Honarium in Townsend Letter's
2011 "Best of Naturopathic Medicine Competition"
Every seasoned naturopath has in his or her possession a treasured handful of what might be called "stellar" cases. These are cases that leave an indelible imprint on the doctor's memory because of the gravity of the presenting situation and because of the remarkable healing that occurred with alternative medical treatment. These cases are also remarkable in that they give us seemingly inexhaustible amounts of inspiration during those inevitable times of discouragement in practice! This past year I saw such a case involving what appeared to be incipient autism in a 13-month-old child.
In July 2010 I received a call from the parents (Cindy and Keith*) of a 13-month-old girl (Melissa*). They had been referred to me by a nutrition-related business in the town where they live, about an hour's drive from my office. The call came in on a Thursday evening, while the parents were on a ferry to Seattle. Their destination was Children's Hospital, where they were hoping that their daughter could be seen as soon as possible. After briefly hearing about Melissa's condition, I suggested that the best course of action would be to get an assessment and treatment at Children's, and let me know the following day where things stood. Keith called my office on Friday, and after talking with him about Melissa's continued lack of progress, I agreed to see them the next day, Saturday.
Cindy and Keith arrived at my office on Saturday, with Keith carrying a very limp and listless little child in his arms. Melissa looked healthy in terms of physical development, but she lay passively in her father's arms, looked at me with a dull stare, and showed no interest in her new surroundings. Cindy glanced at her daughter worriedly, and said to me "Our daughter has been a totally different child now for almost a week. All she wants to do is sleep – she doesn't want to do anything else. She has stopped playing with her toys. She has even stopped eating and drinking. And she seems to hate being touched, which is very unusual for her.
"She's just a totally different child now," repeated Cindy. "She is 95% less active and responsive than she was only a week ago."
Here is the history of this illness that Keith and Cindy related to me: One week ago, on a Saturday, they had noticed that she was a little fussy, and that she was salivating more than usual. When she swallowed, she tended to choke on her saliva. They thought that this might be related to teething because "she's been teething pretty intensively lately." The following day she stopped eating and also began refusing liquids, and that night she had a fever of 102.7 º. Her parents tried giving her Tylenol, and then Ibuprofen, but the next day the fever remained the same, and she was still having trouble swallowing. Swallowing seemed to be painful for her. They took her to their family medical doctor, who did a strep test, which was negative. It was suggested that this might be a viral infection that would run its normal course in a few days' time.
By Tuesday, however, Melissa was much worse. She had become progressively more lethargic, and had been showing no interest in playing with her toys. She was still refusing liquids, and only drank the small quantities that her parents managed to get into her by force.
Her MD did blood work, and everything was within normal limits. A herpes swab test was negative. Three canker sores were observed in her mouth at this time. Benadryl was prescribed, in addition to a Mylantin wash for the canker sores. Tuesday night she developed a rash of "little red dots," which began around her ankles and on her forearms, as well as a few on her torso and fingers. The next day she developed diarrhea, and Amoxicillin was prescribed. However, the following day no changes were observed, and the diarrhea continued. Because she was still not drinking liquids, dehydration became a significant concern. Thursday night Melissa was seen at Children's Hospital, with a fever that was fluctuating between 99 º and 102.7 º, despite doses of Tylenol and Motrin. A urine culture was done, and the result was negative. She had an intermittent cough at this time, and was given a diagnosis of croup. This was treated with intravenous fluids and one dose of an oral steroid. By the time they got home late that night, Melissa's temperature was 103.1 º, and more Ibuprofen was given. Her weight before this illness was 20 pounds, and by Thursday night she had lost a pound.
The following day, Friday, her fever was 99 º. Beyond the physical symptoms that Melissa was exhibiting, even more alarming was her rapid change from an active, curious, playful child to a very apathetic, irritable child who showed no interest in anything and who only wanted to sleep. "She would sleep 24/7 if we let her," said Keith. "But we wake her up and try without success to get her to drink or eat, or to play with her toys." Cindy said, "I'm afraid we're losing our child. She hasn't talked in almost a week – she hasn't said one word in days, and she won't make eye contact with us. A friend of ours has a child who developed symptoms like this three years ago after getting vaccinated, and their child has never been the same since." When was Melissa's last vaccine? "A month ago," Keith replied.
Melissa had been a very healthy child until this episode. She had never been ill, and had never had antibiotics until this recent course of Amoxicillin. She had a catheterization in May 2010 because her mother had noticed blood in her diaper, but everything checked out fine and no treatment was needed. Her physical, mental, and social development had all been within normal limits.
4 mo. DTaP, Hib
6 mo. DTaP, Hib
9 mo. DTaP, Hib
12 mo. Polio, Pneumococcal – one month before symptoms started
No obvious reactions were noted to any of the vaccines she had received other than "sleeping a lot" the day of the vaccines.
In the Office
Throughout the intake, Melissa lay in her father's arms, dozing off for extended periods of time, and then waking with a pitiful, irritable crying and whining, seemingly extremely uncomfortable. No rash was visible at this point in time, and her temperature wasn't elevated. She did not want to be disturbed, and showed absolutely no interest in her environment. At one point rather late in the office call her mother reached out to gently touch her daughter's arm and Melissa immediately began to cry and wail in a strange, disturbing way that literally sent chills down my spine, and I thought to myself, "This child is in trouble. This is way beyond teething or a viral URI. This problem – whatever it is – is settling deeply into the central nervous system."
And with this thought also immediately came an absolute certainty about the homeopathic remedy that Melissa needed. I remembered studying it many years ago, a remedy for conditions related to profoundly disordered brain function, but for the life of me I couldn't remember the name of it! Fortunately, however, the unfathomable, quirky workings of my memory gave me the first letter of the remedy: "H." So I took Roger Morrison's Desktop Guide to Keynotes and Confirmatory Symptoms off my desk, leafed through the H's one by one, and very quickly I had found it: Helleborus. Helleborus, which I had never before had occasion to give.
The remedy Helleborus is from a plant in the Ranunculus family: Helleborus niger. It is commonly known as Christmas rose, or snow rose. I have very lightly paraphrased the following quotes in several places. In his Desktop Guide, Morrison states: "Helleborus produces stupefaction in all of its complaints, whether it be a migraine which produces a temporary dullness of mind or whether it be in organic brain conditions ... the patient seems cut off from the world and from his own thoughts and perceptions ... at times he feels almost no emotions and is indifferent to the surroundings. Staring, vacant look. Mental dullness." From Robin Murphy's Lotus Materia Medica: "Irritable, worse consolation, does not want to be disturbed. Would not eat or speak. Helleborus niger produces a condition of sensorial depression. It is a remedy for low states of vitality and serious diseases. It affects the mind and the brain, even to the point of complete unconsciousness." Hahnemann's well-known discourse on Helleborus includes these descriptions: "One of the first effects is a kind of stupor. With perfectly constituted gustatory organs, everything seems to have lost its taste. With sight unimpaired, nothing is seen very fully and the patient does not pay attention to anything. The hearing is perfectly sound, but nothing is heard distinctly. Nothing gives one any pleasure." It is thus a remedy to be thought of in such serious conditions as coma, concussions, meningitis, central nervous system impairment following head injuries, epilepsy, and autism.
Keith and Cindy left my office that Saturday afternoon with one dose of Helleborus niger in a10M potency. They gave this to their daughter in the car before their hour-long drive home. No additional treatments were prescribed, other than keeping her well hydrated, making sure that she received probiotics, and letting her sleep uninterrupted. They were instructed to call me the next day, Sunday, for an update.
Sunday afternoon I received a call from Cindy. She said that on the drive home the day before, about 10 minutes after they gave their daughter the remedy, Melissa reached out to play with some sunglasses. They were elated to see this, because it was the first time in a week that their child had reached out for anything. The rest of that day she slept, waking up once to take 23 ounces of milk without protest.
On Sunday morning "she gave me two big smiles, the first smiles in a week!" Cindy reported. Here is an excerpt from that Sunday's health log that Keith and Cindy had been keeping: "Sunday was a good day in that Melissa showed much improvement. She made eye contact the entire day, was interested in toys again, and actually allowed us to touch her. Her crawling was still weak, though she showed interest in moving around and not being asleep the entire day. ... She even took a few bites of melon, though it still seemed to bother her to swallow, though not as much as before. She took about 18 ounces of milk this day. Diarrhea was gone, as was the fever."
"She has even said a few words today," said Cindy. I asked Cindy approximately how much better, percentagewise, Melissa was compared with yesterday (Saturday), and she said, "She's 90% better. She still won't get up on her feet like she used to, but she has made a huge shift overnight. We are so relieved! Do you think she will have any setbacks?"
Follow-Up Appointment on Tuesday (Three Full Days After Initial Treatment)
Melissa is carried in by her father, and looks at me with bright, inquisitive eyes. She wants to be put down and immediately begins exploring the office, crawling around, smiling and laughing, interacting with everyone very sociably. She then begins playing industriously with a puzzle on the floor, and says a few words intermittently, related to her endeavors. I am amazed and delighted – and relieved – at the rapidity and extent of her recovery. Her parents said that they discontinued the Amoxicillin the night before (Monday night) because they realized that Melissa hadn't been diagnosed with a bacterial infection, and also because she had gotten quite a bit worse the day after she had begun this antibiotic. She is still salivating a lot, and is still teething. The canker sores are better, and she remains afebrile. She still has a very slight cough – which I only hear twice during this office call – just one small cough each time. All in all, Melissa looks and acts like a healthy, normal 1-year-old. And this is how she has remained, four months later at the time of this writing. My muscle-testing kept indicating that Melissa's vaccines had been a significant contributing cause of this condition, so her parents were advised to give her no further vaccines.
Exploring Possible Causal Levels
Two weeks after having treated Melissa with Helleborus, I happened to develop a keen interest in the wide spectrum of disorders caused by gluten sensitivity. I decided to read a book on this subject called Dangerous Grains: Why Cereal Grains May Be Hazardous to Your Health, written by James Braly, MD.1 I also read Going Against the Grain, written by nutritionist Melissa Smith.2 I was surprised to read that recurrent aphthous ulcers (canker sores) are experienced by some gluten-sensitive people. I recalled that Cindy and Keith had been concerned about the painful multiple canker sores that their daughter was experiencing at the time of her illness. My naturopathic training decades ago had included the observation that focal irritations and ulcerations in the gut sometimes give rise to ulcerations in the mucosa of the mouth. The logic behind this is that the mouth, being an extension of the gut, will often directly reflect conditions of the gut.
In gluten-sensitive people, gluten proteins are known to damage the lining of the small intestine. The degree of this damage varies, depending on the severity of the sensitivity. Those with celiac disease sustain serious, sometimes life-threatening intestinal damage if they do not carefully follow a gluten-free diet. Braly in Dangerous Grains (p. 188) states that "up to 25% of celiac patients may have a history of oral ulceration." One recent study from Iran concluded that "a significant minority of recurrent aphthous stomatitis (RAS) patients have gluten-sensitive enteropathy. ... This study suggests that evaluation for celiac disease is appropriate in patients with RAS."3 Since celiac disease is now beginning to be understood as just one aspect of a much vaster spectrum of gluten-sensitivity disorders, studies such as these support the practice of screening all patients with RAS for gluten sensitivity.
It is currently well known that some autistic children significantly improve on a gluten-free, casein-free diet. In fact, a recently published article details the case of one child who was initially misdiagnosed as autistic, but eventually the correct diagnosis of celiac disease was established. When this boy received treatment for celiac disease, his "autism" disappeared.4 In her book, Recognizing Celiac Disease, Cleo Libonati writes that "neurological disorders stemming from celiac disease have been widely documented in medical literature. Some of these conditions include poor balance, tremors, migraines, chronic fatigue, schizophrenia, epilepsy, apathy, depression, insomnia, behavioral disorders, inability to concentrate and anxiety."5
Given this additional information about canker sores, I began to wonder if dietary exposure to gluten had somehow played a significant part in Melissa's precipitous descent into an autistic-like state. I called Cindy and Keith and scheduled another appointment for them. During this appointment, I discussed with them the possibility that their daughter might have a significant degree of gluten sensitivity, and since Keith had also commented that he has a problem with recurrent canker sores, I suggested that this might be an inherited condition. I questioned them about gluten in Melissa's diet prior to the illness in July. They replied that wheat and other gluten-containing grains had always been part of her diet, but just prior to her illness she had been eating a lot more wheat crackers on a daily basis because the family had been on a road trip and the crackers were convenient. I suggested that both Melissa and Keith make use of the reasonably priced gluten-related tests offered online at gastroenterologist Kenneth Fine's EnteroLab.com. These tests include a stool test for gluten sensitivity and a gene test for gluten sensitivity. I also recommended that in the meantime they significantly restrict Melissa's intake of gluten. This testing has yet to be done, so results are unfortunately not available at this time.
There are four other possible contributing factors when considering the etiology of Melissa's alarming, rapid mental decline. The first is that she most likely had a viral URI during that same week. Viruses have long been suspected as latent or occult contributing causes of a wide spectrum of illnesses. The second is that she had received a vaccine a month earlier. Vaccines have, of course, been speculatively linked to autism for quite some time now. The mercury that had been used in the preservative thimerosal was considered to be the most likely culprit, since mercury is highly toxic to the central nervous system. Vaccines have, however, supposedly been kept free of mercury in North America and Europe since 2001. Therefore, if Melissa's illness was in part vaccine-related, then the causative factor or factors must be something other than mercury. The third is that Melissa was given Ibuprofen/Motrin on and off throughout the week of her illness. This NSAID is well known to cause gastric and upper intestinal inflammation. Therefore, it could have exacerbated a gluten-induced inflammation of her small intestines. The fourth is that the Amoxicillin may have aggravated an already compromised gut by adversely affecting the gut flora in favor of Candida and other antibiotic-resistant microbes.
I am left wondering if gluten-sensitive children are for some reason more likely to have adverse vaccine reactions, such as autism, especially if they have eaten a lot of gluten within a certain time period that coincides closely with being vaccinated. Perhaps there is some kind of cross-reactivity that occurs with a component of the vaccine and antibodies to gluten that has the potential to severely harm the brain and/or the blood–brain barrier?
Here is another consideration: does increased intestinal permeability (caused by gluten-induced inflammation) cause increased permeability of the blood–brain barrier? If it does, then a child who is gluten-sensitive could be at higher risk during times of vaccination from components of vaccines that normally do not cross the blood–brain barrier, and/or from gluten-derived opioid peptides. My briefest of Internet searches on this topic led to one article, published in 1999, in the American Journal of Physiology. Gastrointestinal and Liver Physiology: "Experimental colitis increases blood-brain barrier permeability in rabbits."6 Here, the authors' research indicates that intestinal inflammation tends to cause a measurable increase in the permeability of the blood–brain barrier. Perhaps their preliminary results involving the colons of rabbits extend to the small intestines of humans?
As of this writing, Melissa has had no subsequent canker sore outbreaks, which leads me to believe that she has had little, if any, intestinal inflammation since the episode in July 2010. My best guess as to what precipitated her rapid decline into an autistic-like state is that something she was exposed to severely exacerbated her (assumed) gluten sensitivity. This "something" could have been a virus, a vaccine, a NSAID, an unusually high dietary gluten load, an antibiotic, any combination of one or more of these factors – or perhaps it was something else entirely. This caused deeper inflammation of the small intestine, which was reflected in the appearance of numerous aphthous ulcers. The gut inflammation also caused increased permeability of the blood–brain barrier, which allowed agents (gluten-derived opioid peptides, and/or vaccine components, and/or viral components) into the brain that are toxic to the central nervous system.
I would like to suggest that if parents choose to vaccinate their children, gluten and any other agents that are known to cause gut inflammation be avoided in the diet for two months prior and two months after the vaccine.
This case made it very clear to me that it is of the utmost importance to accurately diagnose cases of autism/autistic-like syndromes as early as possible. Keith and Cindy followed their instincts as parents. They knew that something terribly wrong was happening to their daughter, even though lab test results were all negative. It was because of very early treatment that Melissa could recover from such an illness so rapidly and so completely.
Finally, I would like to thank the spirit of Helleborus niger for offering to us its far-reaching, profound healing powers. And thank you, homeopathy, for making it possible to deliver such potent medicines in such an easy, safe, and effective way.
1. Braly J, Hoggan R. Dangerous Grains: Why Cereal Grains May Be Hazardous to Your Health. Avery Trade; 2002.
2. Smith M. Going Against the Grain: How Reducing and Avoiding Grains Can Revitalize Your Health. McGraw-Hill; 2002.
3. Shakeri R, Zamani F, Sotoudehmanesh R, et al. Gluten sensitivity enteropathy in patients with recurrent aphthous stomatitis. BMC Gastroenterol. 2009;9:44.
4. Genuis SJ, Bouchard TP. Celiac disease presenting as autism. J Child Neurol. 2009 Jun 29.
5. Libonati CJ. Recognizing Celiac Disease: Signs, Symptoms, Associated Disorders & Complications. Gluten Free Works Pub.; 2007.
6. Hathaway CA, Appleyard CB, Percy WH, Williams JL. Experimental colitis increases blood-brain barrier permeability in rabbits. Am J Physiol Gastrointest Liver Physiol. May 1999; 276(5):G1174–G1180.
Artemis Celt graduated from Seattle's Bastyr University in 1985 as a naturopathic doctor. She currently practices in Port Townsend, Washington, with a focus on the treatment of chemical, drug, vaccine, and radiation miasms, in addition to other common nonphysical causes of physical illness. She has written many articles on the homeopathic treatment of chemical, drug (both prescription and recreational), vaccine, and radiation miasms. You can visit her website at www.deitycentral.com.