PUTTING IT ALL TOGETHER
Edward Lichten, M.D.,
There have been many stories about patients and their recoveries in this book: there was Jodi with intractable menstrual pain, Denise with PMS monthly seizures, Karen with atypical migraine and a broken neck, Craig with near suicidal clusters, Dennis with rapid healing from hip surgery, and of course Anthony who would changed the course of medical treatment for diabetes. Each patient visit, and Dr. Lichten is now approaching his 200,000th physician-patient interaction, brought a new level of knowledge and understanding to both the doctor and his patient. The science of medicine begins with an observation and the greatest part of that observation is what the patient tells the doctor about his perception of the illness. This is called ‘taking a history’ and this takes more than the three minutes. It takes not only time, but also trust. And trust takes a delicate interplay between two equal human beings who have a common goal: improved health.
Dr. Lichten has always rejected the concept that a physician cannot invade a patient’s space. If he or she does not want an interaction, then by all means, supply the prescription and say goodbye. But when the patient is reaching out for life and health, to barricade oneself behind a desk appears to the patient as an insurmountable wall. No, Dr. Lichten will sit on a stool and meet the patient face-to-face. He will shake his or her hand. He will draw the blood and take the blood pressure, listen to the heart and lungs and check the thyroid for enlargement. He will touch the patient to determine exactly where the pain is reported. He will answer the telephone calls and the Emails. And more than once, Dr. Lichten will gratefully receive a holiday card and appreciate a spontaneous hug from a most satisfied patient.
If only, Dr. Lichten says, we all could do more.
And then, in the summer of 1999, on a Monday morning at 8:30 to be exact came to Dr. Lichten’s office a 16-year-old pixy young girl of 4’4” in height. She had the brightest shine in her eyes and no hair. After she put her hand braces to the side, she positioned herself on the examination table and looked intently into his eyes and smiled! Surprised by her self-assuredness and her ability to get around unaffected, Dr. Lichten was more surprised by her first statement, “Are you the doctor that is going to make me well?” “I will do my best and try,” was his response. And Dr. Lichten did.
For CG had been a normal sprite of a girl, blond, blue eyes and weighing barely 22 pounds at two years of age. But then at 4 years, she had a double whammy: first she contracted a central nervous system complication and coma four weeks from a routine vaccination and then after recovering from that she fell against a piece of furniture and sent a splinter of her shattered nasal cartilage into her pituitary stalk. For whatever reason, she started to lose her hair, and get weak, and get sickly. And all these maladies happened within months of the vaccination and the fall. Her mother had taken her to 17 university professors from east to west coast. Some looked at the hair loss for which they had no answer. Some looked to the muscle weakness and wanted to treat her for lupus, and connective tissue disease and even muscular dystrophy. No one addressed the fatigue that was forcing CG to sleep for more than 14 hours per day. No one had answers to a weaken immune system that was leaving her open to infections. And with the recommendations of methotrexate, 5-FU for skin lesions, and high dose steroids, her mother did the right thing—she moved the family to Southern California where the consistent warm weather minimized the havoc forced upon CG by a changing environment. She made CG self-sufficient and never once commented about her loss of hair although every other concerned individual had CG wondering if she was dying of cancer or some other deadly disease.
And on that Friday, before the fateful visit to Dr. Lichten, while readying for a move back to Michigan where her son would attend university, CG’s mother was intrigued by the torn cover of a book entitled Grow Young with HGH by Doctors Klatz and Goldman. For the book had been at that bookstore for months with a $1.50 price tag and no takers. But CG’s mother had wondered if hGH was a possible answer to CG’s small statue and weakened immune system. So she bought the book. And on the first page of the Appendix of expert doctors was the story of Dr. Lichten’s philosophy. And so she called and got the fateful appointment three days later.
So, surprised by her directness, Dr. Lichten returned to the problems at hand. “All diseases that are not genetic, I believe are affecting the endocrine system. The endocrine system has six major glands and any major disruption of these glands results in an imbalance and illness. It is, a physician’s responsibility to first correct these imbalances and then address whatever disorders persist”.
The endocrine glands and their associated medical symptom and normal range of blood tests have appeared previously:
Initial Laboratory Assessment
►CG did not get adequate sun light as seen with her lily white, almost albino thin skin.
►CG did not have adequate human growth hormone as demonstrated by many fine wrinkles over her face, neck and forehead. Her small statue was a symptom and the pituitary injury the proof of a major cause of her disease state and its continuing effect on thyroid, adrenal and her childlike body development.
►CG had cold hands and cold feet and a low body temperature, as she preferred the weather in California.
►CG had extreme fatigue and needed to nap for hours every afternoon. Her fatigue prevented her from even studying at home.
►CG had no evidence of puberty as she was well into her teen years without development of any secondary sexual traits typical of her gender and age.
The laboratory tests were drawn and the following interpretations was noted:
So, organ by endocrine organ, the team of patient, mother and physician organized a medical plan to stabilize and improve each item. The medical plan was to replace all six endocrine hormone systems at the same time and adjust the replacement amounts based on symptomatology and patient compliance. By educating the patient and mother to what was the importance of each system, Dr. Lichten could co-ordinate all the hormone actions and monthly visits would be punctuated by frequent telephone calls.
►CG got placed on vitamin D to increase serum levels of Vitamin D3 using 2000IU/ drop fish oil. She was to take the vitamin D at bedtime and every night. At this dosage, 2000-4000 IU per night, Dr. Lichten has not seen side-effects.
►CG was placed on human growth hormone and began 1.0 iu per day at night. Because the dosage used for children is much higher than for adults, the dose would be increased to 2 IU per day for the first 30- 90 days before titrating down to 1.0 iu/ per day. The limiting factor would be side-effects of swelling in the hands/ carpal tunnel or worsening arthritis. With the IGF-1 levels in normal range and no symptoms, the treatment with hGH for short statue and true hypopituitarism would continue for years.
►CG was placed on Armour thyroid 1 grain in the morning. After one month, she still had low basal body temperature and her thyroid values were still in the normal suppressed range. Therefore, Dr. Lichten added 0.50 mcg of synthetic thyroid. The body temperature did increase 0.5 degrees. There were no increased in thyroid medication as the patient could not tolerate additional compounded T3, Armour thyroid or synthetic thyroid.
►CG was placed on DHEA. She developed acne and was offered 7-keto DHEA instead. 7-Keto DHEA was compounded and the dosage of 25 mg in the morning was too much. She took 10-20 mg in the morning and 10 mg in the afternoon along with the split dose of thyroid.
►CG was placed on natural cortisol, Cortef 10mg. She increased her dosage from 10mg in the morning and 5 mg in the afternoon to 30-40 mg in the morning and 10 mg as needed in the afternoon. As he had no working adrenal cortex, a form of Addison’s disease, the patient learned that failure to take her natural cortisol would leave her listless and medically stressed. She adapted her knowledge of this, increasing Cortef when stressed. She totally adapted and her school days became almost routine.
►CG was placed on oral contraceptives to give her estrogen to prime her for bone growth and normal pubescent development. In time she developed breast buds and a true womanly figure.
►CG was placed on Lupron acetate to keep the epiphyses (ends of bones) from fusing closed before she had reached optimal height. Under the care of the pediatric endocrinologist, she gained almost 8 inches in height.
It was fortunate that the family had sought out Dr. Lichten. As CG’s mother would relate, she had seen the chairmen of endocrinology at the local university and had traveled to so many facilities where she was given no help, yet alone the growth hormone that other physicians had measured low. CG’s mother had heard so many times that “we don’t do that” that she was belatedly elated that Dr. Lichten had offered that treatment first. And all would remain wondrous of that chance meeting precipitated by a torn book in the Del Mar bookstore.
So follow up, every few months for the following six years corresponded to normal levels of these six hormone systems paired with relief from symptoms and a positive response. Normal Blood Level—Relief of Symptoms—Normal deep sleep, tissue repair, warm hands, no fatigue, no pre-diabetes and normal secondary sexual characteristics, except in this case, no body hair. But Dr. Lichten knew that life had become more normal after CG began having regular menstrual periods and her mother asked for a change in the ratio of hormones because of the premenstrual moodiness. And for the most part, that change in birth control to a lower dose pill, one with a mild diuretic and then the continuous three-month without a menses program worked well.
Follow up laboratory values after 6 years are as follows. Note that the very high levels for T3, T4, DHEA and cortisol are after ingestion of the hormones that morning. Normal values were seen at half these values after being without medication for 24-hours.
A Happy Continuing Story
As Dr. Lichten will tell the story, this young lady went on to academic heights never before seen. She graduating from the international academy with seven advanced courses; she went on to the highly ranked university to graduate in a little over two years with a degree in biology; and then she entered medical school just before turning 20 years of age. Not once has she ever complained about her fate or her hair and she is very much the young lady and responsible adult. She not only goes back to help supervise the biology/chemistry scientific fraternity but she organizers special events for children with alopecia many times throughout the year. Her achievements in medical school, where she is on average five years younger than her classmates, put her in the top of her class with numerous honors. And as she told Dr. Lichten, soon after he became her doctor, she would be a doctor who would be there to take over Dr. Lichten’s mantra. She too would treat patients to make them well. And with a deep sense of honor, Dr. Lichten says today, “I know she will. I couldn’t be more proud of her if I were her father.” And in a sense, Dr. Lichten truly is.
Dr. Lichten is passionate about medicine. This is not a job, an employment opportunity, a level of academic achievement—medicine is a calling. Dr. Lichten has stated that there is no greater privilege than to be entrusted with someone’s life and health. Yes, doctors are there to write prescriptions but the doctor must know why he/she is writing the prescription, to whom he/she is writing the prescription and most importantly, what are the benefits and disadvantages of the prescription and how is this prescription going to affect the patient’s lives.
Dr. Lichten is horrified by the story of the elderly who are taking their food money to buy expensive and often time unnecessary medications like the statins. As a physician, Dr. Lichten feels, that the physician must temper his need to prove his worth by writing a prescription with the facts that the statins are unproven in the over 70 years old crowd and fish or cod liver oil with a digestive enzyme would better serve the patient’s needs. Dr. Lichten feels we prove our worth by our commitment to programs that improve the health of our patients, one person at a one. And in the hospital where he first learned to 'step outside the box' to treat women with menstrual pain, where many of his and other doctors' discoveries were first made, is a plaque that comes from the Talmud, an integral part of Jewish education. The hospital has been closed for more than 15 years but the words are as clear to him today as they were when he first saw them almost 30 years ago:
“To save a village is to save the whole world.” To save or improve even one life is to improve the wellbeing and in a small way, save all of humanity. “Change the world just one patient at a time,” has been told to doctors for eons. It is Dr. Lichten’s mantra, his mission, his quest -- it should be all of ours; a mission of health.