Irritable bowel syndrome helped by montelukast.

previously disappeared from her extremities (thought to be secondary to either the autoimmune disease or medication side effect) has regrown. Prior to oxygen therapy, her soft tissues in the extremities were painful with a boggy firmness, a fibromyalgia-like finding also thought to be part of the autoimmune syndrome. This symptom has gradually, but significantly, improved through a combination of body work (osteopathy and massage) and oxygen therapy. Prior to receiving supplemental oxygen, the same type of body work had been only minimally effective. Researchers1–5 have reported exercise intolerance and pulmonary function in patients with mitochondrial dysfunction. Reports of aerobic training have documented increased oxidative capacity in patients with mitochondrial myopathies.6,7 One aerobic study7 suggested that the cellular basis of improved oxygen utilization is related to training-induced mitochondrial proliferation. However, in this same study, genetic analysis indicated a trend toward preferential proliferation of mutant genes relative to wild-type mitochondrial DNA. These investigators raise concerns about the long-term benefits of aerobic conditioning in these patients.7 Previous reports of aerobic training have not described any trials of therapeutic oxygen for mitochondrial myopathy. This case report suggests that supplemental oxygen can enable patients to perform higher levels of cardiopulmonary work with less lactic acid accumulation than room air alone. The use of supplemental oxygen may not only improve functional capacity and certain physiologic abnormalities but may also minimize the mitochondrial stress, which has been postulated to increase the proportion of mutant mitochondria.