Case Histories

How You Feel Is Our Concern

At our medical practice, no patient case is too difficult to treat. Dr. Van Reken’s approach is thorough and unusually comprehensive. Significant time is spent with each patient. At the end of each visit a laser printed report is generated and given to the patient which includes that day’s history, exam, diagnoses, tests ordered, exact medication program, etc. Many times a patient will have physical and cosmetic issues that benefit nicely from treatment that are addressed the same day. There are very few doctors who are skilled at taking care of both.

This is best illustrated by the following examples:

Case Histories:

Case History #1:
A thirty five year old Italian woman saw Dr. Van Reken for a new patient physical. Her complaints included fatigue, muscle aches, overweight, high cholesterol, irregular periods, severe acne, dark facial hair and borderline diabetes. He spent about 98 minutes with her on the initial physical and came up with two new diagnoses: muscle aches from vitamin D deficiency and polycystic ovary disease. Her muscle aches were due to a combination of vitamin D deficiency and use of Lipitor (atorvastatin) for her cholesterol. After a month on vitamin D her muscle aches resolved and he restarted the Lipitor. Her muscle aches did not return. Her fatigue was 75% better after a few months on Vitamin D. The ovarian hormonal problem was at least partly responsible for her severe acne, overweight, irregular periods, facial hair and prediabetes. He started low dose birth control pills and metformin. Metformin helped her lose a few pounds, but she remained overweight. Her hemoglobin A1c improved to the nondiabetic range with a level of 5.6%. Her periods normalized and her acne improved by 70% within two months. She was not completely satisfied with 70% improvement and so he added Retin-A. Her acne was about 85% better after a few months on this combination. She wanted further improvement in her acne and he had the team perform photodynamic therapy with the Candela Vbeam laser and Levulan (aminolevulinic acid). Her face was markedly improved from her pretreatment photos three weeks after two treatment sessions. Hair growth was some better with the birth control and metformin, but being Italian her remaining hair was dark. She opted for laser hair removal with laser energy settings designed by the doctor. After a series of six treatments her dark facial hair was markedly decreased. While this was all going on her mother had a heart attack at only 60. After revealing this to Dr. Van Reken he suggested a more comprehensive exercise program and even more aggressive treatment of her cholesterol and this was begun.

Case History #2:
Mr. L was an 80 year old, retired, intelligent, well educated executive, referred to me by a physician relative about 2007. He had recently seen his prior internal medicine doctor and a cardiologist, but had not seen a neurologist. When he came to me he was obese, had extensively swollen ankles, was in a wheelchair for gait difficulties, and on oxygen for respiratory failure, which was felt to be due to emphysema. He had smoked for many years, but quit at age 60. He was on many medications including some for hypertension, diabetes, and pain pills for a terrible rotator cuff problem in his right shoulder. He had been an alcoholic for decades, but in recent years had not used alcohol. I immediately admitted him to the hospital and made 4 diagnoses that were new to him. The first was Parkinson’s disease, which seemed probable on exam. The second was heart failure, probably due to alcoholic cardiomyopathy, a weakened heart muscle from his drinking years. The third was cirrhosis of the liver from drinking. The fourth took a week to make, when his vitamin D level came back low. He did have emphysema, but it was mild. His heart failure contributed heavily to his breathing difficulties.

Sinemet was started for Parkinson’s disease and within a week he was walking and out of the wheelchair. His heart failure was treated with standard drugs, including lisinopril, carvedilol, spironolactone and diuretics. His ankle swelling and trouble breathing improved and about 15 pounds of fluid was removed with the diuretics. He was taken off home oxygen within 10 days. His liver cirrhosis was mild and mostly affected medication choices for other conditions. Active treatment was not required other than low doses of spironolactone. His vitamin D was replaced with both prescription and non-prescription vitamin D.

Within 3 weeks his fatigue was markedly diminished, he was able to walk without his wheelchair and his family was amazed at his improvement. His complaints soon shifted to his orthopedic problems such as his bad shoulder. He was, after all, more active. He had 2 pretty good and happy years after meeting me. His heart failure and activity levels worsened during his last year and he began to develop some dementia as well, especially after his wife of many years died. Toward the end he and his family asked that he be placed on hospice care. He died within a few months of being on the hospice program. I am now seeing his son.

Case History #3:
Mrs. J. was a dedicated 40 year old housewife and mother. She had menopausal symptoms including hot flashes. She also had fatigue, constipation, marital strain, depression and was told she had fibromyalgia by her previous doctor. She blamed all her symptoms on the menopause and fibromyalgia. However, she had no major orthopedic complaints below the waist indicating to me that fibromyalgia was unlikely. Her major complaints orthopedically included a painful left shoulder, painful left wrist and a numb left hand. She also had frequent calf cramping waking her at night.

After a careful exam I found no evidence of fibromyalgia, but she had wrist tendinitis, shoulder bursitis and a pinched nerve in her neck. I placed her on Cymbalta for her depression and this also helped her numb hand and neck issues. Her wrist dramatically improved within a few days of my giving her a small steroid tendon sheath injection. Her shoulder was some better with Cymbalta, but I later injected it and this made most of her pain go away. At this point her shoulder was calmed down enough that she was able to start shoulder exercises. Her shoulder did well without further injections for a year, but then she was hit by a car and knocked off her bicycle, sustaining a broken collar bone and rotator cuff tear. After this she required rotator cuff surgery.

Although not drinking alcohol, she had significant spider veins and rosacea on her nose and cheeks. She received two treatments with our Vbeam Perfecta Pulsed Dye Laser to her nose and cheeks and the rosacea and spider veins improved by about 80%.

Her hot flashes were decreased, but not eliminated, by the Cymbalta. She had received a hysterectomy with ovarian removal prior to meeting me. At this point I added low dose estrogens and her hot flashes resolved. Her marital strain had been punctuated by frequent arguments with her husband. After treatment for depression she noted the arguing was much less and she got along better with her husband. She had moderate facial rosacea that both she and her sister had. She was quite pretty other than her facial spider veins. With one Vbeam laser therapy her rosacea was about 50% better. I suggested another treatment of the same, but she declined, being happy with 50% improvement.

She tried over the counter quinine pills from Mexico for her leg cramps. This worked for the cramps, but caused a low platelet count and she had bloody stools requiring hospital admission and transfusion. She required a few months of iron supplements to build her blood count back up to normal. Her leg cramps continued to interrupt her sleep and I started magnesium 200 mg 3 times daily and her leg cramps were reduced by almost 90%. The magnesium also helped her constipation.