An injury to tendons should repair and recover completely over a period of about a month, barring repeated injury. When this fails to happen, doctors begin to think the patient is a malingerer.
Paill Spectrum however causes a very predictable pattern of tendon pains. Typically, affected areas include: the shoulder tendons, tennis elbows, and golfers elbows, to name just a few. The conditions vary in intensity and site over time, but tend to remain present over decades. They do often seem to go for short periods of time. Many treatments do seem to work though only for a while.
See Tennis Elbow or Golfers elbow page for more information.
Insomnia, Palpitations, or funny beats of the heart,
Depressed mood, Crying on occasion
Paill Spectrum can and does cause all of these symptoms. The symptom patterns are not simple though. If you want to learn more about insomnia, see the linked web page. Paill Spectrum causes heart palpitations (typically rapid sudden onset bursts of beats), via its sympathetic nervous system activation effects.
Again, note that the mood changes and crying often follow a stepwise pattern of deteriorations and recoveries over decades.
Chronic headaches, chronic sleep disturbance often occur in depressions. They are not really part of the syndrome of depression though, especially headaches. The Paill Spectrum model of disease predicts that these are typical and common symptoms associated with Paill Spectrum illness and Paill Spectrum depressions.
Antidepressants are often not well accepted by many patients. Dr. Pluta says that generally he finds that many patients are often subtly disappointed in that although the medications help, they do not quite fix the problem that the patient feels.
Paill Spectrum patients are not easy or pleasant to live with when the condition is very active. They are often argumentative, angry, and irritable. Many people describe their ex-partners as mad. They often describe having to live their life as if “walking on eggshells”. Paill Spectrum patients become unwell and stay unwell, often relatively long term. It is no wonder the relationships break up. Libido and sex drive are usually the first casualties in a relationship affected by Paill Spectrum.
Irritability and chronic headaches with no obvious cause are very suspicious symptoms for Paill Spectrum. Libido in women is a complex issue. One likely cause of loss of libido is simply that a patient does not feel well. If you wake up slowly and heavily in the morning, even if you seem to recover to normal after a short time, this is suggestive of Paill Spectrum infection. If you sleep a lot more than normal, even if you feel well, this is suspicious for Paill Spectrum infection.
Going to bed early and waking up late and a bit unwell, really do not do a lot of good to a patient’s sex life.
This patient experiences attacks of "Anxious Depression". This complex history shows the appearance of symptoms of Paill Spectrum such as headaches and the typical sore spots over many years. Paill Spectrum treatment resolves the symptoms. She relapses many months after ceasing treatment, a typical Paill Spectrum scenario. The possibility is raised that other symptoms such as tendon pains, panics, and palpitations may actually be related symptoms. Impulsivity and Poor Judgement feature in the person’s decisions, as predicted by the Paill Spectrum model.. Back to Anxious Depression top
Depression, anxiety, panic attacks, jitters, and chronic headaches that no doctor can help. These symptoms all occur embedded in a years long forlorn quest for help from anyone: medical advisors, dietary supplement salespersons, natural therapists, relatives, and friends.
Aches and pains, particularly in the shoulder tendons or in areas like tennis elbow or golfers elbow are seen in this patient. Dizziness, and vague stomach pains are also experienced. The interesting thing is how innocuously the symptoms appear and disappear.
All these symptoms are apparently unrelated. However, there is really only one “significant” disease process behind it all. Treating this one condition will change the prognosis for “all” these symptoms of illness.
14th January, 1993 Back to Anxious Depression top
Past Medical History:
Removal of Ovarian Cyst
Total Abdominal Hysterectomy with removal of both fallopian tubes and both ovaries
Reduction Mammoplasty (Breasts reduced in size)
Chronic Constipation
Presented with a three-day history of right-sided shoulder pain. It hurts to breathe.
On Examination:
What is this about? (Comment)
This history to most doctors suggests something called “Rotator Cuff Tendonitis.” The condition is usually blamed on excessive or inappropriate activities that the affected person has undertaken. Often the lifting of heavy items includes quite ordinary things such as too many shopping bags out of the boot of the car, or just lifting and holding very heavy toddlers. Back to top
Treatment:
Interferential and ultrasound used in therapy:
Successful relief of symptoms achieved, some of this being noticeable immediately.
1st March, 1993 Back to Anxious Depression top
Complains of
On examination:
Normal Pulse Rate and Normal Blood Pressure
Seems well otherwise
What is this about? (Dr’s Impression)
This situation is a diagnostic problem. It looks like the person is ill, but there is no sign of illness evident. There is nothing at which a doctor can point, and say, “Because I see this symptom or sign of illness, I believe that this particular illness is present. So most doctors would probably look for some common illnesses as possible causes of their patient’s distress.
Management:
Assess hormone status, glandular fever status
Then Trial of HRT (hormone replacement therapy): Ovestin (Oestriol).
11th March, 1993 Back to Anxious Depression top
What is this about? (Dr’s Impression)
This is one of the tests for glandular fever that has fallen into disfavour. It seemed to often give a positive result and seemed to correlate well with the patient’s experiences of illness or especially tiredness. Unfortunately, cross correlation with other glandular fever antibodies failed to cross- confirm that an exacerbation of glandular fever was present. The test could be said to be finding that something was wrong, but when the facts were intensively analysed, glandular fever probably was not what was to blame for the patient’s symptoms.
The test had a growing popularity amongst “general” or “family” doctors in the early 90s. This pathology (blood) test then fell out of favour, amongst pathology doctors who provided the assay, for the reasons given above.
14th March, 1993 Back to Anxious Depression top
What is this about? (Dr’s Impression)
With these test findings, hormonal deficiency appears to be to blame for the patient’s illness. Hormone treatment would often be prescribed. It appears not to have been prescribed, however. A common reason is that patients do not want to go on pills or medications as they think they should be able to get better on their own.
27th May, 1993 Back to Anxious Depression top
(History suggests that the Prothiaden medication is stopped on the patient's own initiative in the past few months. no further amounts of this medication have been written. The patient indirectly confirms that she is not taking an antidepressant medication : such as the Prothiaden.)
What is this about? (Dr’s Impression)
The patient is well. The hormonal problem seems to have gone away by itself.
3rd August, 1993 Back to Anxious Depression top
Patient convinced to take some Hormone replacement therapy as a possible method of relieving her illness.
What is this about? (Dr’s Impression)
The interesting thing here is how this patient and so many like her, would say and quite adamantly, “I am not really depressed” I do not feel well. I know that there is something wrong with me, but no one seems to be able to tell me what it is.
In the long term most of these patients accept that they must really be depressed, because that is what the doctors all keep telling them, so that must be what it feels like to be depressed.
21st October, 1993 Back to Anxious Depression top
Has been unhappy with the effect of Premarin (a weak horse derived oestrogen) medication, though initially seems to have helped.
An oestrogen implant 100 mg of oestradiol (a strong synthetic human type oestrogen) is inserted today.
29th November, 1993 Back to Anxious Depression top
An injectable androgen (male type sex hormone ) is given in an attempt to relieve low libido
21st December, 1993 Back to Anxious Depression top
What is this about? (Dr’s Impression)
Most doctors would say “Aha!” So that is what really been causing all these symptoms” The psychological problems in the patient’s life are responsible for her illness. The libido is bad because the relationship is bad. Back to Anxious Depression top
15th March, 1994 Back to Anxious Depression top
What is this about? (Dr’s Impression)
Responses to treatments and patterns of illness all take reasonably long periods of time. So patients all oscillate between feeling well and wanting to take no medications at all, and being ill and being forced to take lots of medicines: no matter whether the medicine were obtained from the doctor or obtained from the supermarket.
Treatments are used to give relief and in this case, the treatments include hormonal implants. These treatments often give at least “some” relief . There is hope for more response to the treatment, which then subsequently does not arrive. The patient becomes disappointed with the effect of treatment and launches into another search for more help, to achieve wellness.
Overall , this forms the typical complex pattern of unwellness familiar to so many patients with chronic fatigue, depression or the anxiety disorders.
The biggest complicating factor involved in treating patients with psychiatric complaints ,in Dr. Xxxxx’s experience, is the loss of confidence these patients develop in themselves and in their carers. Some patients develop an almost pathological dependence on their medical advisors, some patients cling to anyone who says they have an answer. Some patients just do whatever the circumstances of the day compel them to do, lurching into and out of crises with resigned abandon.
Treating people can be very difficult. The patient’s medical problems themselves make them more impulsive and affect their judgement, exacerbating the problem of retaining patients in therapy programs.
Prozac = Fluoxetine (an antidepressant), used in usual dose of 20 mg (i.e. One daily). With reasonable relief of her symptoms, only generally mildly unwell.
.
20th December, 1994 Back to Anxious Depression top
Anxiety noted ++
Treatment: Prozac = Fluoxetine ( an antidepressant), increased to forty mg,
( = two tablets daily).
What is this about? (Dr’s Impression)
It is notable that the patient has been taking her antidepressant when she became ill. As this failed to keep her well, a dose increase was prescribed. This is another typical part of the illness cycle in depressed patients. Medications that once worked well, with time become more erratic in their ability to control the illness. Doctors would consequently use a higher medication dose or perhaps a second medication. Unfortunately , it is all too common for patients to still fail to respond to these medications. Medication after medication is occasionally tried in a quest to find something that can make the patient better.
Note also that the patient was quite well on her medications until she became ill. The deterioration in her symptoms has appeared very rapidly indeed.
8th May 1995: Back to Anxious Depression top
Prozac blamed perhaps for libido problems and a suggestion is made by the patient to consider changing the medication to something different.
23rd August, 1995 Back to Anxious Depression top
10th November: 1995 Back to Anxious Depression top
Has stopped all antidepressants : feeling OK in terms of depressions or panics though still has frequent headaches.
What is this about? (Dr’s Impression)
Although strange, it is incredible that all the bizarre and unpleasant symptoms of illness have gone. The patient now stays well for many months. All this happens, for no obvious reason at all. It just happens.
22nd May 1996 Back to Anxious Depression top
What is this about? (Dr’s Impression)
Headaches are a difficult diagnostic problem for doctors. In Dr. Xxxxx’s experience, it is important to make the effort to sort out “why.” People often misname their headaches. Dr. Xxxxx often finds that people who believe they are suffering from migraines, may in fact often be suffering from far more mundane causes of headaches, such as sinus congestion or sinusitis.
Unless the underlying cause is treated, the headache will persist, usually with crippling effects on people’s lifestyles.
Dr. Xxxxx believes that in his practice, true migraines are rare, while sinus headaches are very common. There are of course still other causes of headaches.
19th June, 1996 Back to Anxious Depression top
A new antidepressant started: Moclobemide = Aurorix ( a different class of antidepressant medication to Prozac).
What is this about? (Dr’s Impression)
This shows a very human failing, “the need for closure.” I am depressed. The only really depressing thing that I can think of as happening to me, is the death of my father several years ago. So, this must be what is making me ill. Note, that this is the first time in this medical history that the patient has blamed the stress caused by her father’s death as being the cause of her illness. In all the other occasions in the past few years, she has not even remembered about this event at all. She is beginning to “obsess” about this sad memory.
15th November, 1996 Back to Anxious Depression top
4th August, 1997 Back to Anxious Depression top
What is this about? (Dr’s Impression)
Most doctors would probably begin to start reading depression here as the sole medical problem causing the patient’s illness.
13th April, 1998 Back to Anxious Depression top
Trial of a new antidepressant: Zoloft = Sertraline. Previous antidepressant not helping.
1st September, 1998 Back to Anxious Depression top
Menopause Symptom Evaluation Score done: Very high Score
The test result follows:
What is this about? (Dr’s Impression)
Total Score 38 ) Scores over 15 indicator low oestrogen levels).This questionnaire is a way of assessing the average hormonal (oestrogen) status of a female patient. In retrospect, Dr. Xxxxx believes that perhaps some of the symptoms are better attributable to other causes, than simple oestrogen deficiency 
Back to Anxious Depression top
Medications Following this consultation:
Early 1999 Back to Anxious Depression top
A period of wellness for several months
Has received a number of courses of antibiotics for incidental illness.
No sleeplessness, no anxiety, no headaches.
What is this about? (Dr’s Impression)
To all intents, a doctor would look at the last six to twelve months and say, “Yes, I think I have finally sorted out what is wrong with this person” I have finally made this person well.
3rd June, 1999 Back to Anxious Depression top
Very sore left shoulder with no history of injury
Not better with chiropractic treatment
On examination:
Treatment: Painkillers and Interferential; with relief.
The shoulder symptoms continue to recur. The same treatments continue to give relief.
29th March, 2000 Back to Anxious Depression top
The patient subsequently, within the month, stops these medications and stays relatively well.
3rd January, 2001 Back to Anxious Depression top
What is this about? (Dr’s Impression)
The patient is now beginning to develop symptoms of chronic fatigue. This is a new symptom, in the context of the mood problems : depression and anxiety, which she has been experiencing, for some time. With the switchover of the patient’s symptoms to more general medical complaints, more general medical unwellness tests are done.
After all, “everyone” knows (patients and their doctors), that patients with psychiatric symptoms really have nothing wrong with them, so that there is no reason to do any tests usually for patients with psychiatric illness.
E&LFTs
What is this about? (Dr’s Impression)
The general interpretation of these tests results would be that they are all normal, and that there is nothing really wrong with the patient.
1st May, 2001 Back to Anxious Depression top
23rd May, 2001 Back to Anxious Depression top
Treatment : start a new antidepressant: Luvox = Fluvoxamine
2nd October, 2001 Back to Anxious Depression top
What is this about? (Dr’s Impression)
This patient has a depression that comes and goes. She is very bad at taking her medications and cycles between ill and well rapidly. This sort of situation usually earns the patient a “Tut! Tut! You really are very naughty for not taking your medications from most doctors.
Dr. Xxxxx knows this type of patient very well though. When she says she feels well, she really is well. She is alive, alert, vivacious, and full of life. I am not sure that if I felt like that, I would take my medications either under the circumstances. The patient's actions begin to seem more reasonable once the full circumstances of the patient’s condition are appreciated.
7th May, 2003 Back to Anxious Depression top
Both Elbows Sore : now has tennis elbow and golfers elbow
EPP
The general interpretation of these tests results would be that they are all normal, and that there is nothing wrong with the patient.
4th June, 2003 Back to Anxious Depression top
30th July 2003 Back to Anxious Depression top
Moody: unable to cope with return to work since mother died about one month ago
Anxious at times: needing occasional sedative (Serepax: oxazepam).
16th September , 2003 Back to Anxious Depression top
Depressed
Nothing she does makes her happy anymore
On examination:
Started on Paill Spectrum protocol compatible antibiotic
EPP Gamma 14 g/l (RR 6-15)
What is this about? (Dr’s Impression)
The patient is worse than she has ever been. The blood test is rising as well in parallel with the general trend in her level of illness. The hallmarks of Paill Spectrum are beginning to be very obvious.
Back to Anxious Depression top
22nd September, 2003 Back to Anxious Depression top
What is this about? (Dr’s Impression)
Antibiotic therapy is working very well so far. You can almost guarantee with this patient that she will stop all her treatments, now that she is better. The Paill Spectrum consequences are predictable. He illness symptoms will recur, though it will probably take months to do so.
20th October, 2003 Back to Anxious Depression top
Management
Encouraged to take zinc, multivitamin and antibiotic at reduced dose.
15th December, 2003 Back to Anxious Depression top
Has managed to complete a short course of antibiotics: last antibiotic course being a few weeks ago
What is this about? (Dr’s Impression)
It will be very hard to get this patient to comply with any long-term treatment as she now feels well. The aim of therapy now becomes to try to change the long-term disease progress by maintaining basic nutritional therapy.
7th January, 2004 Back to Anxious Depression top
Management:
Restart Antibiotics
Back to Anxious Depression top
What is this about? (Dr’s Impression)
Note that the zinc level has fallen. It is likely that the patient is not on a wheat free diet and is experiencing low-grade mineral malabsorption as a result. Note that the Folic acid level is not very good for someone who is supposed to be on a daily multivitamin. It looks like she has stopped taking her multivitamins and minerals.
Consequences: a long term Paill Spectrum flare is likely.
Back to Anxious Depression top
Some anxiety. Noted to have antibiotics left, so has not taken the last course.
Heart Flutter Occasionally : had been to hospital but was assessed as OK, no heart problem.
Had a heavy chest sensation at the time and angina medications, (under the tongue nitrates), had not helped. (had been to hospital).
Complains that the chest discomfort wakes her up at night
Skin crawling sensation
Restless but no longer so sleepy
Complains of a burning sensation in her legs at night. Back to Anxious Depression top
On examination
GAM
EPP Gamma 8 g/l (RR 6-15)
ANF Negative
FBC Normal (WCC 6.0 (RR 3.5-12.0)
ESR 1 mm/hr. (RR 1- 12)
Back to Anxious Depression top
Told to take the antibiotics she had ceased previously: Minocycline 100 mg daily
Told to take multivitamins and minerals as requested previously
Complains of Anxiety , Mood Swings & Irritability
Had a free BP test done yesterday in her local shopping centre: 149/100
Feeling very bad in terms of anxiety and needing to take sedatives to relieve her symptoms
Back to Anxious Depression top
On Examination:
Management:
Encouraged to take her antibiotics: Minocycline, still has some left from last time.
What is this about? (Dr’s Impression)
Dr. told her so! It is beginning to be obvious that illness happens for a reason. The reasons are very basic medical issues such as nutrition related immune function changes. Illness can be predicted. Treatment predictably alters a patient’s prognosis. Treatment cessation also predictably alters a patient’s prognosis.
Back to Anxious Depression top
On Examination:
Management:
Take antidepressant Aurorix = Moclobemide 300 mg twice daily
Take sedative if needed: Oxazepam = Serepax
Encouraged to take antibiotics : Minocycline.
Management:
Increase antidepressant (Aurorix = Moclobemide) 600 mg morning, 300 mg at night
17th December, 2004 Back to Anxious Depression top
What is this about? (Dr’s Impression)
She has become better quite rapidly and predictably. The antidepressant provides rapid symptomatic relief. The treatment has worked far better and more comprehensively than previous antidepressant regimens.
Using traditional therapies such as antidepressants with Paill Spectrum illness is still worthwhile. These treatments do change the symptoms of the “depression.” They do not change the progress of the illness. One the Paill Spectrum treatment protocol has been established with good symptomatic treatment response, symptomatic therapies are much less important. They can in fact often be reduced if not stopped, with the patients still staying well. The Paill Spectrum treatment protocol must be continued.
Back to Anxious Depression top
Medications:
Encouraged to take
What is this about? (Dr’s Impression)
Everything happened as predicted. Everything happened for a reason. It looks like a Paill Spectrum reason.
What does "Paill Spectrum" look like?
Back to Anxious Depression top
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Case 1
Calendar Date Link
| 14th January, 1993 | | 1st March, 1993 | | 11th March, 1993 | | 14th March, 1993 ||
| 27th May, 1993 | | 3rd August, 1993 | | 21st October, 1993 | | 29th November, 1993 |.
| 21st December, 1993 | | 15th March, 1994 | | 1994: | | 20th December, 1994 |
| 23rd August 1995 | | 10th November 1995 |
| 22nd May 1996 | | 19th June 1996 |.| 15th November 1996 || 4th August 1997 | | 13 April 1998 |. .
| 1st September 1998 | | Early 1999 | | 3rd June 1999 | | 29th March 2000 | |3rd January 2001 |
| 1st May 2001 | | 23rd May 2001 | | 2nd October 2001 | | 7th May 2003 | | 4th June 2003 |
| 30th July 2003 | | 16th September 2003 |.| 22nd September 2003 | | 20th October 2003 |
| 15TH December |.| 7th January 2004 | | 13 th February 2004 | | 6th March, 2004 |
| 15th June, 2004 |.| 9th November, 2004 | | 9th December, 2004 | | 17th December, 2004 |
| 8th February, 2005 | | 8th April, 2005 | | 19th May, 2005 |
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CD Book Information
Answers to case questions will appear on our CD Book:
"Closing the Circle - The PaillSpectrum Story", *:-] planned for release in Early 2008.
It describes a range of medical conditions that in their own right may cause symptoms of chronic fatigue.
Accessing Information
Downloadable Information files (zip = pdf +mp3),
are available directly through the web site.
(File on the Download Page: approximately 12MB download). :-? :-O
Click the download activator and "Save to disk". You will need a decompression program such as Winzip or Winrar. Listen to the mp3 file at the same time as following the pdf file supplementary notes. They are designed to be used together, in much the same way as speakers put up prompts or notes for their listeners. Go to Download Page
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The Paill Spectrum Disease Model has been developed by Dr. Andrew Xxxxx. It will be some time before the knowledge of the syndrome becomes independently tested and accepted. Disclaimer
Back to Anxious Depression top