Karina is a 61 year old woman who came to my office after being
diagnosed with polymyalgia rheumatica. She appeared healthy and
fit and expressed confusion about the diagnosis and upset about
her treatment plan from the rheumatologist. Karina had been on
10-20mg of Prednisone daily for almost 1 1/2 years. Her pain was
tolerable on that dose but without it and even at a reduced dose,
she described incapacitating pain throughout her joints.

She described a very active and healthy lifestyle leading up to
the sudden onset of painful joints. She had never taken any
medications and had never been hospitalized. She exercised
regularly and ate a healthy whole foods diet her entire life. She
was eager to get off the Prednisone and to find an explanation
for her illness.

Karina had seen several specialists, including a Lyme disease
specialist. We reviewed pages of labs results and radiographic
studies. Without a clear direction, I asked her to keep a diet
journal for me and fill out other dietary questionnaires. I
started her on Vital Nutrients Ultra Pure High Potency Fish Oil
at 1 teaspoon three times daily with food and ordered the only
test I did not initially see had been done: a serum level of
25-OH Vit D.

Two weeks passed and Karina returned to go over her lab result.
Her Vit D level was significantly below normal and I advised her
to start Vital Nutrients Vitamin D3 2,000iu/cap -1 capsule daily
with food. She had kept up with her fish oil, yet reported only a
slight decrease in pain and stiffness, but said her skin was
softer and her occasional afternoon headache had not occurred
since she started the fish oil.

While reviewing her diet information, I noticed she had eaten
tuna fish every day that she recorded her diet. I asked her about
her fish intake in general. Karina stated that she loved fish and
had eaten it 5-7 days a week for most of her life. Without
hesitation, I discussed with her the concept of heavy metal
toxicity and the idea of taking a DMSA challenge and testing her
urine for toxic elements (Doctor’s Data (800) 323- 2784 or
www.doctorsdata.com).

Karina’s urine test results showed the highest levels of
mercury and arsenic that I had seen. Using the standard protocol,
she underwent two rounds of DMSA therapy before we evaluated her
levels again. Although her pain symptoms had only reduced about
50% after the 2 rounds of DMSA, she had been able to also wean
entirely off her Prednisone. When the repeat test showed about a
60% reduction in the levels of Arsenic and Mercury, we discussed
repeating another round of DMSA treatment and did so. Currently,
Karina has been off her Prednisone for 4 months and completed her
DMSA treatment 6 weeks ago. She is virtually pain free and has
started exercising again. She is happy to get the benefit of
essential fatty acids from the Fish Oil she is taking without
worrying about the potential heavy metal hazards of eating fish
and admits she is so overjoyed by her comfort. Her energy has
returned and she is happy to eat fish once a year, on her
birthday, if she feels the need.