Oct
26
2013

Being SAD in Fall (Seasonal Affective Disorders)

By | Abdominal Pain, Hormones, Insomnia, Mental Health, Pain, Prevention, Stress management, Vitamins and supplements

Any general practitioner knows that fall and winter are the time when patients come in with a variety of complaints like a lack of energy, problems sleeping, inability to cope with stress, but often there may be non-specific pains like muscle spasm in the back, the shoulders, or indigestion. These symptoms can all be part of seasonal affective disorders (SAD) like depression, the winter blues, often coupled with anxiety.

Emotional health does not fit easily into our health care model. The receptionist will warn the doctor that this is going to be a “difficult” patient. If the doctor has only time for a 5 or 10-minute visit, where only one or two problems can be dealt with, then this does not fit when a patient with SAD has a problem concentrating, falling asleep, and presents with a long list of other complaints. Even 20 minutes or 30 minutes may not be enough to deal with this patient adequately. It is easier to send the patient for tests and to prescribe an antidepressant and a sleeping pill and reschedule for a follow-up appointment. But this likely will result in normal blood tests and investigations, added health care costs, but no solution to the patient’s problem when he  or she simply states “doctor, I feel so sick”.

I thought it would be interesting to review how our emotions can get out of balance and review an integrative approach to SAD.

Definition of SAD

Seasonal depression (also called seasonal affective disorder) occurs during fall (autumn) and winter, but this alternates with no depressive episodes during spring and summer. A person defined to suffer from SAD would have suffered from two major depressive episodes during the past 2 years with no depressive episodes in the intervening seasons of spring and summer (Ref.1). Alternative names for SAD are winter depression and wintertime blues. Typically SAD lasts about 5 months.

Brain hormone disbalance

Around 2002 it was detected that in mice there was a second light sensitive pathway from ganglion cells in the retina that were responsible for circadian hormone rhythms. This was later confirmed to be true also in humans, where photosensitive retinal ganglion cells buried deep in the retina and containing the pigment melanopsin absorb blue light in the visible light spectrum. The electrical signals are sent along the retinohypothalamic tract, so that light from the retina regulates the hormone circadian rhythm (daily hormone fluctuations including the sleep/wake cycle) in the hypothalamus. The hypothalamus is one of the major hormone centers in the center of the brain. As this publication shows there are minor genetic sequence changes for the retinal photopigment, melanopsin in patients with SAD. This affects about 1 to 2% of the American population. Many more have probably partial defects in the function of this pigment.

Being SAD in Fall (Seasonal Affective Disorders)

Being SAD in Fall (Seasonal Affective Disorders)

Many hormones in our brain experience a circadian rhythm.

When the sun goes down, melatonin is produced making us sleepy. In the morning serotonin production goes up and stays up all day, which normally prevents depression. There are other hormones that cycle during the course of the day. Cortisol is highest in the morning and low in the evening and at night. Growth hormone and prolactin are highest during sleep.

There is a lack of serotonin in the brains of patients with SAD and depression.

Symptoms of SAD

A person affected by SAD or any other patient with ordinary depression will present with symptoms of lack of energy, with tearfulness, negative thought patterns, sleep disturbances, lack of appetite and weight loss and possible suicidal thoughts. On the other hand symptoms may be more atypical presenting with irritability and overindulging in food with weight gain. Some patients somaticize as already mentioned in the beginning of this review experiencing a multitude of functional symptoms without any demonstrable underlying disease. It is estimated that up to 30 to 40% of patients attending a general practitioner’s office have some form of depression and in the fall and winter season a large percentage of them are due to SAD.

Treatment approaches to SAD

There are several natural approaches to SAD. However, before deciding to go this route, a psychiatrist should assess the patient to determine the risk for suicide. When a patient is not suicidal, light therapy can be utilized.

1. Light therapy: According to Ref. 2 a light box from Sun Box or Northern Light Technologies should be used for 30 minutes every morning during the fall and winter months. The box should emit at least 10,000 lux. Improvement can occur within 2 to 4 days of starting light therapy, but often takes up to 4 weeks to reach its full benefit (Ref.2).

2. Exercise reduces the amount of depression. The more exercise is done the less depression remains. A regular gym workout, dancing, walking, aerobics and involvement in sports are all useful.

3. Folate and vitamin B12: Up to 1/3 of depressed people have folate deficiency. Supplementation with 400 mcg to 1 mg of folic acid is recommended. Vitamin B12 should also be taken to not mask a B12 deficiency (Ref.3). Folate and vitamin B12 are methyl donors for several brain neuropeptides.

4. Vitamin D3 supplementation: A large Dutch study showed that a high percentage of depressed patients above the age of 65 were deficient for vitamin D3. Supplementation with vitamin D3 is recommended. (Ref.3). Take 3000 to 4000 IU per day, particularly during the winter time.

5. St. John’s Wort (Hypericum perforatum) has been found useful for minor to moderate depression. It is superior in terms of having fewer side effects than standard antidepressant therapy (Ref.3).

6. Standard antidepressants (bupropion, fluoxetine, sertraline and paroxetine) are the treatment of choice by psychiatrists and treating physicians when a faster onset of the antidepressant effect is needed (Ref.3).

7. Electro acupuncture has been shown in many studies to be effective in ameliorating the symptoms of depression and seems to work through the release of neurotransmitters in the brain (Ref.4).

8. A balanced nutrition (Mediterranean type diet) including multiple vitamins and supplements (particularly the vitamin B group and omega-3 fatty acids) also stabilize a person’s mood (Ref.3). Pay particular attention to hidden sugar intake, as sugar consumption is responsible for a lot of depression found in the general population.

9. Restore sleep deprivation by adding melatonin 3 to 6 mg at bedtime. This helps also to restore the circadian hormone rhythm.

Conclusion

Seasonal affective disorder is triggered by a lack of light exposure in a sensitive subpopulation. An integrative approach as described can reduce the amount of antidepressants that would have been used in the past in treating this condition. This will reduce the amount of side effects. The use of a light box can reduce the symptoms of this type of depression within a few days. But the addition of electro acupuncture and St. John’s Wort may be all that is required for treatment of many SAD cases. Regular exercise and a balanced nutrition (with no sugar) and including vitamin supplements complete this treatment. If the depression gets worse, seek the advice of a psychiatrist and make sure your doctor has ordered thyroid tests and hormone tests to rule out other causes where depression is merely a secondary symptom.

More information on depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

References

  1. Ferri: Ferri’s Clinical Advisor 2014, 1st ed. © 2013 Mosby.
  2. Cleveland Clinic: Current Clinical Medicine, 2nd ed. © 2010 Saunders.
  3. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders.
  4. George A. Ulett, M.D., Ph.D. and SongPing Han, B.M., Ph.D.: “The Biology of Acupuncture”, copyright 2002, Warren H. Green Inc., Saint Louis, Missouri, 63132 USA

Last edited Nov. 7, 2014

Oct
12
2013

Music More Powerful Than Anti-Anxiety Drugs

By | Autism, Cancer, heart attack, Mental Health, Pain, Stress management, Substance abuse

When was the last time you saw your physicians for anxiety and you were given a prescription that said: “for anxiety listen to your favorite music!” instead of receiving a prescription for an anti-anxiety drug (anxiolytic). This is exactly what a recent study suggests that showed prior to surgery you can control your anxiety either with anti-anxiety drugs or by listening to your favorite music. Listening to your favorite music will do you no harm, while many drugs do have harmful side effects.

How singing can change the brain chemistry

Other studies have investigated how singing can change your brain functioning in terms of brain chemistry. The researchers found that singing will release dopamine in your brain, which is responsible for feeling pleasure; it will stimulate your immune system by elevating immunoglobulin A and decreasing cortisol (the stress hormone). This in turn will preserve your immune cells (lymphocytes). Oxytocin levels of your brain are increased, which promotes social affiliation. It also calms down the autonomic nervous system resulting in a better airway opening, calming of your heart rate and soothing the wave-like muscle contractions in your gut, medically called peristalsis. You would refer to that as “butterflies in your stomach”. Music therapy reduces pain and anxiety by 50% and is important for children and adults alike.

Pain and anxiety reduced

A study in Germany showed that pain and anxiety were significantly reduced with music therapy. A Taiwanese study of women in labor found that music therapy significantly reduced pain and anxiety of women during labor. Ref. 1 explains that music therapy is useful as an adjunct to treating cancer pain, and reducing anxiety associated with colposcopy procedures. It also can help when treating patients who had heart attacks in the setting of a cardiac care unit.

Music More Powerful Than Anti-Anxiety Drugs

Music More Powerful Than Anti-Anxiety Drugs

Hypnosis and guided imagery

Music has been successfully combined with clinical hypnosis and guided imagery where words are carefully chosen to help the patient experience pleasant feelings, which counteract the experience of pain, anxiety or fear of dying. A simple relaxation CD or tape with soothing background music will facilitate this type of therapy. This is useful for patients in a palliative care unit where they prepare themselves to accepting the inevitable death from an incurable disease. But chemotherapy patients undergoing these procedures for cancer treatments also have benefitted from a significant reduction in nausea, vomiting (side effects of chemotherapy) and pain.

Autism and music therapy

A Cochrane study showed that autistic children did better in terms of communication skills when music therapy was incorporated into the treatment protocol. One of the core deficits in autistic children is in the area of communication and social skills. This is where music therapy was most effective. Behavioral problems (stereotypic behavior) in autistic children did not respond to music therapy. A comprehensive treatment program for autistic children should therefore incorporate music therapy. Here is a blog that describes what difference music therapy can make in the lives of autistic children written by a member of the American Music Therapy Association.

Substance abuse and music therapy

An area where you may not expect music therapy to have a role is in the area of drug and substance abuse rehabilitation , which is discussed in more detail in this site. The beauty about music therapy is that it is not a drug, yet the natural endorphins that are released by the brain help the affected person getting through withdrawal easier. Music therapy helps building up self-esteem, participating in group activities, promoting self awareness and expressing feelings.

Mood disorders in adolescents

One important area where music therapy has been employed is with anxiety and depression in adolescents. Adolescents spend an average of 4 hours per day listening to music. So they are already programmed to listen to music. With the help of a music therapist they can be directed to listening to the type of music that will help them get motivated, relax more, make them feel accepted and be part of their peer groups. In this study the authors suggested to combine music therapy with dance and art therapy. In this way the whole person gets involved in the treatment and this can be integrated with conventional antidepressant treatments at reduced doses (with less side-effects) or with cognitive therapy.

General objectives of music therapy

Music therapy is best incorporated into a treatment protocol as an adjunct. It can help reduce the use of drugs for psychiatric patients, for people with anxiety and for patients with pain conditions. The Cleveland clinic has a useful summary about music therapy, which describes the uses of it for reducing anxiety, for helping with coping skills, mood improvement and distraction from pain. There are registered music therapists you can ask for help. The website of the American Music Therapy Association may have other useful links for you.

Conclusion

Music therapy is a treatment modality with no side effects, but providing effective treatment for quite an impressive range of clinical conditions as discussed. Music therapists are widely available in the US and many other countries. This treatment can be integrated with conventional or complementary treatments. It helps people to heal the body as a whole unit (mind and body).

More information on anxiety disorders: http://nethealthbook.com/mental-illness-mental-disorders/anxiety-disorders-panic-disorders-phobias-ocd-ptsd-anxiety-others/

References

1. Rakel: Integrative Medicine, 3rd ed.© 2012 Saunders. Chapter on Integrative Therapy; subchapter of Mind-Body Therapy.

Last edited Nov. 7, 2014

Sep
28
2013

Sleepless Nights

By | Health, Hormones, Insomnia, Mental Health, Pain, Prevention, Sleep apnea, Substance abuse, Vitamins and supplements

Sleeping problems (insomnia) are very common. About 10% of the population suffers from chronic insomnia; 30% of the population suffers from occasional sleep problems. In a large outpatient population of a clinic consisting of 3500 patients who had at least one major clinical condition, 50% complained of insomnia, 16% had severe symptoms, 34% had mild symptoms (Ref.1). Insomnia is more common among women, and older people as well as in people with medical or psychiatric illnesses. Long-term studies have shown that the same insomnia problems persist throughout many years. It is not possible to offer a simple remedy for insomnia, because insomnia is a complex problem. Here I will discuss some of the causes of insomnia and also discuss some of the treatment options.

Symptoms of insomnia

The person who suffers from insomnia will usually state that they have problems falling asleep. Worries of the day suddenly circulate through their thoughts and they toss and turn nervously looking at the clock from time to time and getting more and more anxious that they cannot sleep. Others fall asleep OK, but in the middle of the night they wake up perhaps to visit the restroom, but then they cannot go back to sleep. Others wake up 2 hours before their normal alarm clock time and they feel their stomach rumbling making it impossible to fall back to sleep. Older people with chronic diseases and general poor health suffer more from insomnia. In this setting insomnia may be more related to the underlying disease rather than old age. Psychiatric disorders also are associated with more insomnia. Treat the underlying psychiatric illness, and the insomnia disappears.

Although insomnia is a sleep disturbance during the nighttime, people who are affected with this complain of daytime fatigue, of overstimulation, yet they catch themselves making frequent mistakes, and their inability to pay attention gets them involved in accidents and falls. Longitudinal studies have shown (Ref. 1) that people with chronic insomnia are more likely to develop psychiatric disease, such as major depression,  anxiety disorder and alcohol and substance abuse. Unfortunately these disorders can by themselves again cause insomnia, which reinforces chronic insomnia. Insomnia leads to poorer social and physical functioning, affects emotions, leads to a lack of vitality and physical endurance, contributes to worsening of pain and can affect general and mental health.

Research about insomnia

Much has been learnt from sleep studies using polysomnography monitoring during a full night’s sleep. These studies have been used mainly as a research tool. In such studies eye movements, brain wave activity, muscle activity, chest movements, airflow, heart beats, oxygen saturation and snoring (with a microphone) are all simultaneously recorded. This way restless leg syndrome, sleep apnea, snoring, seizure disorders, deep depression etc. that can all lead to insomnia can be diagnosed and separated from insomnia. The stages of sleep (wakefulness, stage 1 to 3 sleep and the REM sleep stage) can also be readily measured using polysomnography (Ref.2). According to this reference the majority of insomnia cases do not need this complex procedure done.

Sleepless Nights

Sleepless Nights

Causes of insomnia

Traditionally insomnia cases are classified into primary insomnia and secondary insomnia. Secondary insomnia is caused by all of the factors discussed below. When they are dealt with, we are left with cases of primary insomnia.

The following medical conditions can cause insomnia: heart disease, pulmonary diseases like asthma and chronic obstructive pulmonary disease (COPD); gastrointestinal disease like liver cirrhosis, pancreatitis, irritable bowel syndrome, ulcers, colitis, Crohn’s disease; chronic kidney disease; musculoskeletal disease like arthritis, fractures, osteoporosis; neurodegenerative disease like MS, Parkinson’s disease, Alzheimer’s disease; endocrine disease like diabetes, hyper- or hypothyroidism, adrenal gland fatigue and insufficiency; and chronic pain conditions. Also, psychiatric conditions like major depression, schizophrenia and anxiety disorders can cause insomnia.

This list in not complete, but it gives you an idea of how complex the topic of insomnia is.
The physician who is seeing a patient with insomnia needs to rule out any of these other causes of insomnia to be certain that the only condition that is left to treat in the patient is insomnia itself. The other diagnoses have to be dealt with separately or else treatment of insomnia will fail.

Ref. 1 points to a useful model of how to think about causation of insomnia: there are three points to consider, namely predisposing, precipitating, and perpetuating factors. Let’s briefly discuss some of these.

Predisposing factors

We are all different in our personal make-up. If you are well grounded, chances are you are not susceptible to insomnia. Anxious persons or persons who have been through a lot of negative experiences in life will have personality traits that make them more prone to insomnia. Lifestyle choices such as late nights out, drinking with the buddies in a bar (extreme circadian phase tendencies) will have an impact on whether or not you develop insomnia.

Precipitating factors

A situational crisis like a job change or the death of a loved one can initiate insomnia.  However, there could be a medical illness such as a heart attack, a stroke or the new diagnosis of a psychiatric illness that has become a precipitating factor. Sleep apnea and restless leg syndrome belong into this group as well as would the stimulating effect of coffee and caffeine containing drinks. Jet lag and nighttime shift work can also be precipitating factors.

Perpetuating factors

Daytime napping to make up for lost sleep the night before can undermine sleep initiation the following night, which can lead to a vicious cycle. Similarly, the use of bedtime alcoholic drinks leads to sleep disruption later that night and can become a perpetuating factor, if this habit is maintained. Even the psychological conditioning of being anxious about whether or not you will fall asleep easily or not the next night can become a perpetuating factor.

I will return to this classification and the factor model of causation of insomnia when we address treatment options.

Drugs that can cause insomnia

One major possible cause for insomnia  can be side effects from medications that patients are on (would belong to the ‘perpetuating factors’ among causes). Physicians call this “iatrogenic insomnia”. The antidepressants, called selective serotonin reuptake inhibitors (SSRI’s) like Prozac are particularly troublesome with regard to causing insomnia as a side effect. Other antidepressants like trazodone (Desyrel) are used in small doses to help patients with insomnia to fall asleep. Some asthmatics and people with autoimmune diseases may be on prednisone, a corticosteroid drug. This can cause insomnia, particularly in higher doses; so can decongestants you may use for allergies; beta-blockers used for heart disease and hypertension treatment; theophylline, an asthma medication and diuretics. Central nervous stimulants like caffeine or illicit drugs can also cause insomnia. Hormone disbalance in general and hyperthyroidism specifically as well as Cushing’s disease, where cortisol levels are high will cause insomnia.

Treatment of insomnia

So, how should the physician approach a patient with insomnia? First it has to be established whether there is secondary insomnia present due to one of the predisposing, precipitating or perpetuating factors. In other words, is there secondary insomnia due to other underlying illnesses? If so, these are being addressed first. Lifestyle choices (staying up late every night) would have to be changed; alcohol and drug abuse and overindulging in coffee or caffeine containing drinks needs to be dealt with. Cognitive therapy may be beneficial when mild depression or anxiety is a contributing factor to insomnia.

The remaining insomnia (also medically termed “primary insomnia”) is now being treated.

The following general points are useful to get into the sleeping mode (modified from Ref. 3):

  1. Ensure your bedroom is dark, soundproof, and comfortable with the room temperature being not too warm, and you develop a “sleep hygiene”. This means you get to sleep around the same time each night, have some down time 1 hour or so before going to bed and get up after your average fill of sleep (for most people between 7 to 9 hours). Do not sleep in, but use an alarm clock to help you get into your sleep routine.
  2. Avoid caffeine drinks, alcohol, nicotine and recreational drugs. If you must smoke, don’t smoke later than 7PM.
  3. Get into a regular exercise program, either at home or at a gym.
  4. Avoid a heavy meal late at night. A light snack including some warm milk would be OK.
  5. Do not use your bedroom as an office, reading place or media center. This would condition you to be awake.  Reserve your bedroom use only for intimacy and sleeping.
  6. If you wake up at night and you are wide awake, leave the bedroom and sit in the living room doing something until you feel tired and then return to bed.
  7. A self-hypnosis recording is a useful adjunct to a sleep routine. Listen to it when you go to bed to give you something to focus on (low volume) and you will find it easier to stop thinking.

Drugs and supplements for insomnia

1. In the past benzodiazepines, such as diazepam (Valium), lorazepam (Ativan), fluorazepam (Dalmane), temazepam (Restoril), triazolam (Halcion) and others were and still are used as sleeping pills. However, it was noted that there are significant side effects with this group of drugs. Notably, there is amnesia (memory loss), which can be quite distressing to people such as not remembering that someone phoned while under the influence of the drug, you promised certain things, but you cannot remember the following morning what it was. Another problem is the development of addiction to the drugs with worse insomnia when the drugs are discontinued. Many physicians have stopped prescribing benzodiazepines.

2. There are non-benzodiazepines drugs that are used as sleeping pills (hypnotics), such as Zaleplon (Sonata), Zolpidem (Ambien) and Eszopiclone (Lunesta).  They seem to be better tolerated.

3. Ramelteon, a melatonin agonist, is available by prescription in the US. It probably is the best-tolerated mild sleeping pill and works similar to melatonin, but is more expensive. Chances are that your physician likely would prescribe one of the non-benzodiazepines drugs or Ramelteon for you as they do not seem to be addicting.

4. However, there is an alternative: Many patients with insomnia tolerate a low dose of trazodone (Desyrel), which is an antidepressant with sleep restoring properties. A low dose of 25 to 50 mg at bedtime is usually enough for insomnia. This allows the patient to fall asleep within about 30 minutes of taking it, and sleep lasts through most of the night without a hangover in the morning. Many specialists who run sleep laboratories recommend trazodone when primary insomnia is diagnosed. However, this is still a drug with potential side effects as mentioned in the trazodone link, but 50 mg is only ¼ of the full dose, so the side effects will also be less or negligible.

5. I prefer the use of melatonin, which is the natural brain hormone designed to put us to sleep. Between 1 mg and 6 mg are sufficient for most people. We know from other literature that up to 20 mg of melatonin has been used in humans as an immune stimulant in patients with metastatic melanoma with no untoward side effects other than nightmares and some tiredness in the morning. A review from the Vanderbilt University, Holland found melatonin to be very safe as a sleeping aid. There are several melatonin receptors in the body of vertebrates (including humans), which are stimulated by melatonin.

6. Other natural methods are the use of L-Tryptophan at a dose of 500 mg at bedtime, which can be combined with melatonin. It is the amino acid contained in turkey meat, which makes you tired after a Thanksgiving meal. GABA is another supplement, which is the relaxing hormone of your brain, but with this supplement tolerance develops after about 4 to 5 days, so it is only suitable for very short term use. Herbal sleep aids are hops, valerian extract and passionflower extract. They are available in health food stores.

Conclusion

A lack of sleep (insomnia) is almost a given in our fast paced lives.

When it comes to treatment, all of the other causes of secondary insomnia need to be treated or else treatment attempts would fail. What is left is primary insomnia. This is treated as follows:

We need to review our sleeping habits, lifestyles and substance abuse. Remove what is detrimental to your sleep. Start with the least invasive treatment modalities such as self-hypnosis tapes, melatonin, L-Tryptophan or herbal extracts. Should this not quite do the trick, asks your doctor for advice. The non-benzodiazepines drugs or Ramelteon would be the next level up. It may be that an alternative such as low dose trazodone would be of help. Only, if all this fails would I recommend to go to the more potent sleeping pills (keep in mind the potential for addiction to them).

References

1. David N. Neubauer, MD (John Hopkins University, Baltimore, MD): Insomnia. Primary Care: Clinics in Office Practice – Volume 32, Issue 2 (June 2005)  © 2005, W. B. Saunders Company

2: Behrouz Jafari, MD and Vahid Mohsenin, MD (Yale Center for Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA): Polysomnography. Clinics in Chest Medicine – Volume 31, Issue 2 (June 2010), © 2010 W. B. Saunders Company

3. Jean Gray, editor: “Therapeutic choices”, 5th edition, Chapter 8 by Jonathan A.E. Fleming, MB, FRCPC: Insomnia, © 2008, Canadian Pharmacists Association.

Last edited Sept. 28, 2014

Aug
03
2013

Treat Causes, not Symptoms

By | Anti-aging medicine, Arthritis, Asthma, Diabetes, Fitness, Gastrointestinal Disease, heart attack, Heart Disease, High Blood Pressure, Insomnia, Nutrition, Obesity, Pain, Prevention, Stroke, Weight loss

Introduction

In this article I describe that physicians should treat causes, not symptoms. When you see a physician about a health problem, he or she generally listens to your symptoms and examines you. This leads to a diagnosis and the treatment of your symptoms. Medicine has been evolving since, anti-aging medicine has become more prominent and comprehensive medical practitioners have started to treat differently. Some examples below best explain the new approach. This is important as many general practitioners continue to treat symptoms and neglect to search for causes.

Big Pharma and the status quo

Big Pharma is trying to keep the medical system in the “status quo” (the way it is), because they make big money by having general practitioners try out different ineffective medications (this way the profits keep on coming in.) One example is the cholesterol story. High cholesterol only causes 50% of heart attacks, but physicians continue to prescribe statins whenever they detect high cholesterol levels to prevent a heart attack. But high cholesterol could be a cause from hypothyroidism (when the thyroid gland does not produce enough thyroid hormone). Diet can also play  a role, if the patient eats too many helpings of fatty meats and drinks alcohol regularly. Just prescribing statins to lower cholesterol is not the answer, treating the cause is!

I am going to describe 5 clinical examples where physicians usually treat symptoms instead of the causes. If you are in a hurry, just read example 3 below (gastritis and duodenal ulcer). After that you can skip forward and read the conclusion, where I will summarize what I think we should learn from this.

Treating Symptoms Not Effective, Find And Eradicate Causes

Treating Symptoms Not Effective, Find And Eradicate Causes

1)  Rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease where autoantibodies attack the joint surfaces. It is a multifaceted disease and typically requires a rheumatologist to order detailsed tests and formulate the treatment. The standard treatment for RA is summarized in this link. Before engaging in these toxic treatments, it is very worthwhile to study this link and see, if any of your food components may have triggered your arthritis. Various agents in the food can contribute to the development of autoantibodies, such as wheat, soy, MSG, even salicylates. An elimination diet approach could pinpoint if there is any food component that may be the cause of your RA.

Hormonal deficiencies in RA patients

Dr.Lichten treated many RA cases and found (Ref.1, p. 85 and 86) that many patients had hormonal deficiencies. He points out in particular that these patients often lack DHEA. DHEA is known to treat immune deficiencies and T cell responses were observed to raise 10-fold after DHEA supplementation; IGF-1 levels (an indirect measure of human growth hormone) increased and muscle mass improved when exercised as well along with DHEA replacement. RA patients responded well to relatively low doses of DHEA (25 mg daily for women and 50 mg daily for males). When other hormone tests are done to look for deficiencies, Dr. Lichten found sometimes thyroid deficiencies requiring hormone supplementation.

Sex hormone deficiencies often present in RA patients

Similarly, when saliva tests are done to look for sex hormone deficiencies, there may be progesterone and/or estrogen deficiency in women and testosterone deficiency in males that needs to be replaced with bioidentical hormones. In RA patients there may be adrenal gland deficiency setting in, which can be diagnosed by a four-point saliva cortisol hormone test. Only these cases of true hormone deficiency will benefit from small doses of cortisol (the original bioidentical human hormone) given four times per day.

Here is a summary of the usual recommendations for home remedies for treating rheumatoid arthritis. Using electro acupuncture can be very useful for controlling chronic pain, but you still need to work out the cause for your particular case of RA.

2) High Blood Pressure

Most cases of high blood pressure (hypertension) are simply there without a particular cause. It used to be called “essential hypertension”, a fancy name meaning “essentially, we do not know the cause”. The doctor will start treatment with drugs to bring high blood pressure down. Before that the doctor is supposed to ask you to make a good effort to change your life style (cutting out additional salt, exercising, weight loss), but this is often glossed over and drugs are used right away. Drugs for hypertension are not harmless; here are some of the side effects.

Medical textbooks unclear about causes of high blood pressure

The medical textbooks are not very clear on what causes high blood pressure. With renal causes (narrowing of a renal artery) a stent can be placed, the cause is treated and the blood pressure normalizes. As indicated, essential hypertension is the name for the majority of other cases of high blood pressure where officially no cause is known. Patients are usually put on life-long antihypertensive medications, often several drugs in combination, to bring the blood pressure down to 120 over 80.

Factors that contribute to high blood pressure

Despite the notion that we do not know the cause of high blood pressure, we do know that a number of factors can contribute to developing high blood pressure: too much salt in the diet, too much nicotine from smoking and too much alcohol consumption.

A lack of nitrates from green vegetables can cause high blood pressure as well. Nitrates are necessary for the body to produce nitric oxide, a powerful messenger that dilates blood vessels lowering blood pressure. It is produced every second by the lining inside the walls of your arteries. Greens and vegetables, particularly beets, provide nitrates for nitric oxide production.

Nitric oxide and omega-3 fatty acids

Nitric oxide, along with omega-3-fatty acid and prostaglandins are important in relaxing the arterial walls, thus lowering high blood pressure. We also know that in diabetes and obesity high blood pressure is very common, because inflammatory substances circulate in the blood, which interfere with the normal production of the blood pressure lowering nitric oxide.

Treating high blood pressure with the conventional drugs will mask the real underlying causes.

The DASH diet

The DASH diet has helped a lot of people to get their blood pressure under control. However, the critical point in that diet is the limitation of the amounts of grains. In my opinion, wheat and grains, starches and sugar are all empty calories and only stimulate your appetite because of the high leptin and gliadin content from wheat and wheat products. According to the cardiologist, Dr. William Davis, cutting these out will cure not only many cases of hypertension, but also diabetes and obesity. Many physicians criticized him, but in my opinion his work is on solid researched ground. If a patient honestly gives lifestyle changes a try, many side effects and deaths from antihypertensive drugs could be avoided.

3) Gastritis and duodenal ulcer

You see your doctor, because lately you regurgitate acidy stomach contents. You may be diagnosed with gastritis and get a prescription for an acid suppressive drug. But before you take proton pump inhibitors (PPI) study the side effects here. The interesting part is that many chronic gastritis cases are associated with a bacterium called H. pylori. Unfortunately, cimetidine, ranitidine and particularly PPI’s treat the acid problem (the symptomatic treatment of acid suppression). But on the longer term the triple therapy encourages H. pylori to grow more, particularly in the stomach. H. pylori undermines the lining of the stomach and the duodenum. This interferes with the protective mucous production, which protects you from gastritis and ulcers.

Breakdown of the mucosal barrier

Dr. Murray explains that the cause of gastritis, gastric ulcer and duodenal ulcer is the breakdown of the mucosal barrier (Ref. 3, p.73-75). The symptomatic treatment of the H. pylori infection with triple therapy (2 antibiotics and a PPI) is the conventional medical treatment, but in many cases it does not cure H. pylori. Some patients develop diarrhea from a Clostridium difficile super infection as a result of the antibiotics from the triple therapy requiring even more expensive antibiotics for that condition. This only happened, because the physician treated the patients’ symptoms instead of the cause. The cause of gastritis and duodenal ulcers is a weakening of the lining in the stomach and the duodenum resulting in a breakdown of the mucous barrier.

Too much wheat consumption can be a cause

In some people dietary habits play a role, like too much cereal and wheat consumption with too little alkaline vegetables in the meals to neutralize the acid formation (see Ref. 2 for more details). However, when a simple licorice compound (DGL, which stands for deglycyrrhizinated licorice) is given, the symptoms from gastritis, acid reflux, and ulcers in the stomach or duodenum disappear. DGL supports the lining of the stomach and duodenum and re-establishes the defense against the acidy milieu. Not only that, but after a few weeks of DGL treatment all of the findings on endoscopy such as inflammation and ulcerations disappeared.

DGL restores the stomach lining

Dr. Murray states that he has not encountered a case of gastritis or ulcer that would not have responded. It appears that the cause of gastritis and ulcers in the stomach and duodenum is not from too much acid, not from H. pylori infection, which appears to just be a concomitant infection, but actually is due to a breakdown of the barrier in the lining of the stomach and duodenum, which responds to DGL. The other interesting thing is that you can buy DGL in the health food store; the dosage is two to three chewable tablets on an empty stomach three times per day. According to Ref. 3 the patient has to take DGL 8 to 16 weeks, after which there is a full therapeutic response. Pepto-Bismol is another coating substance that is available over the counter and works well for minor stomach upsets.

4) Chronic back pains and insomnia

Many people see their chiropractor for chronic recurrent back pains and their physician for insomnia to get sleeping pills. It all depends what the underlying causes are of back pains and insomnia. If there is a misalignment in the spine, a chiropractor doing manipulation would be a reasonable approach and the back pain symptoms often disappear. However, thyroid deficiency, adrenal gland insufficiency or adrenal gland fatigue may also be the cause of back pains and muscle cramps. Unless the physician treats the  underlying cause (in the case of hypothyroidism treatment with thyroid hormones), the back pains stay.

Muscle pain in fibromyalgia patients

In fibromyalgia where muscle pains are all over the body, the standard treatment with antidepressants and pain pills just will not do it on the long-term. These patients require a detailed work-up with analysis of the hormonal status. Often, they are suffering from a lack of thyroid hormones, a lack of sex hormones (in women a lack of estrogen and progesterone, in men a lack of DHEA and/or testosterone). But they may also have weak adrenal glands and a lack of growth hormone. An anti-aging physician (A4M) can order the appropriate tests and treat the underlying causes.

Insomnia in fibromyalgia patients

Fibromyalgia patients often have insomnia (sleep disorders). Dr. Lichten (Ref.4) recommends GABA in small doses (125mg to 250 mg) at bedtime along with 500 mg of L-tryptophan. He also recommends 4000 IU – 5000 IU of vitamin D3 (as often insomnia patients are deficient in vitamin D3) as well as 500 mg to 1000 mg of magnesium. If this alone is not sufficient, melatonin, 1 mg to 3 mg at bedtime will be beneficial. Dr. Lichten cautions that GABA leads to tolerance quickly, so the patient should take GABA only 5 days out of 7 to allow the body’s receptors to recover. This alternative approach to treat insomnia prevents addiction to sleeping pills (hypnotics).

5) Asthma symptoms

Not every case of asthma needs steroid inhalers and salbutamol or other bronchodilator inhalers as treatment. Low thyroid hormone levels can also cause asthmatic symptoms of wheezing and shortness of breath. It is important to listen to the patient’s symptoms, but the treatment will only be successful when the cause is treated. Dr. David Derry described in this link how many of his severe asthma patients had iodine deficiency and low thyroid hormones and no longer had to see him when iodine treatment and desiccated thyroid hormone replacement was given as treatment. This goes against what the standard recommendation for asthma treatment is, but it seems to get patients unhooked from dependence on steroid inhalers.

Steroid dependency from anti-asthmatic inhalers can suppress the adrenal glands and lead to adrenal gland insufficiency.

Corticosteroid inhalers in asthma treatment can suppress the stress response

The adrenal glands are vital for coping with stress as the more stress you are under, the more your pituitary gland produces ACTH hormone, which in turn stimulates the adrenal glands to produce cortisol. However, a significant percentage of patients with asthma that been on corticosteroid inhalers for a long time, experience a suppression of the pituitary gland and the adrenal glands cannot produce the required stress hormones; in other words, adrenal fatigue or adrenal insufficiency can set in.

This is an example where corticosteroid inhalers control asthma symptoms, but they undermine the stress hormone circuit to the point where the patient experiences another disease (called a “iatrogenic disease”, a disease from the side-effects of drugs). Treatment of adrenal fatigue is described in this link.

Conclusion

Medicine can become quite complex as these examples show. Many times physicians tell their patients that they do not know the cause of their symptoms. However, this is not always true, but conventional medicine continues to hold onto the old dogmas. With the third example above (gastritis and duodenal ulcer), until the mid 1980’s the original theory in medicine was that too much acid production would be the cause of these conditions and treatment concentrated on suppressing acid production. Then the new theory came up that H. pylori, a bacterium would be the cause of chronic inflammation, which together with too much acid would cause the condition. That is why physicians now treat it with the triple therapy, a good deal for Big Pharma, but a bad deal for many patients.

DGL, a simple licorice compound can strengthen the lining of the stomach

Patients still do not experience a cure, but develop a worsening of their conditions as H. pylori growth proliferates, particularly from the PPI’s, which undermines the lining of the whole stomach. As pointed out above DGL, a simple licorice compound, which is available in health food stores, can strengthen the lining of the stomach and duodenum, which at the same time gets rid of the H. pylori problem without any other drugs.

The problem with conventional medicine is that in many cases physicians still treat symptoms instead of treating known causes. Big Pharma supports this, as it is expedient for them to protect their multi-billion-dollar industry. Patients should ask their physicians to treat the causes of their diseases rather than the symptoms.

References

1. Dr. Edward M. Lichten: Textbook of bio-identical hormones. ©2007 Foundation for Anti-Aging Research, Birmingham, Michigan, USA

2. William Davis, MD: “Wheat belly. Lose the wheat, lose the weight, and find your path back to health.” HarperCollins Publishers Ltd., 2011.

3. Michael T. Murray, ND: “What the drug companies won’t tell you and your doctor doesn’t know”. Atria Books, New York, 2009.

4. Dr. Edward M. Lichten: Textbook of bio-identical hormones. ©2007 Foundation for Anti-Aging Research, Birmingham, Michigan, USA

Incoming search terms:

Jun
15
2013

Electro-Acupuncture Is Twice As Effective As Conventional Acupuncture

By | Abdominal Pain, Arthritis, Gastrointestinal Disease, Other neurological conditions, Pain, Substance abuse

I am discussing here that electro-acupuncture is twice as effective as conventional acupuncture. Imagine that you had lower back pain and your doctor said that physically everything was OK. Would you consider traditional Chinese acupuncture? According to Ref. 1 chances are that 70% of patients with back pain will get better with a few visits to an acupuncturist. In 1972 Dr. Ulett’s laboratory at the University of Missouri succeeded in getting the first NIH research grant for the study of acupuncture in the US. During these studies they found remarkable facts, the most important perhaps that electrical stimulation of acupuncture needles resulted in a doubling of the effectiveness of traditional Chinese acupuncture. After extensive research Dr. Ulett stated: ”The ancient practice of traditional Chinese acupuncture is now obsolete” (Ref.1). The much simpler, but more effective electro-acupuncture using electrical skin pads instead of needles replaced traditional Chinese acupuncture.

The science of electro-acupuncture

In 1958 news came from China that they were doing major surgeries with patients staying awake and pain free only with the use of electro-acupuncture. In other words no chemical anesthesia was necessary to make patients comfortable. Professor Ji-Sheng Han from the Beijing Medical University observed that only electrical stimulation was powerful enough to produce the pain relief that was necessary to allow general surgery. Dr. Han conducted systematic experiments to study the phenomenon of electro-acupuncture and published this in Ref. 2. One of the experiments consisted of two rabbits. Electro-acupuncture anesthetized the donor rabbit. The vet removed spinal fluid from the first rabbit and transferred it into the second rabbit (the recipient rabbit) that did not receive further treatments.

The second rabbit was pain free and the vet performed surgery 

The injection of spinal fluid made the second rabbit pain free to the point where the vet could performed surgery on it without pain. Other researchers such as Dr. Pomeranz found that the brain released endorphins in response to electro-acupuncture, powerful morphine-like substances. It was the endorphins that were responsible for making the recipient rabbit of Dr. Han’s experiment pain free. Other experiments of Dr. Pomeranz showed that naloxone, a morphine and endorphin blocker also blocked the analgesic effect previously found by transferring spinal fluid. These lines of experiments also explain why some patients did not respond to electro-acupuncture, as they have a deficiency in the pain control system of their brain lacking endorphin release. Dr. Han did 30 years of experimentation and also observed patients very closely.

Placebo effect investigated by Dr. Han

Dr. Han also investigated the placebo effect and found that this can explain about 30% of healing. However, the remainder of the 70 to 75% response to electro-acupuncture in his opinion was due to the procedure. He was able to explain that traditional Chinese acupuncture points were merely spots on the body where electric currents penetrate the skin easier. When internal nerves pick up the electrical signals the also transmit to the spinal cord and to the brain. The electrical impulses then switch over in the brain and spinal cord to nerves that go to other areas of the body. This explains how electrical impulses can travel from conducting polymer pads applied over acupuncture points, release neuropeptides in the brain and help the body to heal. Functional MRI studies confirmed that certain frequencies stimulate the brain through electro-acupuncture or traditional Chinese acupuncture to give pain relief.

Electro-Acupuncture Twice As Effective As Conventional Acupuncture

Electro-Acupuncture Twice As Effective As Conventional Acupuncture

Electro-acupuncture produces stronger signals in the brain

These types of studies have also shown that electro-acupuncture produces stronger signals in the brain than traditional Chinese acupuncture.

Beside pain relief many other applications exist for electro-acupuncture. Addiction medicine makes use of electro-acupuncture in weaning people from morphine or heroine etc. The health professional can use this method to treat psychiatric illness, particularly depression. It is useful in relieving nausea and vomiting due to chemotherapy with cancer treatments or associated with pregnancy without affecting the pregnancy. However, this may also be useful as an adjunct to treating high blood pressure and cardiovascular disease.

One area where clinical hypnosis and electro-acupuncture have a closely relationship is called “conditioned healing” (Ref.1). For instance, with posttraumatic stress disorder (PTSD) in soldiers who returned from battle or in rape victims researchers showed that hypnotherapy treatment while using electro-acupuncture for 30 minutes at the same time can be useful in alleviating the symptoms these patients experience.

A few case studies using electro-acupuncture

Here are a few case studies that illustrate the use of electro-acupuncture with regard to patients (modified Ref.1). A treatment consists of a 30-minute session where the patient is either sitting or resting comfortably on an examining table. Treatments initially are often given twice per week until the pain is only about 50% of the original pain (severity of pain is scored on a 0 to 10 scale in the beginning). From that point on the visits are reduced to weekly sessions. Most clinical problems require three to 12 sessions. If the pain goes away, but returns after a few weeks, repeat sessions can be scheduled, which often lead to pain relief in a shorter time interval than was the case with the original problem. Chronic problems can be treated on an ongoing basis once per month, if there was a clinical response, but the pain reoccurs.

A 53-year-old painter with left shoulder pain

A 53-year-old painter with left shoulder pain, which radiated into the left chest, had problems with painting above his head. His physician did heart studies, but everything was OK. He was told that this was due to a muscle spasm in the shoulder muscles. One electrode was placed over the hoku point (also called LI-4  acupuncture point), which is located over the first interosseous muscle between the thumb and index finger, the other electrode over the area of pain in the left shoulder. Only seven treatments, twice per week for 2 weeks were given, then treatments with weekly intervals were administered. This approach cured his shoulder problems, and he could return to paining.

A 39-year-old woman with lower back pain

A 39-year-old woman came to the office complaining of lower back pain, which radiated into her right leg to the knee area. After tests she was told that she had spinal stenosis with sciatica (irritation of the sciatic nerve). No surgery could be done for this. She was given twelve electro-acupuncture treatments with one electrode placed below her right knee (ST-36 acupuncture point) and another electrode placed over her right lower back over one of the BL acupuncture points. She was almost pain free for about two weeks, but the pain came back after the last treatment. Since then she has been getting ongoing monthly electro-acupuncture visits with about 80% pain relief. Keep in mind that spinal stenosis is a condition for which regular medicine has nothing to offer other than symptomatic pain medication, which she did not want.

A 30-year-old schoolteacher with anxiety attacks 

A 30-year-old schoolteacher suffered from anxiety attacks and agoraphobia (fear of open spaces) for several years. The therapist used conditioning with electro acupuncture to treat this woman. She received a series of treatments with electro-acupuncture over both interosseous muscles (hoku acupuncture point or LI-4) for 30 minutes during which time she was also listening to a relaxation tape with music in the background and suggestions for self-hypnosis. The physician taught her how to do self-imagery at home. Subsequently she did this for 10 minutes two or three times per day. Several weeks later she was able to control her anxiety attacks and overcome her fear of open spaces. In the beginning she rated her symptoms as 8 to 10 in severity on a scale from 0 to 10. At the end of the sessions, she only had occasional symptoms with a 1 to 2 rating on this scale.

A 50-year-old man with cluster headaches 

A 50-year-old man with cluster headaches who had been investigated extensively by a neurologist without any other underlying cause was treated with electro-acupuncture. The electrodes were placed on acupuncture points of the head. Within only 4 sessions most of the headaches were gone. After 8 sessions he had no more headaches. However, a few weeks later his cluster headaches returned, but with ongoing monthly treatments he is able to prevent them from recurring. He did not like the side effects of all the pain medications, so he rather goes for his monthly booster electro-acupuncture treatments.

Take-home message regarding electro-acupuncture

Many people never considered traditional Chinese acupuncture for fear of needles. However, extensive research by Dr. Han and Dr. Ulett showed that electro-acupuncture with electrically conducting polymer pads or with EKG pads will replace the acupuncture needles. Not only is this method needle free, but also the weak electrical impulses that are used with electro-acupuncture treatment double the effectiveness of the older acupuncture method.

Many acupuncturists use both methods of acupuncture, but Dr. Ulett who used traditional acupuncture in the past has completely abandoned it and uses electro-acupuncture with the HANS machine instead. It is a complementary medical treatment, which has been authorized by the FDA.

More on pain conditions: http://nethealthbook.com/neurology-neurological-disease/pain/

References

1: George A. Ulett, M.D., Ph.D. and SongPing Han, B.M., Ph.D.: “The Biology of Acupuncture”, copyright 2002, Warren H. Green Inc., Saint Louis, Missouri, 63132 USA

2. J.S. Han: “The Neurochemical Basis of Pain Relief by Acupuncture”. Vol. 2. Hu Bei Science and Technology Press, Beijing, 1998 (784 pages).

Jun
01
2008

Puzzling New Neurological Syndrome Investigated

By | Other neurological conditions, Pain

A new neurological syndrome has been described in early December 2007 and is presenting a challenge not only to the affected patients but also to the health professionals. The illness is characterized by pain, sensory symptoms, weakness and fatigue. Abnormal lab tests and MRI scan results were also present. The syndrome has affected at east two dozen workers who are working in pig slaughterhouses in three states of the U.S. Researchers have now a somewhat clearer picture of the mysterious illness, but Dr. Daniel Lachance, assistant professor of neurology at the Mayo Clinic in Rochester, Minnesota, describes the illness as one of the kind that has “defied explanation and a name”. At this point investigators have called it “progressive inflammatory neuropathy” (PIN), but the term is merely descriptive but not accurate enough. Dr. Lachance described the clinical picture based on findings on 18 patients from Minnesota who have been investigated in the most comprehensive manner.

The course of their illness was marked by pain, decreased sensation and tingling along with weakness and fatigue which far exceeded the findings of physical examinations. All of the affected individuals had abnormal MRI’s and abnormal results of the labs of their cerebrospinal fluid. Various tests of reflexes or quantitative sensory testing also showed abnormalities, and nerve conduction studies were abnormal in most of the patients. All of them had a new IgG auto-antibody biomarker. The findings point to an immune-mediated phenomenon which translates into a neurological illness. The workers affected all were exposed to aerosolized brain particles from slaughtered pigs.

All workers worked in the “warm room” where pigs were slaughtered and the brain extracted in a technique in which compressed air is shot into a dead pig’s foramen magnum. This blast of compressed air not only emulsifies the brain, but some of it becomes aerosolized and airborne. Symptoms seem to start within days or weeks of exposure, after which the course of the disease is chronic.

Puzzling New Neurological Syndrome InvestigatedProgressive inflammatory neuropathy caused by aerosolized brain particles from slaughtered pigs

Treatment has been symptomatic in those most severely affected with the medications of choice being methylprednisolone and/or intravenous treatment with immune globulin. Researchers have tested early on for human and porcine pathogens, but no infectious agent has been found. The precise mechanism by which the illness is occurring is not fully understood, but the syndrome does not seem to be food borne or transmissible from person to person.

Reference: The Medical Post, May 13, 2008, page 14, 15.

Last edited December 4, 2012

May
01
2008

When Kids Are Migraine Sufferers

By | Other neurological conditions, Pain

It is often assumed that migraine headaches are reserved for people with a family history of migraines and that those who are afflicted by those disabling headaches are usually adults. When a child has the symptoms of migraine headaches it is usually a source of grave concern to the parents. Dr. Lewis reported about his findings at a meeting which was sponsored by Rady Children’s Hospital. He has seen many young persons who suffer of headaches and pointed out that the greatest fear of the patient and the parents, is the thought of a developing brain tumor. If a patient has been having headaches for half a year or two years and has had an entirely normal neurological exam, Dr. Lewis can reassure the patient that there is no brain tumor. Breaking the vicious cycle of fear by reassurance often lifts a load of the patient’s back and things may settle down. About 11% of children in the age group of 5 to 15 years have migraine type headaches. The incidence has a peak at 12 years in boys and at 14 years in girls. Migraines have different criteria than headaches: there are at least 5 lifetime attacks that have a least two of the following symptoms: severe aches on both sides of the head, the front or on one side only, throbbing aches, moderate to severe pain that gets worse with activity. At least one symptom of the following has to be present: either light sensitivity, sensitivity to noise, nausea and vomiting. Dr. Lewis reports that proper sleep habits can make a difference. Too little, too much or inconsistent sleep is closely associated with the frequency of migraines. He cited the example of a sixteen year old who started having migraines after school ended at the end of June. She stayed up late and slept till noon. Once she returned to a regular sleep cycle she did a lot better. Eating patterns can play a role too. One of the common stories is the student skipping lunch and developing a headache about an hour later. Other migraine triggers can be sensitivities to certain foods, altitude changes, weather, motion sickness on a trip, excitement, dehydration and learning problems. Dr. Lewis reported that many of the very young patients age 4 to 5 with migraines may have attention-deficit hyperactivity disorder. If the performance problems are addressed headaches will resolve in 80 to 90% of the time. Headaches can also be linked to emotional aspects, peer problems at school, family problems or depression.

When Kids Are Migraine Sufferers

When Kids Are Migraine Sufferers

There is no drug that is officially approved for migraines in children. The medication that has been studied most closely is ibuprofen. A controlled trial of 7.5 mg/kg showed a response of 76 %. Acetaminophen with a dose of 15 mg/kg was studied in patients aged 4 to 16 years. The response was 54%. Neither of those two medications showed any adverse side effect. Sumatriptan nasal spray was well tolerated, showed a 1 hour response of 58%, had no side effects, but a bitter aftertaste. It was also pointed out that in a study oral sumatriptan and placebo scored the same. It is obviously most important to get to the root of the problem and eliminate the triggering factors after which medication can be used. The general consensus is to treat the attacks rapidly and consistently, get the patient back to his or her daily functioning, minimize backup medications and make sure that there are minimal or no adverse side effects.

More information about:

1. Attention-deficit hyperactivity disorder: http://nethealthbook.com/mental-illness-mental-disorders/developmental-disorders/attention-deficithyperactivity-disorder/

2. Migraine headaches: http://nethealthbook.com/neurology-neurological-disease/common-causes-headaches/migraine-headache/

Reference: Presentation at Annual Advances in the Practice of Pediatrics: San Diego 2008; Feb. 22-24, Hilton La Jolla

Last edited November 3, 2014

May
01
2008

Early Use of Immunosuppressive Drugs for Early Crohn’s Patients

By | Arthritis, Gastrointestinal Disease, Pain

So far the strategy of treating patients, who were newly diagnosed with Crohn’s disease, was the use of corticosteroids to control abdominal pain and bloody diarrhea. The conventional mode of treatment consisted of a “step-up” treatment: after corticosteroids the use of immunosuppressants and finally antibody treatment would follow to curb the inflammatory response. International data which were published in the Lancet (February 23 issue) points to a safer and more effective treatment protocol. It consists of a “top-down” approach rather than of the conventional “step-up” approach. Patients receive immunosuppression early in the form of azathioprine and also the antibody infliximab, known as Remicade. Another study examined patients who were on maintenance therapy with adalimumab (Humira). They experienced sustained improvements in the symptoms that are associated with Crohn’s disease. After 4 weeks of induction therapy with the medication patients with mild and severe depression had improved to such an extent that they returned to the normal range. They were also assessed regarding fatigue and after treatment they showed a significant improvement in their daily functioning. The two treatment protocols were compared in a trial involving 129 patients with Crohn’s disease who had no previous treatment. At the end of the trial the researcher found that 65% of the group that had received the “top-down” treatment was symptom free after 26 weeks of treatment. Contrary to this only 36% of the “step-up” patients went into remission during the same time.

Early Use of Immunosuppressive Drugs for Early Crohn's Patient

Crohn’s before and after immunosuppressive drugs

When the patients were examined after 1 year, 62% of the “top-down” group was still symptom free, but only 42% of the “step-up” group had no symptoms. Dr. Brian Feagan of the University of Western Ontario coordinated this trial involving international sites in Belgium, Holland and Germany. He points out that the newly diagnosed Crohn’s disease patient that has the worst prognostic signs will benefit from this form of treatment. The top-down modality also is safer, as it protects the patient from high exposure to steroids. Similar results were demonstrated in patients with rheumatoid arthritis. The results of these trials and Dr. Feagan’s research suggest that the top-down treatment option could also give the best chance to patients with other chronic autoimmune diseases such as ulcerative colitis.

More information about Crohn’s disease: http://nethealthbook.com/digestive-system-and-gastrointestinal-disorders/crohns-disease-crohns-disease/

Reference: The Medical Post, March 4, 2008, page 2; April 1, 2008, page 17

Last edited November 3, 2014

Apr
01
2008

Short Daily Exercise Helps Chronic Pain Patients

By | Arthritis, Fitness, Health, Pain

Chronic pain can be an affliction that turns normal living and functioning upside down. Quality of life will be negatively affected, and often depression and anxiety are resulting mental problems. Effective pain relief is crucial, but often there are undesirable side effects to pain medication, and the patient will explore other avenues that bring a measure of relief. Amy Burleson, Psy.D. of the Cleveland Clinic’s chronic pain rehabilitation program found that chronic pain patients were physically deconditioned due to chronic pain and a chronic lack of physical activity. Depression and other mood disorder also were very common. A 10 minute exercise program was added to the treatment of a group of 28 patients who suffered of various chronic pains: back pain, fibromyalgia, neuropathy and migraines. Patients started a simple routine of walking on a treadmill, starting with a low speed of 1 mile per hour and increasing the speed every few minutes, till they walked at a speed of 3 miles per hour, a speed which was manageable for all patients. After 3 weeks patients found that their physical endurance had increased. They also experienced less depression and anxiety. Even more remarkable was the fact that the patients’ pain perception had diminished.

Short Daily Exercise Helps Chronic Pain Patients

Short Daily Exercise Helps Chronic Pain Patients

Likert scale scores which were used in the assessment of pain perception showed a drop from 7.32 in the beginning of the program to 2.75 at 3 weeks. It is obvious that even mild exercise has benefits for patients with chronic pain: the overall well being receives a noticeable boost through an approach that has no pharmacological impact, no side effects and has no high cost of health care.

More information on the right dose of exercise: http://nethealthbook.com/health-nutrition-and-fitness/fitness/right-dose-exercise/

Reference: Pain Medicine, Volume 9, Issue 1, Page 88-141 (January/February 2008)

Last edited November 3, 2014

Apr
01
2007

Disc Transplantation New For Herniated Disc

By | Orthopedics, Pain

Back problems can be a source of chronic pain and it is a significant reason for disability in the general population. Often the patient lives with the problem, and treatment with pain killers or over the counter remedies proves to be useless. Once the symptoms are becoming more severe and there is a feeling of numbness that extends into the leg or foot, even the most stoic back pain sufferer will seek out medical advice. Tests such as a CAT scan or MRI scan will reveal that the reason for the chronic pain is a herniated disk.

The only treatment that could be offered has been a discectomy which is performed by an orthopedic surgeon. So far fusion surgery has been the modality of choice, which has the unfortunate consequence of predisposing patients to degeneration in other levels of the spine as the wear and tear following fusion surgery is higher at the adjacent levels.

Dr. Dike Ruan from the Navy General Hospital in Beijing reports about a new treatment in the form of disc transplantation instead of fusion. Artificial materials have been tested and the results have been very variable. Contrary to organ transplantation it is possible to work with donor material from non-related persons as the inert disk material does not cause transplantation rejection. The herniated disc is removed including the adjacent end plate and a fresh-frozen composite disk with end plate is introduced. Five patients who underwent the procedure had improved neurological status after three months. Also the bony union at the end plate was nearly complete after three months. Long term follow up, which continued for at least five years, continued to show improvement.

Disc Transplantation New For Herniated Disc

Disc Transplantation New For Herniated Disc

Contrary to organ transplants in which anti-rejection drugs have to be used, the disk transplants caused no immunological reaction. Motion and stability remained excellent, and only minor degenerative changes were observed after five years.

With further refinements, such disc transplants will likely become an effective alternative treatment for degenerative disc disease.

More information about disc herniation treatment suggestions: http://nethealthbook.com/arthritis/lower-back-pain/treatment-low-back-pain-2/disc-herniation-treatment-suggestions/
Reference: The Lancet, 2007; 369-993 and p.999

Last edited November 2, 2014