Multiple Sclerosis
Sample treatment outline
18, 10 08, 08:52 Filed in: Medical
When I had a layover thursday on the way to the ACAM convention, I ran into a woman who’s had multiple medical issues and was walking around with a backpack full of medications. She’s been going to a variety of specialists and overall her problems have been dealt with using a variety of medications. As we got to talking, she shared some of her diagnoses with me and I mentioned some other avenues she may want to investigate.
Now, I will probably never see her again, but she stayed on my mind as she’s a complex medical case. With the variety of problems, most doctors get frustrated and throw up their arms in frustration or try the couple therapies they have at their disposal then reject the patient if they don’t work. This doesn’t help the patient.
So, perhaps she will have a chance to read this and be able to take advantage of some of these therapies (I’m only including the diagnoses and avoiding any personal details so she’ll be the only one who can identify herself from this information). For everyone else, you’ll get a chance to see the approach that I take.
Her problem list includes (I wasn’t taking notes, so this relies on my memory and may have some errors): thyroid cancer in the past (eventually had entire thyroid removed) but doing well until last winter when she had sudden onset of attacks or episodes of (I don’t remember the details) fatigue and palpitations. Since then she has been diagnosed with multiple sclerosis (can only tolerate one MS drug), bone loss, massive iron deficiency anemia, massive vitamin D deficiency (I think she said she needed 60,000iu weekly just to bring her to perceptible levels, Ehlers-Dahnlos (not type 4), autonomic dysfunction, mast cell instability, hypoglycemia, orthostatic hypotension, some muscle/tendon shortening from limited use, and probably a few other things. She has tried an elimination diet in the past, eating nearly exclusively chicken and rice and felt weaker and lost weight during that time.
In terms of going after some of her current diagnoses directly, here are some things that she could try (you’ll notice some things come up more than once):
History of thyroid cancer and now completely without a thyroid: with her other problems, she may not be converting T4 (in synthroid, what is usually prescribed) to T3 (the active thyroid hormone), sometimes lab tests can help but sometimes you just have to do a trial of the different forms (Armour thyroid, cytomel, or compounded thyroid hormones) and see where the patient feels the best.
For her MS: Estriol (one of the estrogens, this is the weakest estrogen and least inflammatory) ~6 mg daily (this is the estrogen that is most elevated in pregnancy which is one time women with MS have fewer symptoms, a trial of estriol showed reduced white matter lesions in women with MS on estriol) applied transmucosally (this avoids the first pass liver metabolism that gives more metabolites from taking pills); vitamin D, enough to get her blood levels up to 60 ng/ml (plenty of data showing a connection between low vitamin D and MS); low dose naltrexone 3-4.5 mg before bed (learn more about it from this website); it’d be good to check her stomach acid production as it’s typically low in people with MS (I had a patient the other day who took nearly 2 hours to reacidify her stomach, normal should be under a half hour, so this means food isn’t getting digested).
Bone loss: she’s already taking calcium and magnesium, but extra magnesium may be warranted and the form of calcium certainly matters in someone who’s likely low in stomach acid (and another reason to check her stomach acid); enough vitamin D is essential for calcium metabolism so we’ll make sure she’s over 60 ng/ml; estrogen can help keep her bones strong and we already have another indication for using estriol and progesterone can help to encourage growth of the bones while testosterone (bringing back up to normal levels only) is also important for keeping bones strong; weight bearing exercise; maybe some additional supplements to support her bones.
Iron deficiency anemia: she can’t tolerate regular iron (ferrous sulfate), so while some IV iron may get her levels up right away, she should take a more gentle iron like bis-glycinate or some other chelated iron and take it with vitamin C to increase absorption; also, resistant iron deficiency anemia is a red flag for gluten intolerance or helicobacter pylori infection, so those need to be ruled out.
Ehlers-dahnlos: this is a connective tissue disorder that is typically genetic, so without knowing what the genes in her situation are coding for (they code for enzymes and other proteins so knowing where the defect it you can sometimes get around it) I would at least recommend a decent amount of vitamin C since it is essential for collagen formation and making strong tissues.
Mast cell instability: quercetin is a bioflavanoid that stabilizes mast cells and may be more effective than the cromolyn that she’s taking now (see this book).
Orthostatic hypotension: licorice can help retain sodium and may help her get her blood pressure up, though she may well have adrenal problems so a thorough evaluation of them would be warranted.
Autonomic dysfunction: once again, adrenal problems here, too, though this is a shoe-in for the environmental illness work-up below.
Hypoglycemia: small frequent meals is the mainstay of treatment here, but using more protein and fat can stabilize things a bit; sometimes food allergies can be an issue here.
More global solutions (we’re trying to find the root cause so she doesn’t need to be taking all this stuff) since when someone has all these problems there’s often something behind it:
More thorough allergy evaluation and repair of the gut may be warranted, perhaps she’s allergic to chicken and that’s whey she did so poorly.
Heavy metal testing: sometimes heavy metals can trigger all these weird symptoms, and remember that chicken is often loaded with arsenic.
Environmental illness: toxic mold (were there some water leakage problems in her house?) or some other environmental stressor can lead to this seemingly hopeless array of problems, so a work-up by someone who knows about environmental medicine is warranted.
Yeast: sometimes candida can become systemic and cause lots of weird symptoms, but I don’t recall her having much of an antibiotic history so it depends on the history and presentation.
Other infectious cause: lyme disease can sometimes cause a host of strange problems, and conventional testing isn’t fantastic, so even a trial of therapy could be warranted.
So, perhaps this short list of possible approaches just off the top of my head (I’m away at a conference on integrative treatment of cancer right now so don’t have access to my references) will be helpful for people to understand how I approach things and perhaps they will help this person if she happens upon my website.
Now, I will probably never see her again, but she stayed on my mind as she’s a complex medical case. With the variety of problems, most doctors get frustrated and throw up their arms in frustration or try the couple therapies they have at their disposal then reject the patient if they don’t work. This doesn’t help the patient.
So, perhaps she will have a chance to read this and be able to take advantage of some of these therapies (I’m only including the diagnoses and avoiding any personal details so she’ll be the only one who can identify herself from this information). For everyone else, you’ll get a chance to see the approach that I take.
Her problem list includes (I wasn’t taking notes, so this relies on my memory and may have some errors): thyroid cancer in the past (eventually had entire thyroid removed) but doing well until last winter when she had sudden onset of attacks or episodes of (I don’t remember the details) fatigue and palpitations. Since then she has been diagnosed with multiple sclerosis (can only tolerate one MS drug), bone loss, massive iron deficiency anemia, massive vitamin D deficiency (I think she said she needed 60,000iu weekly just to bring her to perceptible levels, Ehlers-Dahnlos (not type 4), autonomic dysfunction, mast cell instability, hypoglycemia, orthostatic hypotension, some muscle/tendon shortening from limited use, and probably a few other things. She has tried an elimination diet in the past, eating nearly exclusively chicken and rice and felt weaker and lost weight during that time.
In terms of going after some of her current diagnoses directly, here are some things that she could try (you’ll notice some things come up more than once):
History of thyroid cancer and now completely without a thyroid: with her other problems, she may not be converting T4 (in synthroid, what is usually prescribed) to T3 (the active thyroid hormone), sometimes lab tests can help but sometimes you just have to do a trial of the different forms (Armour thyroid, cytomel, or compounded thyroid hormones) and see where the patient feels the best.
For her MS: Estriol (one of the estrogens, this is the weakest estrogen and least inflammatory) ~6 mg daily (this is the estrogen that is most elevated in pregnancy which is one time women with MS have fewer symptoms, a trial of estriol showed reduced white matter lesions in women with MS on estriol) applied transmucosally (this avoids the first pass liver metabolism that gives more metabolites from taking pills); vitamin D, enough to get her blood levels up to 60 ng/ml (plenty of data showing a connection between low vitamin D and MS); low dose naltrexone 3-4.5 mg before bed (learn more about it from this website); it’d be good to check her stomach acid production as it’s typically low in people with MS (I had a patient the other day who took nearly 2 hours to reacidify her stomach, normal should be under a half hour, so this means food isn’t getting digested).
Bone loss: she’s already taking calcium and magnesium, but extra magnesium may be warranted and the form of calcium certainly matters in someone who’s likely low in stomach acid (and another reason to check her stomach acid); enough vitamin D is essential for calcium metabolism so we’ll make sure she’s over 60 ng/ml; estrogen can help keep her bones strong and we already have another indication for using estriol and progesterone can help to encourage growth of the bones while testosterone (bringing back up to normal levels only) is also important for keeping bones strong; weight bearing exercise; maybe some additional supplements to support her bones.
Iron deficiency anemia: she can’t tolerate regular iron (ferrous sulfate), so while some IV iron may get her levels up right away, she should take a more gentle iron like bis-glycinate or some other chelated iron and take it with vitamin C to increase absorption; also, resistant iron deficiency anemia is a red flag for gluten intolerance or helicobacter pylori infection, so those need to be ruled out.
Ehlers-dahnlos: this is a connective tissue disorder that is typically genetic, so without knowing what the genes in her situation are coding for (they code for enzymes and other proteins so knowing where the defect it you can sometimes get around it) I would at least recommend a decent amount of vitamin C since it is essential for collagen formation and making strong tissues.
Mast cell instability: quercetin is a bioflavanoid that stabilizes mast cells and may be more effective than the cromolyn that she’s taking now (see this book).
Orthostatic hypotension: licorice can help retain sodium and may help her get her blood pressure up, though she may well have adrenal problems so a thorough evaluation of them would be warranted.
Autonomic dysfunction: once again, adrenal problems here, too, though this is a shoe-in for the environmental illness work-up below.
Hypoglycemia: small frequent meals is the mainstay of treatment here, but using more protein and fat can stabilize things a bit; sometimes food allergies can be an issue here.
More global solutions (we’re trying to find the root cause so she doesn’t need to be taking all this stuff) since when someone has all these problems there’s often something behind it:
More thorough allergy evaluation and repair of the gut may be warranted, perhaps she’s allergic to chicken and that’s whey she did so poorly.
Heavy metal testing: sometimes heavy metals can trigger all these weird symptoms, and remember that chicken is often loaded with arsenic.
Environmental illness: toxic mold (were there some water leakage problems in her house?) or some other environmental stressor can lead to this seemingly hopeless array of problems, so a work-up by someone who knows about environmental medicine is warranted.
Yeast: sometimes candida can become systemic and cause lots of weird symptoms, but I don’t recall her having much of an antibiotic history so it depends on the history and presentation.
Other infectious cause: lyme disease can sometimes cause a host of strange problems, and conventional testing isn’t fantastic, so even a trial of therapy could be warranted.
So, perhaps this short list of possible approaches just off the top of my head (I’m away at a conference on integrative treatment of cancer right now so don’t have access to my references) will be helpful for people to understand how I approach things and perhaps they will help this person if she happens upon my website.
The HBOT that just won't stop
03, 09 07, 16:51 Filed in: Medical
Alright, new there's even more stuff I've found on hyperbarics and I hate to keep it to myself. HBOTreatment.com carries a variety of mountains of info on the utility of HBO, including this article (in PDF format) on HBO for multiple sclerosis. In fact, this page is a catalog of articles on using HBO in a variety of disorders.
The AAHA (American Association for Hyperbaric Awareness) is seeking to advance the understanding of HBOT. Their website is worth a look (just be ready for the audio "Welcome!" when the page loads). The Hyperbaric Healing Institute has a few notes on using HBO for various disorders.
The AAHA (American Association for Hyperbaric Awareness) is seeking to advance the understanding of HBOT. Their website is worth a look (just be ready for the audio "Welcome!" when the page loads). The Hyperbaric Healing Institute has a few notes on using HBO for various disorders.
More on Hyperbarics
20, 08 07, 02:24 Filed in: Medical
Every time I read more on the utility of hyperbaric oxygen (HBOT), I'm more annoyed that it isn't being used more frequently to treat some of the things it's really good at: neurovascular diseases (MS, alzheimer's, etc.), ischemic conditions (stroke, heart attack, sickle cell exacerbations). In addition to the article I mentioned last november, I've come across a couple more: a journal article about the successes of HBOT (and the politics holding it back) and an article about the unrelenting attacks on a physician who is using it to successfully treat patients, as well as an article about the American Heart Association's demonstration that HBOT is an effective treatment for heart attack.
In fact, here's 13 benefits to the heart from HBOT (from that last article, please see it for the references):
1. Hyperbaric oxygen therapy applied to the heart during critical loss of oxygen exerts a remarkable defibrillating effect so that tremulous, rapid, ineffectual contractions are prevented; total death of the heart muscle cells is avoided; and abnormal dilation of the blood vessels with subsequent complications is controlled.1
2. Using HBOT in conjunction with various drugs enhances the effectiveness of both the oxygen and the drugs.2,3,4,5
3. Combining HBOT with drugs completely arrests or considerably reduces angina attacks in patients otherwise resistant to prolonged drug treatment.6,7,8.9
4. Patients with cardiac pain from ischemic heart disease experience total relief, along with disappearance of dyspnea (difficulty breathing), when they receive HBOT.10,11
5. Administering HBOT lowered elevated blood cholesterol in all 220 patients cited in a study conducted by the Russian internist Dr. S.A. Borukhov and her colleagues.12
6. HBOT normalized electrocardiograms in all patients in that same Soviet study.13
7. For diminished muscular power of the heart, HBO exerts long-term normalizing effects for circulating blood through the body.14
8. HBOT exerts antiarrhythmic action on the heart.15,16,17
9. HBOT increases heart patients' tolerance to hard work and taking on physical loads.18,19
10. HBO taken at three atmospheres of pressure (a pressure rarely used in the United States) protects any individual's heart from damages due to lack of oxygen.20
11. One's entire heart conduction system functions better from receiving HBO treatment (even when prophylactically administered).21
12. Without taking drugs of any kind, breathing oxygen under pressure stabilizes impaired fat metabolism and improves liver function for someone with ischemic heart disease.22
13. Due to its characteristic of mollifying stress and distress, HBO has long-term and short-term protective effects for a person with a heart problem.23
Finally, I just came across a virtual font of articles on HBOT written by Dr. R. A. Neubauer MD, including 2 articles specifically about the etiology of multiple sclerosis and the treatment of MS with HBOT (1, 2).
In fact, here's 13 benefits to the heart from HBOT (from that last article, please see it for the references):
1. Hyperbaric oxygen therapy applied to the heart during critical loss of oxygen exerts a remarkable defibrillating effect so that tremulous, rapid, ineffectual contractions are prevented; total death of the heart muscle cells is avoided; and abnormal dilation of the blood vessels with subsequent complications is controlled.1
2. Using HBOT in conjunction with various drugs enhances the effectiveness of both the oxygen and the drugs.2,3,4,5
3. Combining HBOT with drugs completely arrests or considerably reduces angina attacks in patients otherwise resistant to prolonged drug treatment.6,7,8.9
4. Patients with cardiac pain from ischemic heart disease experience total relief, along with disappearance of dyspnea (difficulty breathing), when they receive HBOT.10,11
5. Administering HBOT lowered elevated blood cholesterol in all 220 patients cited in a study conducted by the Russian internist Dr. S.A. Borukhov and her colleagues.12
6. HBOT normalized electrocardiograms in all patients in that same Soviet study.13
7. For diminished muscular power of the heart, HBO exerts long-term normalizing effects for circulating blood through the body.14
8. HBOT exerts antiarrhythmic action on the heart.15,16,17
9. HBOT increases heart patients' tolerance to hard work and taking on physical loads.18,19
10. HBO taken at three atmospheres of pressure (a pressure rarely used in the United States) protects any individual's heart from damages due to lack of oxygen.20
11. One's entire heart conduction system functions better from receiving HBO treatment (even when prophylactically administered).21
12. Without taking drugs of any kind, breathing oxygen under pressure stabilizes impaired fat metabolism and improves liver function for someone with ischemic heart disease.22
13. Due to its characteristic of mollifying stress and distress, HBO has long-term and short-term protective effects for a person with a heart problem.23
Finally, I just came across a virtual font of articles on HBOT written by Dr. R. A. Neubauer MD, including 2 articles specifically about the etiology of multiple sclerosis and the treatment of MS with HBOT (1, 2).
Hyperbaric Oxygen and the "noncovered conditions"
14, 11 06, 22:05 Filed in: Medical
Hyperbaric Oxygen Therapy (HBOT) is quite useful for a number of conditions, though the medicare laws have a curious and unusual statement about HBOT: a non-covered conditions list. Most therapies' entries in the medicare laws don't even list covered conditions, so why does this specifically name 22 conditions as being "non-covered"? This is especially interesting because the 22 conditions are all clearly effectively treated by HBOT.
The last issue of Hyperbaric Medicine Today has an interesting article about how this happened. You can go read it yourself at http://www.hbomedtoday.com/PDF/HBOMT_8.pdf The article starts on page 7, you'll have to scroll down to it in the acrobat file yourself. Interesting reading.
If you'd like to read some information about HBOT by physicians who use it, try here. You can read a (relatively) short bibliography of research on HBOT here.
Here is the medicaid list of noncovered conditions:
1. Cutaneous, decubitus, and stasis ulcers
2. Chronic peripheral vascular insufficiency
3. Anaerobic septicemia and infection other than clostridial
4. Skin burns (thermal)
5. Senility
6. Myocardial infarction
7. Cardiogenic shock
8. Sickle cell anemia
9. Acute thermal and chemical pulmonary damage, i.e., smoke inhalation with pulmonary insufficiency
10. Acute or chronic cerebral vascular insufficiency
11. Hepatic necrosis
12. Aerobic septicemia
13. Nonvascular causes of chronic brain syndrome (Pick's disease, Alzheimer's disease, Korsakoff's disease)
14. Tetanus
15. Systemic aerobic infection
16. Organ transplantation.
17. Organ storage.
18. Pulmonary emphysema
19. Exceptional blood loss anemia
20. Multiple Sclerosis
21. Arthritic Diseases
22. Acute cerebral edema
As the author of the "noncovered conditions" list points out, there is no law against using HBOT for these conditions, they are merely off-label uses for HBOT. There are also articles about using HBOT for migraine and Lyme disease (which medicare presumably won't cover either, nor, by extension, would insurance companies). And since I have a special interest in MS, I dug up this page which is the beginning of a discussion on HBOT for MS.
Why do I take this interest in HBOT? I managed to get my hands on a modest chamber and have been looking into using it therapeutically.
The last issue of Hyperbaric Medicine Today has an interesting article about how this happened. You can go read it yourself at http://www.hbomedtoday.com/PDF/HBOMT_8.pdf The article starts on page 7, you'll have to scroll down to it in the acrobat file yourself. Interesting reading.
If you'd like to read some information about HBOT by physicians who use it, try here. You can read a (relatively) short bibliography of research on HBOT here.
Here is the medicaid list of noncovered conditions:
1. Cutaneous, decubitus, and stasis ulcers
2. Chronic peripheral vascular insufficiency
3. Anaerobic septicemia and infection other than clostridial
4. Skin burns (thermal)
5. Senility
6. Myocardial infarction
7. Cardiogenic shock
8. Sickle cell anemia
9. Acute thermal and chemical pulmonary damage, i.e., smoke inhalation with pulmonary insufficiency
10. Acute or chronic cerebral vascular insufficiency
11. Hepatic necrosis
12. Aerobic septicemia
13. Nonvascular causes of chronic brain syndrome (Pick's disease, Alzheimer's disease, Korsakoff's disease)
14. Tetanus
15. Systemic aerobic infection
16. Organ transplantation.
17. Organ storage.
18. Pulmonary emphysema
19. Exceptional blood loss anemia
20. Multiple Sclerosis
21. Arthritic Diseases
22. Acute cerebral edema
As the author of the "noncovered conditions" list points out, there is no law against using HBOT for these conditions, they are merely off-label uses for HBOT. There are also articles about using HBOT for migraine and Lyme disease (which medicare presumably won't cover either, nor, by extension, would insurance companies). And since I have a special interest in MS, I dug up this page which is the beginning of a discussion on HBOT for MS.
Why do I take this interest in HBOT? I managed to get my hands on a modest chamber and have been looking into using it therapeutically.
