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Table of Contents

  • [00:00:03] - Introduction
  • [00:01:24] - Meeting Dr. Hannelie and finding the sources of pain
  • [00:04:00] - Dr. Hannelie details the blood work process at The Spero Clinic
  • [00:05:40] - An explanation of Gastroparesis
  • [00:07:32] - Discussing the Vagus Nerve and linking common symptoms of pain
  • [00:15:38] - Diagnosing viral and bacterial infections
  • [00:17:33] - Epstein-Barr Virus
  • [00:19:35] - Treating infections with antivirals/antibiotics
  • [00:22:35] - Interstitial Cystitis
  • [00:25:25] - The joy of witnessing patients recover, and how to set up an appointment for blood work with Dr. Hannelie

Episode Transcript

Dr. Katinka: Welcome back to our podcast. I promised you that we are going to delve in and look at practical aspects of chronic pain and also things that may be missed medically. And I really want to delve into that.

[00:01:24] I want to give you guys valuable information. Today, I have Dr. Hannelie van der Merwe as a guest. I’m so excited to have her on. She happens to be my sister, and she fulfills a very important role in our practice. While she prefers to be buried in a lab or blood work and studying and having consults with patients, I drag her out of her lab every now and then to share her knowledge with you guys. So welcome, Dr. Hannelie.

[00:01:54] Dr. Hannelie: Thanks for having me on today.

[00:01:57] Dr. Katinka: Thank you for doing this. When we bring a patient in, we look at the whole body and we do blood work and lab tests, and we delve into those numbers. When you see so many people that have the same type of pain over time, you start looking for commonalities. And that gives us clues as to what could be at the bottom of the pain. When you go to most allopathic doctors, they look at symptoms. They look at ways to numb the pain, interrupt the pain. Basically, it’s like a fire alarm and you’re putting a wet blanket over it because you don’t like the sound of that alarm. But the thing is, pain serves a function. Your body is crying out for help. It is trying to communicate to you that there is a bigger problem.

[00:02:47] Dr. Katinka: And so, it’s very important that you peel the layers, and you get down to the bottom of how things went wrong. And normally it’s not just one thing. You know, there are many, many ways that our bodies get offline, so to speak, and things start going wrong. And pain is just at the very end of that process where your body is trying to alert you that things are not good inside of you. So, our job is not just to be doctors, but to be detectives. You know, I’ve said before, and I say this all the time, it’s not the eight out of 10 people that motivate you, but it’s the two out of 10 patients that you cannot help. And so, we are constantly looking for ways to help everybody. Why do we get stuck with a specific patient? Why is that patient not responding? And so, we’ve learned that when a patient goes through care, we have certain clues to alert us that there is yet another problem and another doorway to open and examine and a puzzle to delve into. To that end, Dr. Hannelie, talk to me about the blood work that we typically perform.

[00:04:00] Dr. Hannelie: My role in our practice is to remove any obstacles to treatment. So just yesterday morning, I had a patient come in and say, you know, she’s tried physical therapy many times and she was specifically very sensitive to any kind of electrical therapy. She had a very negative reaction.

[00:04:20] So what I do is we break it down to the basics.

[00:04:24] What we find oftentimes is that most of the missed opportunities are occurring in the very basics of the blood work. We have to take it back to the building blocks where we go look at the very day to day blood work, no fancy tests. We go see if we can find any obstacles to treatment that can be removed. Now, in her case, it is a viral infection that she had – a chronic viral infection.

[00:04:52] We also see a lot of electrical stem sensitivity in people with bacterial infections. And you’re just going to have negative outcomes with those patients, if you don’t remove those obstacles first.

[00:05:05] Now these are patients, if we put them on any kind of electric current, their pain will actually start increasing.

[00:05:15] And instead of making progress and having gains with their pain levels, we find that they have a very negative reaction to the current, correct?

[00:05:27] Dr. Hannelie: Yes, absolutely.

[00:05:29] Dr. Katinka: And another clue is that these patients often come in and they have what is called gastroparesis. So, Dr. Hannelie, explain gastroparesis and what that entails.

[00:05:40] Dr. Hannelie: Gastroparesis, I don’t like the name – it implies a paralyzed gastric system, but it’s just really a slow digestive system. And everything about the system is slow. It’s not just the motility where food won’t move, but your body is not going to make bile, it won’t make stomach acid. It’s like the brain has flipped the digestive switch into the off position and nothing about the system will work the way it’s supposed to.

[00:06:10] Dr. Katinka: So, some of the common symptoms we see with gastroparesis patients is nausea, a lot of vomiting, inability to tolerate food, you don’t feel hungry anymore.

[00:06:23] Dr. Hannelie: They typically will eat a few bites of food and then feel full. They are not able to eat high fiber food anymore. It actually makes them more constipated.

[00:06:35] Dr. Katinka: Neurologic patients often are told that they have a separate problem with their GI tract and that it is not connected to their nervous system. However, recent research actually finds a great connection between the GI tract and the nervous system. Parkinson’s, for instance, they just completed a study at the University of Montreal where they found that GI infections directly lead to Parkinson’s in the brain. So, Dr. Hannelie, explain to me how the brain is connected to the gut.

[00:07:11] Dr. Hannelie: It is a very well researched connection there, and it’s more than just the brain. It’s things like the person’s or the patient’s wellbeing. Things like anxiety and depression go back to the gut. 80 percent of your immune system is housed in the gut.

[00:07:32] Dr. Katinka: So, there is a nerve called the vagus nerve. It is the tenth cranial nerve. Now, your cranial nerves, you have 12 pairs of cranial nerves that come out of the brainstem, which is the bottom part of the brain, and they have various functions. So, for instance, the nerves that help you to taste or move your eyes or help you to hear all are cranial nerves. The 10th cranial nerve, the vagus nerve, is a very big nerve. It’s a wide nerve that runs to all areas of your GI tract. It communicates with your heart and your intestines, your bladder. And they find that the vagus nerve controls immune function in the body. But it also acts as a ladder, doesn’t it?

[00:08:20] Dr. Hannelie: It is very much a two-way system, and that’s the part that the scientists did not expect to find, that it’s more than just a nerve. It is like a ladder. So, in some of the rat studies that they did, if they introduced these proteins in the guts of the mice, that could kind of be the precursor for Parkinson’s disease in the mice. Now, of course, you know, medical model, they sever the vagus nerve. If they break that connection between the brain and the gut, the animals that they did that in did not go on to develop Parkinson’s.

[00:08:59] Dr. Katinka: That’s really interesting. It’s so tragic to me that you guys have all these separate symptoms that no one is tying together for you.

[00:09:08] So I really want you to start thinking of your body as a whole and understand that a lot of research out there – you’re going to have to find for yourself. You’re going to have to Google things and try to figure out how is one piece connected to another piece. You have to be your own best advocate. Medical doctors are incredibly intelligent and certainly medical science in this country has developed so that they can do incredible things on the operating table and with medical devices and transplants. But the problem with the allopathic thinking is that each expert knows so much about just their area. And in our medical schools at this point, they’re not really taught how to link one thing with the other.

[00:09:59] We don’t have a virtual roundtable where all your doctors sit around and communicate with each other and try to figure out how one thing is connected to another thing, and that is one thing I feel that we’re very good at here. We’ve treated almost four hundred patients with serious chronic pain, and we have now done lab work on most of those patients. And I know when patients come in here, they bring us stacks of paperwork, just stacks. They have files, they have ledgers, they have bags. And they do very fancy blood work, expensive blood work, genetic work, especially in the alternative world now, we’re driving a lot of those very expensive tests. Tell me a little bit about how you feel about those.

[00:10:46] Dr. Hannelie: It’s frustrating. It’s a privilege also to work with all of these patients and especially the ones that come in with 10 years’ worth of blood work. You know, I’m busy building a database of blood work that we can use computerized systems to tie all of these things together, that’s an amazing opportunity. I think the biggest frustration in working with patients is that most of the missed opportunities occur at the ground level.

[00:11:18] It is this simple, simple things that get overlooked and then they go on to order more and more expensive, more and more specialized tests where by the time the patient gets to you with a file that may or may not fit in a suitcase, you can go back five years and find the answer plain as day, where it was very evident five years ago. And there is frustration in the sense that you think, boy, if I got a hold of her in 2015, we could have fixed this.

[00:11:50] Dr. Katinka: So some of the common symptoms that we see in you guys that I want you to link together. Let’s start from the brain down is headaches, migraines, daily headaches, feeling of pressure, sometimes burning in the eyes or behind the eyes, pain that goes down the neck and brain fog. Brain fog is a big one.

[00:12:15] Dr. Hannelie: Brain fog is a big one. We also see frequent sore throats. You know, you go for strep testing fairly frequently. You may or may not come back positive. A lot of our patients have their tonsils removed at a very young age.

[00:12:33] Dr. Katinka: What other organs do they like taking out?

[00:12:36] Dr. Hannelie: Another one that we see a lot is gall bladder, where there is gall bladder discomfort. They can’t find anything definitive on tests. They will pull the gallbladder, and the gall bladder pain will still be there, unchanged.

[00:12:52] Dr. Katinka: You call that phantom bladder syndrome, don’t you? Yes, it’s the ghost gall bladder. So brain fog, to get back to the brain is caused by swelling or inflammation in the brain. If you have inflammation in the GI tract, the vagus nerve will act as a highway or a ladder, and that inflammation will eventually reach your brain.

[00:13:15] And that could cause headaches and migraines and also brain fog where you cannot think of everyday words. You’re forgetting your children’s birth dates. You cannot remember whether you left the stove on and you kind of honestly just feel like you’re losing your mind and no one can link that symptom for you. A lot of patients will be told that pain medication is causing these memory issues. And while that could be, most commonly, we link it to inflammation.

[00:13:49] Dr. Hannelie, what are some of the other symptoms and systems that start breaking down in our patients?

[00:13:55] Dr. Hannelie: Connective tissue disorders are very common in this patient population. We have issues with gut linings thinning, so we see a lot of food sensitivities. Issues with food. They’re very persnickety eaters.

[00:14:11] They’re their choices of foods will dwindle, and they become very difficult to feed as a group. We see a lot of issues with bladder infections, the bladder wall infections, so interstitial cystitis. We have inflammation of the lungs that kind of acts like asthma, but it’s not quite as severe. You just have sensitive lungs.

[00:14:36] And then, of course, the female system, I would say at least 80 percent of our chronic pain patients come in with some kind of a birth control to stop their cycles altogether because they see flares worse days when they’re on or close to a cycle and they simply cannot handle it anymore. They tend to also have a really high incidence of polycystic ovarian syndrome, endometriosis, those kind of female dysfunctions where it is linked to excessive androgens in the female body. So, your female body actually starts making those male hormones because of the increased pain levels from the vagus dysfunction.

[00:15:20] Dr. Katinka: And we do see a lot of polycystic ovarian syndrome patients as well. A lot.

[00:15:26] Dr. Hannelie: I don’t even ask my females anymore. I just give them a list of symptoms and say, you know, do you check these boxes? And they will just nod.

[00:15:38] Dr. Katinka: So, let’s get back to the whole virus, bacterial infection connection. I would say that at least 80 percent of our patient population, if not more, suffer from viral and or bacterial infections. Dr. Hannlie, what kind of blood work do you use to diagnose these infections?

[00:15:59] Dr. Hannelie: Well, we start with just truly the basics. We’re going to add things as we go as needed, but we’re going to start with a complete blood cell count. You have to get the differential on there. That is the name for when they go look at the different white blood cells and the balance between those white blood cells. We get a metabolic panel, lipid panels, some basic inflammatory markers. We always check a vitamin D level.

[00:16:30] So what specific markers do you tend to see in the blood work?

[00:16:37] We look for a tilt to the left or the right in the immune system, where you’re either favoring bacteria or viruses. We look for systemic inflammation. So, issues with vitamin B absorption. So, there’s this gene snip: MTHFR.

[00:17:00] I know it’s been beaten to death, but a very high percentage of our patients have issues with that gene snip, or they just don’t methylate
well. So, there is almost some kind of anemia that we have to deal with, either iron anemia because of the heavy cycles or just lack of absorption, because you’ve now grown sensitive to gluten and grains and that causes some absorption issues with iron.

[00:17:27] So what are some of the most common viral infections that we see in our patients?

[00:17:33] I would say the biggest one that we see is the Epstein Barr virus. And if you go to a medical doctor and they do a mono spot test on you – if I see another one of those, I’m going to cry. Mono spot tests looks and see if you have mono right now.

[00:17:51] Other than that, it’s absolutely useless information. Our patients have the recurrent or recurring kind of EBV, Epstein-Barr virus, that comes and goes. Your body has problems suppressing the immune system, so the condition that you now have is no longer called mono. So, the mono spot test will come back negative. You need a different test for that. We see cytomegalovirus. We see all of the herpes viruses. And Epstein-Barr virus is one of the herpes viruses. HPV is one that we see sometimes. Not too often.

[00:18:32] All of the enteroviruses. So for a lot of our patients, it started with a bout of food poisoning, what felt like food poisoning.

[00:18:41] Dr. Katinka: So, what are some of the symptoms that patients with chronic Epstein-Barr viral infection will experience?

[00:18:51] Dr. Hannelie: There is a very well linked connection there with chronic fatigue. If you put in the works chronic fatigue, Epstein-Barr virus and research, you will find all of the studies that have been done on that. So chronic fatigue is probably the most common and toughest symptom to get rid of. Headaches that respond very poorly to medication – that’s only present in about 50 percent of those patients with the EBV. Frequent sore throats, earaches, you know, upper throat/back of the head kind of symptoms and pressure. Depression is very common with that and just, you know, malaise, general malaise.

[00:19:35] Dr. Katinka: So, I know that our patients often ask, well, if I have infections, can I just take antivirals? Go to my doctor and ask for those, or take antibiotics for bacterial infections. What are your thoughts on that?

[00:19:49] Dr. Hannelie: It’s funny you should mention that I just got off a zoom call with one of my patients that just did six months’ worth of acyclovir for EBV infection that’s on paper. It’s very big. It’s there. And acyclovir, we don’t get any results with that. I have several other different formulas that we use, and we usually start with lesser difficult to digest versions of it. We start with the cheap and easy stuff, as I call it. And then from there we will go on to add more specialized things if you don’t respond. Now, I like to retest about every four to eight weeks. We run that CBC with differential again to see are we moving the needle? If we’re moving the needle, we stick with what’s working. If it’s a tougher case, we will move on to the next formula.

[00:20:41] Dr. Katinka: Now, I have the same question about this common bladder infection stuff we see. I know that sometimes a patient will have aching in their bladder area, burning upon urination, or some foods that irritate their bladder. But yet, when they go to their doctor and do a quick urine test for infections, it doesn’t show any infections. Do you find that that’s common in our practice?

[00:21:06] Dr. Hannelie: It’s very common in our practice. It’s just as common to have an interstitial cystitis that barely shows up on a UA, so a urine analysis. You know, your doctor may something like, oh, it’s a little something there. We’re not sure if it was just not a clean catch. Only 50 percent of interstitial cystitis patients actually do have symptoms. A great many of my patients, when we run the tests and get a positive result, they will think about it a bit and then say, yeah, now that you mention it. But it’s not the kind of thing where you’re stuck on the toilet and you can’t go anywhere. It’s mild, it comes and goes, and it really interfere with your immune system.

[00:21:54] Dr. Katinka: I want you guys to think about your body as a kitchen.

[00:21:58] Where you have a gas stove, and you have a very small leak where you’re constantly leaking gas into the room and then you light a match and the whole thing goes up in flames. So, inflammation is that gas leak. It’s dangerous. It causes other issues down the line. It can lead to your immune system becoming overactive and not having a good immune response to infections. And it can certainly worsen chronic pain. Very much so. So, Dr. Hannelie, do you have basic things that patients can take if they suspect that they have interstitial cystitis?

[00:22:35] Dr. Hannelie: Yes, there’s a few things that we do. And the most common thing that I hear frequently from patients is, oh, I have tried that before. It didn’t work. I like to say it’s in the combination of products. So, the first thing that we do is we introduce D-Mannose, it’s a simple sugar that your body cannot digest, so it goes through to the urine and it draws the bacteria to it. So as soon as you start taking D-Mannose, yes, your symptoms will get worse. Save this one for weekend. Then I like to use tea that you steep and drink three times a day. And we make a drink with baking soda and lemon juice. So, it’s kind of basic Alka Seltzer, if you will. But for some reason, Alka Seltzer in the US, they’ve added a bunch of pain pills to it. So we just make a simple salt with half a teaspoon of baking soda, not baking powder, and then lemon juice that you consume with a little bit of water three times a day to alkalize the urine. Now, 95 percent of UTI eyes are e-coli. This formula tends to work for those that are E. coli. So, if I get a patient that that doesn’t work on it, you’re going to do that 10 days. We like to go on and culture the urine and what we’ll usually find in that case, it’s going to be either a strep or a staph urine infection, and those may or may not require antibiotics.

[00:24:09] Dr. Katinka: Thank you so much for that advice. I just have to add that our advice is not meant to replace the advice of your medical provider. We have to say that.

I so appreciate your presence in this clinic and your role in our team.

[00:24:25] And I think it’s a beautiful example of all the different tools we have in our tool bag, where you cannot just have one simple approach. But really, you need what I call shock and awe, meaning we combined 16 different treatments and approaches, and we do it all at once.

[00:24:45] I always say chronic pain is something where you have to chop its head off and drive a stake through its heart. So that when our patients are here for 12 weeks and they go home, they can resume a normal life. Even if they’ve been sick for twenty-four years, 30 years, it’s never too late to recover. So, Dr. Hannelie, I know that you didn’t set out to treat this patient population. This was in your chosen path. You’re doing a lot of very exciting research for conditions like Alzheimer’s. But what is it that keeps you coming back to this round table and working with this patient population? What what drives you?

[00:25:25] Dr. Hannelie: You mean besides the fact that we never have boring days? I mean, what gets me is the people and, you know, working with them in the way that we do is such a satisfactory line of work. We’re not like a medical doctor where you come in and I prescribe things and send you, and I get the next round of sick patients; you actually get to follow a patient on their journey getting better. Little things like the mind fog lifting and getting to meet that person underneath that layer of fatigue and just hopelessness when you work with them. It is a very rewarding thing to do.

[00:26:07] Dr. Katinka: Yes, it is. It brings many amazing moments into our practice and that certainly drives us to continue our work and get this knowledge out to you guys. We have a two-day program available where you can visit our clinic and get your blood work done here, or you can bring it with you and then meet with Dr. Hannelie. And after she establishes a patient relationship with you, she will continue to work with you over zoom, so you can order blood work at home, correct?

[00:26:40] Dr. Hannelie: Correct.

[00:26:41] With the way medicine is currently set up, we get to do Zoom conferences with patients that I’ve met and created a relationship with. Now, technically, I can do that from a distance, but I like to get my eye on people, get to meet them. Plus, I prefer to order my own labs. And with our lab that I trust, I know them, I’ve worked with them for years and it gets processed locally and then we go from there.

[00:27:13] Dr. Katinka: You guys, thank you so much for joining us today. Dr. Hannelie, thank you for your expertise and input. I really appreciate it.

[00:27:21] If you leave with nothing else, I want you to start building upon hope and understand that you are in control of your health and your future and that you must never, ever stop fighting for yourself because a true full life filled with joy and the lack of pain is worth fighting for.

[00:27:42] Thank you for joining us today.

[00:27:44] Kaylie: Thank you so much for joining us today. We are excited about every new person we are able to reach. It is our most sincere. Your hope that our podcast will bring hope to many. We hope you’ll join us for our next episode, where Dr. Katinka will be talking about why modern medicine is failing people who suffer from chronic pain, if you are someone you love is suffering from chronic pain.

[00:28:04] Please don’t lose hope. Visit our website at for more information and stories of hope. That’s for more information and stories of hope.

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