Terms and Conditions

Consultation

I have "Rooms" rather than a clinic, where I see people more as two people might come together to discuss a medical condition that one of them has, rather than a traditional doctor patient consultation.

I believe we should both learn from each other. I help you understand what I know and you help me become more informed in my area of interest. This is not a traditional doctor patient relationship and I do not act as your doctor

Fees

The "fee" is the free sharing of knowledge and that we publish any pictures and useful information, anonymously, on the Internet. Your consent is assumed, although I may also ask you to sign a formal consent document, should there be a possibility of your case being of sufficient medical interest to be published in a medical journal.

You may if you choose make a donation to my company Well & Working, but that is not expected or necessary. See Interests

I may suggest some investigations which can be arranged privately. You are responsible for paying for these investigations and I will not suggest anything that I do not believe is necessary. I have no financial interest in recommending you to a particular place - only for economy and convenience.

I do not prescribe medication, although I may suggest that you visit your doctor and ask about the possibility of any prescription medications that may be helpful.

Interests

My interest is in exploring disease and in progressing such "medical" knowledge.

I hope one day to have a full laboratory to investigate the role of the autonomic nervous system in disease. The equipment that would support such an interest costs well into five figures. I am not rich, because I have always chosen to do the right thing, and what I believe to be in the best interests of the "patient" and maintain my interest in medicine rather than concentrate on earning money.

Contact

Please email me at Dr at Drlizmiller dot com

Many thanks

Hair loss, gum disease

Dear Dr. Liz Miller,

Thank you for your last replies.

Concerning the gum:
I have gingivitis around 2 mm. though all the ordinary dental care actions have been taken. However, gum hypertrophy has not been proposed neither by my physician nor dentist. This hypothesis I will pursue.

Since I also have reacted to the D-vitamin perhaps there is an interaction between the gum disease and a potential Hyperparathyroidism, or alternatively that one acts as a moderator for the other.

I do not have a picture of my gums, except for an X-ray picture.

I would like to visit your clinic/ hospital in London as soon as possible – clinic?

Concerning the hair loss:
My original hair density has been high, but after the strong adverse reaction to D-vitamin in March 2007 I lost quite much hair during a 2-3 day period some weeks later. The hair loss is distributed across the scalp, with small areas which seems to be attacked more severely that the rest of the scalp (e.g. at the side of the scalp and at front), though not in the way of alopecia areata.

I suspect that part of the hair loss partly to be due to the seborrhoeic eczema which has yielded much scaling at the scalp. The eczema was aggressively activated in Jan. 2002 after as a reaction to a hair coloring product, where 2-3 months followed with abnormal hair loss (not reversed). Receding lines was one of the outcomes.

Not infrequently hair falls of as glued to together in a pair at one the end of hair shaft (a white-yellow substance hold the two hairs together at the follicle-end).

Thank you for your time.

Best regards,
GK

Gum disease
Gum disease is an indicator of either poor general health or poor dental hygeine. Gum hypertrophy - where the gums overgrown, is more likely to be related to drugs such as phenytoin or hormone/endocrine conditions such as hypothyroidism, where there is excess Thyroid Stimulating Hormone; Giganticism, where there is excess Growth Hormone (think Jaws from the Bond movies); and Hyperparathyroidism, which also affects calcium and vitamin D metabolism

"Since I also have reacted to the D-vitamin perhaps there is an interaction between the gum disease and a potential Hyperparathyroidism, or alternatively that one acts as a moderator for the other."

At this stage, the best way to see what is happening would be for you to visit my rooms.

"I suspect that part of the hair loss partly to be due to the seborrhoeic eczema which has yielded much scaling at the scalp. The eczema was aggressively activated in Jan. 2002 after as a reaction to a hair coloring product, where 2-3 months followed with abnormal hair loss (not reversed). Receding lines was one of the outcomes. "

Have you tried an antifungal dandruff product on your hair? Fungal infections are a common cause of dandruff like conditions especially against a background of poor health and poor diet?

The loss of two hairs together is probably not significant but may indicate that two hairs are coming to the end of their life cycle at the same time.

Hair Loss
Regardless of the cause, and what you read about hair restorative products the results are not usually that good. However a healthy diet and healthy lifestyle do support good hair growth

Gum Movement,

Dear Liz Miller,
The dosage of D-vitamin was 3000IU per day for 8 days. Originally it was prescribed for a 2-month period to alleviate seborrhoeic dermatitis at the scalp. However, after 8 days I experienced the adverse reactions of extreme tiredness and paleness. These two effects have seemingly been reversed.

Incremental gum movements meaning that the gum seems to have moved outwards several times noticed ex-post, but not the teeth or jaw. The teeth are aligned as before, and there has been no pain.

I have had allergic reaction to soya when in contact with the skin, and problems with proper digestion (high values of triglycerides, possibly too much yeast, sensitive to gluten). I do not take any medications. I also lost much hair in a 2-3 day period shortly after the D-vitamin intake, an effect not previously experienced.

The gum movements might have no causal connection to the D-vitamin intake, but a correlation might be present since it was the first time for both the reactions. I have no hypothesis concerning a potential “third” condition.

The D-vitamin measures have always been at the lower interval border of the normal distribution (as measured in Norway), while the calcium level slightly above the upper level.

Thank you.

Best regards,
GK

28 January 2009 18:19


Dr. Liz Miller said...
Hi GK,

Thanks for this extra information
That your calcium levels are slightly high and vitamin D low, suggests that you may indeed by hypersensitive to Vitamin D because of an underlying Hyperparathyroidism. Parathyroid hormone increases the level of calcium in the blood.

It acts in conjunction with Vitamin D to increase the level of calcium in the blood - this may account for your response to Vitamin D.

Although above daily requirements, the doses of Vitamin D you were given should not be dangerous - except in the presence of raised Parathyroid hormone.

The gum enlargement is interesting against this background. It can be caused by hormones, such as Thyroid stimulating hormone, and growth hormone and both of those hormones are similar in structure to parathyroid hormone, so there may be some overlap.

If you are ever in London and can bring a full copy of your notes, it might be useful to arrange some hormone blood tests, including Growth hormone, TSH and Parathyroid Hormone.

In the meantime this is turning into a medical whodunnit.
Parathyroid hormone levels would be certainly be interesting

Seborrheic dermatitis, is generally thought to be a fungal infection - and an antifungal shampoo such as Nizoral may be helpful.

Do you have a photo of your gums? -
I have to add that the commonest cause of gum hypertrophy is gum disease due to gingivitis but I assume this would have been noticed by your dentist/doctor

Hair loss - difficult one! very little evidence one way or the other - was this a patchy loss or generalised thinning??
29 January 2009 02:35

Gum movement

Gum movements occurring after use of D-vitamin:

Since May 2007 I have experienced several incremental movements forward of what seems to be the gum.

A month prior to the first gum movement in May 2007 I reacted strongly to a 2-week D-vitamin supplement as prescribed by my physician (2000-3000 IU) - symptoms included strong tiredness and pale face for several months.

It seems that the gum is more prone to an incremental movement forward in situations where I am more tired, e.g. a night with few hours of sleep, or accumulation of little sleep over 2-3 days. I also suspect that my calcium and D-vitamin processing and processes are not as they should be.This condition has been presented for a few physicians which have not been able to propose any hypotheses.

I have been advised to consult a maxillo-facial specialist by the British Dental Health Foundation. I have visited a few dentists concerning this matter, but no tests have been taken. Moderator variables:
Age: 31
Sex: M
Cigarettes/week: 0
Alcohol Units/week: Little
Height: 1.86
Weight: 71kg
Exercise Sessions/week: Several

Thank you for your time.
Best regards,GK



Hi GK

This is an unusual problem and I cannot think of anything specific.

You do not say why you were prescribed the Vitamin D - the recommended daily intake is 400IU, 2-3,000 IU over two weeks would not be excessive.

It is difficult to understand why that does had that effect, unless this effect was related to the original condition for which you were prescribed it.



I am not sure what exactly you mean by incremental gum movements

Teeth move within the gums, and for this reason people can have braces fitted at almost any age to move their teeth.

Is it possible that when you are tired, you are more prone to teeth grinding or teeth clenching which might affect the position of your teeth

Gums can overgrow, typically with drugs such as phenytoin (Dilantin), calcium channel blockers such as amilidopine for raised blood pressure

In general, your response to Vitamin D is difficult to understand. It is not clear why, in the dose you describe, it would have such an effect. What makes you think that you have problems with your calcium and Vitamin D metabolism?

Vitamin C is also important in gum health, as are regular visits to the Dental hygienists

This is not perhaps as helpful as might be hoped but you have got an unusual problem - Is there any other information that you feel might be relevant ?

Heartburn, stress, itching

hi. for the past few months i have been getting quite alot of heartburn, plus all over body itching mainly after a bath and keeps me awake at night,

i have had a cough where i am constantly coughing to clear my throat too but last 3 days given up smoking and thats seems to have calmed down,(using a nicotine patch) and now my bad eye gone more blurry and eyes are itchy and sore,i am under alot of stress as got a disabled child and more so now with the smoking and wondered if that y my eye gone bad, i suffer from anxiety attacks to so don't leave house often, plz help!!! worried!!! age 38 don't drink,hight 5ft 5in weight 8 halkf stone


____________
Thank you for your consultation,

Heartburn - by which I assume you mean pain in the lower part of the chest, associated with food, possibly acid coming back into the mouth, and possibly pain as you swallow food, is caused by the stomach acid coming back up the gullet and causing inflammation in the gullet.

Stomach acid is a strong acid, in pH terms it can be as low as pH 2 or 3. The lower the "pH" of an acid the stronger it is, 7 is neutral. If stomach acid gets outside the stomach - which has a strong protective lining, when healthy, it damages tissues. If people vomit regularly, for whatever reason, stomach acid can damage the teeth.

Heartburn means that stomach acid is getting back up the gullet.

In a normal unstressed person, the activity of the autonomic nervous system (the housekeeping part of the nervous system) stops the stomach producing acid when it isn't needed and when a person is relaxed the autonomic nervous system works on helping the stomach digest food, by producing acid and making sure the stomach works normally. Under stress, the autonomic system does not work so well and this can cause havoc with the digestive system. Instead of the guts being "switched off" and inactive when they are not needed to digest food, they are constantly active. This causes a range of symptoms from heartburn, indigestion to irritable bowel,

Cigarettes and sugary drinks such as coke seem to encourage the stomach to make more acid and make the problem worse, so well done on stopping smoking - that will help, at least in the longer term.

In the short term, heartburn and indigestion can be helped by drugs that stop the stomach producing acid, but in the longer term it is best to look at the cause of the problem, which is stress.

It is enormously difficult to look after a disabled child, as you well know. You have my respect, it is probably one of the hardest things to do in modern society. Not only do you have the extra physical and mental work that comes with needing to help them more than a child without those problems, but you also have a daily fight with the NHS, Social Services etc to get at least some of the resources you need. You do not say how old your child is, but this in itself is exhausting and with time you become exhausted by it and your body becomes stressed by the sheer weight of the demands placed upon it. Your anxiety attacks als reflect this stress.

Stress

It looks as though you are under a lot of stress, this is almost certainly because of everything you have to do, to look after you and your child. It is easy to say this, and I know someone has to look after your child - the problem is that you also have to look after you, so you can look after her or him. It is not selfish to put your own needs first in order for you to stay healthy.

Stress for me, means that a person has more demands than they can meet. This is a very general way of looking at it. To begin with people use up their reserves, and then when their reserves are drained, it is as though they are functioning on emergency power only and this is a state of stress.

Stress is caused by an outpouring of adrenaline as the mind and body desparately tries to get everything to work harder and faster. Pressure in the short term is good for us and can be exciting, but relentless demands day after day, pushing a person and their body to its limits is not good. It drains a person's reserves and damages the body, body and spirit. 

There are only two ways out of stress

1) To work efficiently so no effort is wasted. This can be difficult because under stress people tend (understandably!) to do what is quickest and easiest even if may not be the best in the long term - eg grab a ready processed quick meal and put it in the microwave, rather than cook a proper meal. Most people under stress are already working as efficiently as they can, and there is rarely much room for manoeuvre, as at the very least it takes energy to learn to do things differently - its easier just to carry on with what you are already doing.


More importantly - Do less
2) Do less and get help. In many ways this is harder, because often by the time you have found someone to help with something it is easier to do it yourself but it is important. Under stress, people have to do less to reduce their exhaustion and give themselves a chance to recover, so that they can plan more efficient ways of working.

ie Only do what is absolutely essential. 

This starts to give you a chance to get back on your feet, start to feel better and do the things that help you feel better and make sure everything is done as efficiently as possible

And accept every offer (at least all reasonable offers) of help. If someone offers to help, accept the offer and then find them something they can do. People only offer to help if they want to help, and ideally you need an army of volunteers each doing a little bit to help make you and your child's life a bit easier.  It does people good to do something for someone else, especially a child, so you are helping them by letting them help you! 

However like all armies, volunteers need training! If someone offers help - say yes, then find them something easy to do so that they feel they can help without it being too difficult. With time you can get them to do more complicated and difficult tasks, but start with something easy, so you both feel good. To begin with it may feel as though it is easier to do everything yourself, but people learn to help in all kinds of ingenious ways.

You may find it difficult to ask for help or fed up with how little help that is forthcoming - from neighbours to the social service. Some people are naturally helpful but increasingly, everyone lives in their own world, not involving themselves with what is going on around them. And Social Services are a nightmare. Nonetheless, human beings are a social species and we need for our own sanity to look after each other. There are ways round even the largest obstacles. 


Itching

The itching you describe sounds more like a form of hives, as in the first post, rather than the possibly liver related itching in the previous post. It follows a warm bath/shower which can trigger Hives or urticaria, and again it tends to be worse under stress. 

Urticaria is an allergic reaction where the body releases histamine in response to a stimulus, in your case a warm bath. It may be that the body is oversensitive to heat and is behaving as though it had been scalded, rather than warmed slightly. Adrenaline from stress, increases peoples' sensitivity to a lot of things, including noise, and light touch. 

Have you tried cool baths - just slightly warm? if  you can, you may find a not too warm (not cold!) shower most refreshing. Also avoid the bubble baths and too many bath products - simple soap is best, as other things can irritate the skin

In conclusion

A lot of this sounds as though it is stress related and you need a plan to reduce the amount you do, so that you can get a breathing space and plan something for yourself, whether there are things you want to do or change, and for this you need help 

Heartburn is awful - try and eat a healthy diet where possible, avoid sugar. Stopping smoking will definitely help (it will also help the cough) 

In the short term, your GP can prescribe you with tablets to reduce the acid in the stomach, but in the longer term, you need to do something about the large amount of stress you are under 

Itching - try cooler showers and avoid a bath at night 

Your eyes, I am not sure what is happening there - dry eyes can be a sign of stress, a bit like a dry mouth - more details please!

You may also find counselling helpful, if nothing else than to have someone to talk to and bounce ideas off about how you can reduce the amount of stress/things you have to do. Your GP can arrange this for you and I am sure would be happy to do so. 

I hope this helps 

After cholecystectomy

Anonymous said...
1)uncomfortable feeling in my upper abdomen, across the top of my ribs and radiates down just above my belly button. pain also goes through to my upper back around my rib cage. colic pains and feeling very full rather than out and out pain. Also having twinges and pain spasms below my belly button to the left.

2)only get the uncomfortable feelings after eating in upper abdomen, lower pain below button is constant.

3)every time i eat, and constant pain below belly button

4) always in same 3 places, lower left side belly button, upper abdomen and back.

5)can't work at the moment due to constantly feeling sick when i eat, not sleeping and i can't sleep on my side, skin itching.

6)had keyhole gallbladder removal surgery 3 weeks ago, i think it is still associated with that.

7) gallstones, havent had follow up since surgery.

8) same as 7

9) no further treatment planned since surgery

10)february 2008

11) ibs, me, glandular fever

12) cut out alcohol and fatty foods since being diagnosed, although since surgery eating normally but having the pains all the time, whereas before it was only when i ate fatty foods. bowels opening every other day.

13) self employed no problems at work except not working at the moment.

32
female
none
none
5'7
15'7
walking

Hi,

Thanks for this - as you say it is likely to be related to your recent surgery to your gallbladder. Even though you had keyhole surgery, this is still a major disruption to your abdomen. It is a lot of trauma, the gallbladder is a large organ, between two and three inches across. It sits under the lower surface of the liver and has to be taken off from the liver. Again, the operation is done under a general anaesthetic, which also takes its toll on the body.

The gallbladder is part of the "gastro intestinal tract", which from a practical perspective extends from the mouth to the anus. It is run by the "autonomic nervous system" which are the nerves that do the housekeeping for the body, making sure food gets sorted, digested and converted into waste. The autonomic nervous system looks after all the bits that we are generally not conscious of - so that the conscious part of the brain can get on with earning a living. 

The autonomic nervous system gets affected by stress, by a poor diet,  physically damaged by straining or pushing - either to have your bowels open, or during difficult deliveries and childbirth. 

Eating, from the moment you even think about food, starts the digestive process. Remember the mouth watering cakes from childhood?, even thinking about them starts a person salivating!

The digestive process is continuous and coordinated. Food is chewed in the mouth, releasing saliva, this is swallowed, goes into the stomach where it is churned and separated into its various components. 

The stomach produces acid and enzymes to help the digestive process, squirts some of the meal into the next part of the gut, where the guts adds bile and enzymes from the pancreas. The churning and mixing continues until the food gets digested, passed along the gut until it finally gets expelled. 

Ideally bowel movements, and this is the part people don't often talk about should be large, bulky and soft, be passed easily in the morning and again perhaps midday. Burkitt did a lot of work photographing african stools and comparing them to Western stools, drawing the links between what diseases were common and the patterns of stools. This led to a lot of people recommending fibre in the diet. However almost certainly the link was not just the size and weight of the stools, but the ease with which they were passed. 

Western lifestyles do not lend themselves to the easy passage of stools!, from the sit up and beg toilet ware, as opposed to the african squat, to the time pressures to get on with life and work, as opposed to relaxing and letting nature do her work.

I am sure that this is already more than you wanted to know!! and from your position at the moment, it is likely that you are still nauseous because the surgery has upset your gastrointestinal tract and it is taking its time to settle down. 

However, several points in your history worry me. Firstly that you took the time to find this site and post your question. In other words, this is not something trivial that just needs reassurance. Secondly that you are getting pain when you lie in a particular position only, which may suggest that there is some fluid in your abdomen that is moving around. This may indicate that there has been a little bit of bleeding or even a slight infection and thirdly that you describe "itching". Itching can be an early sign of jaundice which may mean that the liver is upset in some way, and that it is not draining bile as it should be. 

And finally, you are not getting better - the body heals, if everything is going according to plan the body gets better from day to day. You are not getting better and it sounds as though you may even be getting worse. 

What to do:

I believe you need to see your GP as soon as possible, certainly within the next two days. If you were my patient, I would arrange an ultrasound scan of your abdomen and for you to be seen urgently by the surgical team. It may be that your GP will be reassured by examining your abdomen that nothing serious is going on, but obviously over the Internet, it is not possible to do that (yet!). I would also arrange some blood tests to check whether there is an infection and to check on the state of your liver.  

In the longer term, you will benefit from keeping to a healthy diet, avoiding processed food, chewing your food well to help digestion, exercise as that also helps the gut function. Aiming to have your bowels open easily and daily!

Many thanks for such a clear history