with normal eating habits of one’s choice. Certain preventative measures need to be utilized to remain in remission. Education to the patient regarding preventative measures is essential for them to have to choose to best help themselves remain in remission.

Improvements

The patient had continual frustration over the amount of muscle fatigue he had. After revieing his symptoms, and realizing he had none, he was reminded how far he came. The muscle fatigue is part of the regeneration phase that will come back in time.

During months 6-7, the patient reported having intermittent die-off episodes where he would feel pain for a few minutes in various parts of the body, 15 minutes after taking his antimicrobial herbs and supplements. The pain would go away after a few minutes and not return to that area. However, there would be consistent new places that would light up with pain, before moving to the next area.

There were no symptoms of die-off during month 8 and month 9. The patient’s symptoms were completely gone by this time. This 70-year man who at one time was barely being able to walk, in severe pain from head to toe, not being able to feel his feet, with constant severe vertigo was seen during month 6 walking around on his roof with a steep pitch. He was been able to use his body in ways he has not been able to in years, such as physical labor without pain or other symptoms, move irrigation, dig trenches, and more. Before starting this protocol, he had a very difficult time shopping at the grocery store or just walking from his car to an appointment.

Post Treatment

Regular follow up has been provided with this gentleman. We made sure his IGF-1 and testosterone levels were at normal levels with the regenerative herbal formulations he had been taking, to make sure the nerve and tissue regeneration would continue in a timely manner.

For 7 months, none of his previous symptoms have returned, he has continued to get stronger, he met a woman he fell in love with, got married and continues to live a life he has not had in many years.

Symptom Presentation from Start to Finish - Initial Intake in March

Polymyalgia rheumatica Diagnosis 4 years prior to seeing Dr. Lynch

• Severe shoulder pain: May 1 15% improvement. June 7^th 25% improvement. July 12^th 75% improvement. August 30^th 90% improvement. October 7^th no pain. November 15^th no pain, December 30^th no pain.

• Weakness everywhere: May 1 15% improvement. June 7^th 25% improvement. July 12^th 35% improvement. August 30^th 50% improvement. October 7^th 50% improvement. November 15^th 75% improvement, December 30^th 75% improvement.

• Severe hip pain: May 1 0% improvement. June 7^th 0% improvement. July 12^th 20% improvement. August 30^th 80% better. October 7^th 90% improvement. November 15^th 95% improvement. December 30^th 100% improvement. No pain. 

• SOB: May 1 50% improvement. June 7^th 50% improvement. July 12^th 75% improvement. August 30^th75% better. October 7^th 90%. November 15^th 95% improvement, December 30^th 100% improvement.

• Walking around project is a real struggle: May 1 10% improvement. June 7^th 30% improvement. Still must be purposeful better – getting stronger – balance improving – knees ankles and hips are less but still enough to keep attention. July 12^th 50% improvement. August 30^th 75% better. October 7^th 90%. November 15^th 100% improvement, December 30^th 100% improvement.

• Everything is difficult and purposeful: May 1 Not as dangerous. Easier. Less difficult better. June 7^th Not much change since last month. July 12^th 50% improvement. Still must focus, but significant improvement. August 30^th 75% better. October 7^th 90%. November 15^th 95% improvement, December 30^th 100% improvement.

• Balance is terrible: May 1 10% improvement. June 7^th 20% improvement. July 12^th 75% improvement. August 30^th 90% better. October 7^th 90%. November 15^th 100% improvement, December 30^th 100% improvement.

• Esophagus locks up: Feels like being choked out – purposeful how he swallows: May 1 50% improvement. June 7^th 90% improvement. July 12^th 90% improvement. August 30^th 100% improvement. October 7^th 100%. November 15^th 100% improvement, December 30^th 100% improvement.

• Muscles cramping: May 1 10% improvement. June 7^th 80% improvement. Increased activity causes cramping. July 12^th 80% improvement. August 30^th 90% better. October 7^th 90%. November 15^th100% improvement, December 30^th 100% improvement.

• Muscle fatigue: May 1 0% improvement. June 7^th 10% improvement. July 12^th 20% improvement. August 30^th 50% better. October 7^th 80%. November 15^th 90% improvement, December 30^th 90% improvement.

• Bottom of the feet: May 1 0% improvement. June 7^th 50% improvement. Fire is 50% less. Neurological burning is 50% less. July 12^th 80% improvement. August 30^th 90% better. October 7^th 90%. no fire, no neurological symptoms, some weakness. November 15^th 90% improvement, no fire, no neurological symptoms, some weakness. December 30^th 100% improvement.

• Short Term Memory Loss/Brain Fog: May 1 0% improvement. June 7^th 10% improvement. July 12^th20% improvement. August 30^th 70% better. October 7^th 80%. November 15^th 90% improvement, December 30^th 100% improvement.

• Runny nose: May 1 90% improvement. June 7^th 90% improvement. July 12^th 90% improvement.August 30^th 100% better. October 7^th 100%. November 15^th 100% improvement, December 30^th100% improvement.

• Coughing tickle in the throat: May 1 90% improvement. June 7^th 90% improvement. July 12^th 100% improvement. August 30^th 100% better. October 7^th 100%. November 15^th 100% improvement, December 30^th 100% improvement.

• Cramps in the ribs and chest: May 1 30% improvement. June 7^th 50% improvement. July 12^th 100% improvement. August 30^th 100% better. October 7^th 100%. November 15^th 100% improvement, December 30^th 100% improvement.

• Electrical sharp shooting pain in the back/hip: May 1 50% improvement. June 7^th 80% improvement. July 12^th 100% improvement. Gone. August 30^th 100% better. October 7^th 100%. November 15^th100% improvement, December 30^th 100% improvement.

• Drenching night sweats: May 1 100% improvement. Gone. June 7^th 100% improvement. July 12^th100% improvement. August 30^th 100% better. October 7^th 100%. November 15^th 100% improvement, December 30^th 100% improvement.

• Skin rashes, bumps around the abdomen and legs: May 1 30% improvement. June 7^th 100% improvement. Gone. July 12^th 100% improvement. August 30^th 100% better. October 7^th 100%. November 15^th 100% improvement, December 30^th 100% improvement.

• Nightmares: May 1 100% improvement. Gone. June 7^th 100% improvement. Gone. July 12^th 100% improvement. August 30^th 100% better. October 7^th 100%. November 15^th 100% improvement, December 30^th 100% improvement.

• Neck pain all the time: May 1 0% improvement. June 7^th 50% improvement. July 12^th 70% improvement. August 30^th 80% better. October 7^th 90%. November 15^th 100% improvement, December 30^th 100% improvement.

• Severe Anxiety:  May 1 100% improvement. Gone. June 7^th 100% improvement. Gone. July 12^th 100% improvement. August 30^th 100% better. October 7^th 100%. November 15^th 100% improvement, December 30^th 100% improvement.

• Vertigo: May 1 50% improvement. June 7^th 100% improvement. Gone. July 12^th 100% improvement. August 30^th 100% better. October 7^th 100%. November 15^th 100% improvement, December 30^th100% improvement.

• Depressive episodes:  May 1 70% improvement. June 7^th 100% improvement. Gone. July 12^th 100% improvement. August 30^th 100% better. October 7^th 100%. November 15^th 100% improvement, December 30^th 100% improvement.

• Doesn’t Sleep well – May 1 60% improvement. June 7^th 80% improvement. Sleeping much better. July 12^th 100% improvement. Sleeping well. August 30^th 100% better. Sleeping well. October 7^th 100% better. Sleeping well. November 15^th 100% better. Sleeping well. December 30^th 100% better. Sleeping well.

• Numbness fingers hands feet: May 1 10% improvement. June 7^th 30% improvement. July 12^th 50% improvement. August 30^th 70% better. October 7^th 80%. November 15^th 90% improvement, December 30^th 100% improvement.

 © Patrick Lynch DAOM, July 2023 

References:

1. Polymylagia Rhuematica. MedlinePlus.Gov.

Https://medlineplus.gov/polymyalgiarheumatica.html