This blog is a way of sharing the information and resources that have helped me to recover my son Roo from an Autism Spectrum Disorder. What I have learned is to view our symptoms as the results of underlying biological cause, which can be identified and healed. I say "our symptoms" because I also have a neuro-immune disorder called Myalgic Encephalomyelitis.

And, of course, I am not a doctor (although I have been known to impersonate one while doing imaginative play with my son)- this is just our story and information that has been helpful or interesting to us. I hope it is helpful and interesting to you!


Sunday, May 21, 2017

Physical and Manual Therapies

We've found, as many biomed families have, that physical and touch-based therapies are an essential part of healing and can make a profound difference in the day-to-day quality of life of a person.  The better known therapies and techniques include physical therapy, occupational therapy, chiropractic, and yoga.  Each is somewhat different and better suited to some people more than others.  There are so many different methods and with some research and trial-and-error it seems that many people find at least one method that helps significantly.  I am including links below to the various therapies that I'm familiar with, but first a little inspiration and reminder about possibilities:

This beautiful and flexible dance is performed by a woman who fell 40 feet while mountain climbing and was told that she would never walk again, let alone dance.  I don't know what she did as far as treatment (but I will try to find out!) because her healing and abilities now are absolutely amazing.



Real Bodywork
This is a site that has a lot of resources for many different treatment modalities including how-to videos, posters, articles, apps, etc.

Myofascial Release
"Myofascial Release is a safe and very effective hands-on technique that involves applying gentle sustained pressure into the Myofascial connective tissue restrictions to eliminate pain and restore motion. This essential “time element” has to do with the viscous flow and the piezoelectric phenomenon: a low load (gentle pressure) applied slowly will allow a viscoelastic medium (fascia) to elongate.  Trauma, inflammatory responses, and/or surgical procedures create Myofascial restrictions that can produce tensile pressures of approximately 2,000 pounds per square inch on pain sensitive structures that do not show up in many of the standard tests (x-rays, myelograms, CAT scans, lectromyography, etc.)"

CranioSacral Therapy
"CST is a gentle, hands-on method of evaluating and enhancing the functioning of a physiological body system called the craniosacral system - comprised of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. Using a soft touch generally no greater than 5 grams, or about the weight of a nickel, practitioners release restrictions in the craniosacral system to improve the functioning of the central nervous system."

Lymphatic Drainage
"Lymphatic drainage massage is a profound technique to help increase lymph flow. With an increase of lymph flow immune function is increased. Harmful substances are removed from the tissues and neutralized in the nodes. It has also been shown that an increase in lymph flow stimulates an increased production of lymphocytes- enhancing immune function."
     Lymph Drainage for Detoxification
     How to do Self-Lymphatic Drainage to help manage lymphedema

Strain/Counterstrain (also called Positional Release)

Bendable Body

MELT

Feldenkreis
     “She will dance at her wedding”: Healing the girl born without part of her brain

Kinesthetic Storytelling (and the healing power of light touch)
     This is a TED talk called "The Curative Touch of a Magic Rainbow Hug"

Qi Gong and Qi Gong Massage

Mayan Abdominal Massage
"The Arvigo® techniques were developed by Dr. Rosita Arvigo, DN. based on her apprenticeship with the Maya healer Don Elijio Panti and her own education, training, and research as a naprapathic physician. Rosita's lifework, THE ARVIGO TECHNIQUES OF MAYA ABDOMINAL THERAPY®, help to restore the body to its natural balance by correcting the position of organs that have shifted and restrict the flow of blood, lymph, nerve and chi energy. Today the Arvigo® techniques are employed by Arvigo® Practitioners across the globe bringing the benefits of natural healing to their clients."

Dystonia. Rewiring the brain through movement and dance | Federico Bitti | TEDxNapoli
I don't know if this type of therapy has a name, but it is a movement-based approach to treat the spastic movements, pain, cramping, tremors, and frozen muscles that are the hallmark of various movement disorders such as Dystonia. In the case of the speaker at least, it gave him control of his body back and freedom from pain.  This is the presentation given by the man who developed this approach: How your movements can heal your brain | Joaquin Farias | TEDxNapoli
Brain Therapy This is supposedly a further use and development of lymphatic drainage similar to CranioSacral Therapy; however it claims to actually work on the membranes inside the head (such as the Dura mater and Pia Mater) as well as the brain itself.  Honestly, I have no idea how this would work, but it is a very intriguing.

Friday, May 19, 2017

Living With And Overcoming Brain and Neurological Injury

My Beautiful Broken Brain
This video documentary was made by a young woman who suffered a massive stroke, and chronicles her experiences, therapies, and progress in trying to recover as much as she can.  It also provides a powerful window into what life is like for her after the stroke and how it has affected how she sees the world and how she functions in it.

The Real Sleeping Beauty (Medical Miracle Documentary) - Real Stories
This is the story of a woman who came out of a coma after 20 years and began to speak again.  This is almost unheard of and it's not clear why she was able to do it, but it does offer hope that there are more possibilities for healing from brain injury than had previously been thought.

Empowering the Mind to Heal the Brain for Stroke | Dr. Eric C. Leuthardt 
This man gives a talk describing a therapeutic device that he created to help people who have lost some motor function due to a stroke.  It helps the brain learn a new way to control motor movement that has been lost.  This is a new technology that has not been thoroughly studied yet, but so far the results are impressive and people using the device have regained abilities that doctors have considered not possible.

Dystonia. Rewiring the brain through movement and dance | Federico Bitti
This man tells us what developing Dystonia, a neurological movement disorder, felt like and how life limiting it was.  He tried several of the conventional treatments but the disorder continued to worsen.  He did not want to undergo the very invasive brain surgery that was his only option, according to his specialist.  Instead he found someone who was developing a treatment modality based in neuroplasticity- retraining the brain with a customized program of exercises and movements that gave Mr. Bitti back much of the control over his body so that he regained many of the abilities that he had lost.  He then accidentally stumbled onto another way to overcome the remaining symptoms; he discovered that dancing was for him a very powerful way to work with his body and continue to heal.  What it also gave him back was a way to enjoy being in his body again.  For people who lose basic motor function, the experience of physicality- of being in your body- can become so unpleasant, it can feel like fighting a losing battle, and it cannot be emphasized enough how much this affects quality of life.  Finding ways to work with your body and to enjoy movement again can make a profound difference.  As Mr. Bitti says, it can be a way to find your bit of paradise inside of the hell of the movement disorder.


Saturday, March 18, 2017

D.I.Y. Home Remedies

Making our own versions of commercial products such as personal care products, cleaning products, and OTC medications and treatments is one way to significantly lower our exposure to the harmful ingredients that are commonly in the commercial versions of these products.  Homemade products are often less expensive and may also provide more options for addressing our health needs.

GENERAL SOURCES



REPLACEMENTS FOR PERSONAL CARE PRODUCTS

Baking soda and vinegar can be used as shampoo and conditioner.

How to make your own lipstick

How to make bug repellent

How to make rose oil (or other flower oil)

How to make your own deodorant

How to make sunscreen

This is a recipe to make herbal lip balm

How to make your own hairspray

REPLACEMENTS FOR HOUSEHOLD AND CLEANING PRODUCTS

A piece of aluminum foil can replace a dryer sheet for stopping static cling.

REPLACEMENTS FOR OTC HEALTH AND MEDICAL PRODUCTS

Recipe for homemade electrolyte drink

How to make calcium supplements from eggshells

How to make your own Vick's-style vapor rub
(For more on the harmful effects of Vick's VapoRub and why you would want to make your own, read this article)

IMMUNE SYSTEM SUPPORT

Using honey and mead to treat infections

Probiotics can be used to fight a sinus infection

This post describes how one person used ACV (apple cider vinegar) to remove a mole

This tonic made from garlic, raw honey and ACV is a general immune booster



NATURAL TREATMENTS

How to use ear candles

Vaginal steaming to support the female reproductive system

CLEAN AIR

This post has a link that shows you how to make a HEPA air filter out of inexpensive parts available at the hardware store.

NASA guide to plants that clean the air

15 House Plants You Can Use As Air Purifiers

Smudging eliminates harmful bacteria from indoor spaces

Thursday, March 9, 2017

The Movie Shelf

This is a collection of documentary movies and films (that are available online) and relevant to the topics discussed in this blog.

FOOD, NUTRITION, AND THE FOOD SUPPLY:

King Corn

Supersize Me

Food, Inc

AUTISM

Autism Yesterday is a short film about kids recovering from autism with biomed treatments.

Autism - Made in the U S A by Gary Null

Wretches and Jabberers

Temple Grandin

PANDAS/PANS

My Kid is Not Crazy (this is a film being made about PANDAS/PANS)

Unstuck- An OCD Kids' Movie

THE MEDICAL AND PHARMACEUTICAL INDUSTRY

Making Rounds: Medical Education Film.  This is an excellent presentation of what it looks like when very skilled and compassionate doctors go on rounds- how they ask questions to quickly discover relevant medical history, and how they use keen observation of the patients to find clues as to what might be the problem.

Off Label

Undoctored

VACCINES

VAXXED: From Cover Up to Catastrophe

The Greater Good

Shots In The Dark: Silence on Vaccines

The Hidden Truth (Australian movie)

Direct Order (about soldiers forced to take the Anthrax vaccine and were injured by it)

Vaccine Nation

Silent Epidemic; The Untold Story of Vaccines

CHEMICALS AND OTHER TOXINS

Chemerical

The Human Experiment

The Poisoner's Bible is an episode of the PBS show American Experience.  From the site:
"In the early 20th century, the average American medicine cabinet was a would-be poisoner's treasure chest, with radioactive radium, thallium, and morphine in everyday products. The pace of industrial innovation increased, but the scientific knowledge to detect and prevent crimes committed with these materials lagged behind until 1918. New York City's first scientifically trained medical examiner, Charles Norris, and his chief toxicologist, Alexander Gettler, turned forensic chemistry into a formidable science and set the standards for the rest of the country."
This show is very relevant to anyone interested in toxic exposures and the health effects that can result, as well as some of the history of government involvement (or lack of involvement) in regulating toxins and our exposure to them.

The Disappearing Male “The Disappearing Male is about one of the most important, and least publicized, issues facing the human species: the toxic threat to the male reproductive system. The last few decades have seen steady and dramatic increases in the incidence of boys and young men suffering from genital deformities, low sperm count, sperm abnormalities and testicular cancer. At the same time, boys are now far more at risk of suffering from ADHD, autism, Tourette's syndrome, cerebral palsy, and dyslexia.

The Disappearing Male takes a close and disturbing look at what many doctors and researchers now suspect are responsible for many of these problems: a class of common chemicals that are ubiquitous in our world. Found in everything from shampoo, sunglasses, meat and dairy products, carpet, cosmetics and baby bottles, they are called "hormone mimicking" or "endocrine disrupting" chemicals and they may be starting to damage the most basic building blocks of human development.“


SPECIFIC DISEASES AND CONDITIONS

My Beautiful Broken Brain is a film about a young woman working to recover from a severe stroke. It is currently available on Netflix.

Issues With My Tissues is about a woman with Vascular EDS as she works to reach her goal of walking the entire London Marathon.  It's a good window into daily life with EDS.

TREATMENTS AND THERAPIES

Dying to Have Known (film about Gerson Therapy)

The Beautiful Truth (also about Gerson Therapy)

EDUCATION

Class Dismissed is a film about homeschooling.

The War on Kids

FICTION

Awakenings

Cake


Psychedelics as Mental Health Treatment

Mental health is an area of western medicine where there still aren't many treatment options, and many people are helped only somewhat or not at all by what's available.  Recently research into the use of psychedelic drugs for legitimate therapeutic purposes has started up again after being more or less abandoned during the 60s and 70s.  Below is a TED talk about the use of LSD and psilocybin to treat Treatment-Resistant Depression and PTSD.  So far both drugs are showing promise which is  exciting because in the cases of both PTSD and Depression, many patients don't



From the article "Could a Club Drug Be the Secret to Curing PTSD?" that has just appeared in the March issue of Elle magazine:

"Ever since Richard Nixon signed the Controlled Substances Act in 1970, prohibiting the use of almost all psychedelics for any purpose, most scientists have regarded consciousness-altering drugs warily, if they thought about them at all. But as the war on drugs wanes and failures of U.S. drug policy become increasingly clear (witness the opioid epidemic), scientists are revisiting research on psychedelics. There are the studies of MDMA for PTSD, and scientists have also begun exploring the drug's potential to treat addiction, depression, and severe anxiety in adults with autism. Other psychedelics are also yielding promising lab results, including psilocybin (the active ingredient in so-called magic mushrooms), which teams of researchers from Johns Hopkins and New York University found can reduce anxiety and depression in cancer patients."

"Before Ecstasy became famous in the 1990s as the street drug of choice among ravers and curious college kids, a loosely knit network of psychiatrists and psychologists experimented with giving patients medical-grade MDMA, a synthetic compound originally developed by a Merck chemist in the early 1900s, to treat anxiety and depression."

"So far, 77 percent of the participants who have received MDMA in the Boulder pilot no longer meet the diagnostic criteria for PTSD, according to Marcela Ot'alora, the study's lead investigator. After another clinical trial in Charleston, South Carolina, a similar effect was seen in 83 percent of the group that received MDMA treatment (compared to just 25 percent of the group who received talk therapy alone). Perhaps most encouragingly, three and a half years after the Charleston study was completed, the benefits largely held: Three-quarters of the MDMA-treated patients who'd been deemed clinically free of PTSD remained free of it,"

Friday, March 3, 2017

Kounis Syndrome (Allergic Heart Attack)


The correlation between allergic reactions and cardiac symptoms was first officially noted in 1950 during an allergic reaction to penicillin.  Since then, this correlation has been noted at other times, but it wasn't until 1991 when Dr Kounis brought attention to the phenomenon that it started getting more recognition.  Kounis Syndrome (KS) refers to the situation in which an allergic reaction progresses to involve significant cardiac distress that can be an actual heart attack (Myocardial Infarction) or a spasming of the coronary artery that is very similar to a heart attack   Sometimes the chest pain associated with allergic reactions is called Allergic Angina.

The majority of Kounis Syndrome cases occur in Spain, Italy, Greece, and Turkey.  In these areas Kounis Syndrome is seen in about 1 in 5 coronary events.  It seems likely that this reflects a much more widespread awareness of this disorder in these countries, so it seems likely that the rate of Kounis Syndrome in the US is probably much higher than currently thought.  Without recognition of
the relationship between allergic reactions and coronary symptoms, people prone to Kounis Syndrome will continue to have these dangerous attacks until their allergic problems are managed better. KS has been documented in both children and adults.

Medscape explains a Kounis Syndrome episode in more detail:
"The pathophysiologic characteristics of KS involve coronary artery spasm and/or atheromatous plaque erosion or rupture during an allergic reaction. Coronary spasm is the result of local
hyperreactivity of a coronary segment to a vasoconstrictor stimulus.[1] The exact mechanisms resulting in vasospastic angina have not been fully established. It has been postulated that endothelial injury and hypercontractility of vascular smooth muscle may be the result of vasoconstrictor mitogens, leukotrienes, serotonin, endothelin, angiotensin II, histamine, and higher local concentration of blood-borne vasoconstrictors in areas adjacent to neovascularized atherosclerotic plaque.[15]"

There are 3 types of Kounis Syndrome:
-the first type is when the patient does not have existing coronary artery disease, but the mediators released during a mast cell reaction induce spasms in the coronary artery.  This can feel and look like a heart attack but does not always leave behind traces of evidence such as elevated enzyme levels.
-in the second type there is pre-existing atherosclerosis, which can be loosened and freed by the coronary spasms and this can then cause an actual Myocardial Infraction.
-in the third type, the person has a stent and the stent becomes occluded due to inflammation from histamine.  Since most stent-associated occlusions occur soon after they are placed, suspect this if the occlusion occurs long after the stent is placed.

Medscape provides more detail about the first two types:
Type 1 "is the occurrence of chest pain during an acute allergic reaction in patients without predisposing factors for coronary artery disease. An acute allergic event induces coronary artery spasm, resulting in chest pain and ischemic electrocardiographic changes, and the cardiac enzymes can either be normal or reflect progression to an acute myocardial infarction.[6,11] These cases have a normal myocardial perfusion scan, normal coronary angiogram, and positive ergonovine test.[11] The explanation for this type would be endothelial dysfunction or microvascular angina.[12]"

Type 2 "is the occurrence of chest pain in patients with angiographic evidence of coronary artery disease during an acute allergic reaction.[6,11] This type includes patients with quiescent pre-existing atheromatous disease, in whom an acute allergic episode can induce plaque erosion or rupture manifesting as an acute myocardial infarction.[1,6,12]"

More from Medscape "Histamine not only constricts the coronary arteries, but also sensitizes the nerve endings adjacent to adventitial mast cells in atherosclerotic coronary arteries.[20] Cardiac histamine acts via four different histamine receptors, and each receptor can contribute to the severity of the allergic myocardial damage. The H1 receptor mediates coronary vasoconstriction, while the H2 receptor mediates a minor degree of coronary relaxation. The interaction between H1 and H2 causes a decrease in diastolic blood pressure and an increased pulse pressure. H3 inhibits the endogenous norepinephrine release (enhancing the degree of shock observed during allergic reactions), and finally the H4 receptor regulates the chemotaxis of mast cells, eosinophils, and lymphocytes, causing change in the shape of eosinophils and upregulating adhesion molecules.[6,13,20]"

"Not all patients suffering from an allergic reaction develop an acute coronary event. What determines the development of KS remains unclear; however, it has been suggested that there is a threshold level of mast cell activation and mediator release above which the coronary artery spasm and plaque erosion or rupture occurs. This threshold level would be closely linked to the body site where the antibody-antigen reaction occurs, the area of exposure, mediator release, and, of course, the severity of the allergic reaction.[19,23]"


Detecting and Diagnosing Kounis Syndrome

Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management
"Recent research has shown that Kounis-like syndromes can affect the mesenteric and cerebral arteries. The coronary arteries, the heart and the entire arterial system seem to be vulnerable to allergic, hypersensitivity, anaphylactic, and/or anaphylactoid events and physicians should be alert for its consequences."

"The diagnosis of Kounis syndrome is based on clinical symptoms and signs as well as on laboratory, electrocardiographic, echocardiographic and angiographic evidence. A variety of these findings might accompany allergic symptomatology that helps in putting the correct diagnosis. Recently, modern tools such as cardiac magnetic resonance imaging and myocardial scintigraphy have helped to confirm the diagnosis. A high index of suspicion is of paramount importance. Therefore, patients with systemic allergic reactions associated with clinical, electrocardiographic and laboratory findings of acute myocardial ischemia should be suspected as having Kounis syndrome."

In patients with type I variant, treatment of the allergic event alone can abolish symptoms. The use of intravenous corticosteroids such as hydrocortisone at a dose of 1–2 mg/kg/day and H1 and H2 antihistamines such as diphenhydramine at a dose of 1–2 mg/kg and ranitidine at a dose of 1 mg/kg are adequate. The administration of vasodilators such as calcium channel blockers and nitrates can abolish hypersensitivity induced vasospasm. Calcium channel blockers can induce minor skin rash and angioedema is extremely uncommon. However, nitroglycerin can causes hypotension and tachycardia that may further complicate anaphylactic reaction. In addition, although uncommon, allergic reactions to nitroglycerin such as urticaria and contact dermatitis can occur especially with the transdermal use of nitroglycerin. Most patients with these reactions have tolerated oral and sublingual nitroglycerin. Therefore, the use of intravenous or sublingual nitroglycerin seems reasonable and safe in patients with Kounis syndrome if the blood pressure is satisfactory. Bolus administration of antihistamines can precipitate hypotension and compromise coronary flow; therefore, these drugs should be given slowly."

"In patients with type II variant, treatment should be initiated with an acute coronary event protocol together with corticosteroids and antihistamines. Vasodilators such as nitrates and calcium blockers are given when these are necessary. The use of b-blockers can exaggerate coronary spasm due to unopposed action of a-adrenergic receptors. Epinephrine which is the drug of choice and can save lives in anaphylaxis, but in Kounis syndrome can aggravate ischemia and worsen coronary vasospasm. In severe cases sulfite free epinephrine is preferable to be given intramuscularly because it has faster onset of action and more sustained levels as compared with the subcutaneous route (recommended intramuscular doses 0.2–0.5 mg [1:1000]). Aqueous solution is preferable. In patients with previous history of coronary heart disease, who receive b-blockers, epinephrine may be ineffective. It may also induce more vasospasm due to unopposed a-adrenergic effect. In this case glucagon infusion (1–5 mg, intravenously over 5 min, followed by infusion 5–15 μg/min) can be used for patients who are already on beta-blockers or received them during the management of the acute coronary syndrome. Methoxamine, a potent alpha agonist, can also be considered in patients who do not respond to epinephrine. Opiates such as morphine, codeine and meperidine given to relieve acute chest pain should be administered with extreme caution in patients with Kounis syndrome, since they can induce massive mast cell degranulation and aggravate allergic reaction. Acetaminophen (paracetamol) is not recommended, especially its intravenous administration, because it might cause severe hypotension due to reduction of cardiac output. Fentanyl and its derivatives show slight mast cell activation and are preferable."


The utility of cardiac magnetic resonance imaging in Kounis syndrome.
"Dynamic cardiac MR imaging is a reliable tool for assessing cardiac involvement in Kounis syndrome. Delayed contrast-enhanced images show normal washout in the subendocardial lesion area in patients with Kounis syndrome type 1."

Two questions for Kounis syndrome: can we use magnetic resonance imaging in the diagnosis and does ST elevation correlates with troponin levels?
"These cases showed that there seems to be no correlation with ECG and troponin levels in KS. In addition, for patients in whom KS type 1 is expected without troponin elevation, noninvasive cardiac magnetic resonance imaging study seems to be appropriate for the diagnosis of KS."

Prevention and Treatment

As with any mast cell disease, identifying and avoiding triggers is essential, but this may not be easy since there are so many things that can trigger a Kounis Syndrome episode.

Coronary Hypersensitivity Disorder: The Kounis Syndrome
This article has a relatively long section about treatment for each type of Kounis Syndrome.

Stress triggers coronary mast cells leading to cardiac events.
"Stress can precipitate allergies and ACS. Stress stimulates MCs through the activation of high-affinity surface receptors for CRH, leading to a CRH-dependent increase in serum IL-6. Moreover, neurotensin secreted with CRH from peripheral nerves augments the effect of CRH and stimulates cardiac MCs to release IL-6, which is elevated in ACS and is an independent risk factor for myocardial ischemia. MCs also secrete CRH and uroctortin, which induces IL-6 release from cardiomyocytes. The presence of atherosclerosis increases the risk of cardiac MC activation owing to the stimulatory effect of lipoproteins and adipocytokines. Conditions such as Kounis syndrome, mastocytosis, and myalgic encephalopathy/chronic fatigue syndrome are particularly prone to coronary hypersensitivity reactions. Inhibition of cardiac MCs may be a novel treatment approach."

Drugs that may provoke Kounis Syndrome
"KS has been increasingly reported in the literature and has been linked with several conditions, environmental exposures and a variety of drugs, leading many experts to believe that KS is not rare, only "rarely diagnosed". Also:

"Treatment may be challenging because it needs to consider both cardiac and allergic symptoms simultaneously, and the drugs administered for these manifestations can aggravate an allergic reaction and heart function. Cevik et al. have summarized recommendations concerning the treatment of KS from available data, since most information about KS comes from case reports. The authors argue that:

1) Aspirin has the potential risk of aggravating an ongoing anaphylactic reaction since it might shunt arachidonic acid into the leukotriene pathway with overproduction of leukotrienes. Therefore, the utility of aspirin in patients with KS is unknown.

2) Nitroglycerin causes hypotension and tachycardia, which may further complicate anaphylactic reaction, but seems safe in KS if blood pressure is satisfactory.

3) Beta-blockers may induce more vasospasm due to unopposed α-adrenergic effect and may offset some of the beneficial effects of epinephrine.

4) Coronary spasm is very responsive to calcium channel blockers, so they may be considered the initial anti-ischemic drug of choice in patients with KS.

5) Morphine and meperidine should be used cautiously since these opiates can induce mast cell degranulation and aggravate the allergic reaction. Fentanyl and its derivatives show only a slight activation of mast cells and may be the drugs of choice when narcotic analgesia is necessary.

6) Corticosteroids have a major role in the treatment of allergic reactions, and may prevent recurrent or protracted anaphylaxis. A meta-analysis of the studies of corticosteroid treatment in acute MI reported no harm and possible mortality benefit with these drugs in this setting. Therefore, their use is probably safe and appropriate.

7) Epinephrine is the drug of choice in anaphylaxis, but in KS the risks may outweigh the benefits. Epinephrine can aggravate the ischemia as well as induce coronary vasospasm and arrhythmias. The majority of epinephrine preparations contain sulfite which itself may trigger anaphylaxis in sensitive individuals. It may also promote more vasospasm secondary to unopposed alpha-adrenergic effect in patients who have received beta-blocking agents. More case studies are needed to establish the appropriate use of epinephrine in patients with KS.

8) Mast cell membrane stabilizers may be considered in KS."

The more allergens an atopic patient is exposed to, the easier and quicker anaphylactic shock and Kounis syndrome appear: Clinical and therapeutic paradoxes.
"Clinical and therapeutic paradoxes concerning Kounis syndrome therapy, pathophysiology, clinical course and causality have been encountered during its clinical course. Drugs that counteract allergy, such as H2-antihistamines, can induce allergy and Kounis syndrome. The more drugs an atopic patient is exposed to, the easier and quicker anaphylaxis and Kounis syndrome can occur. Every anesthetized patient is under the risk of multiple drugs and substances that can induce anaphylactic reaction and Kounis syndrome. The heart and the coronary arteries seem to be the primary target in severe anaphylaxis manifesting as Kounis syndrome. Commercially available adrenaline saves lives in anaphylaxis but it contains as preservative sodium metabisulfite and should be avoided in the sulfite allergic patients."


Kounis Syndrome (MedScape)

Kounis syndrome; South Med J. 2010 Nov;103(11):1148-55.

Current understanding of Kounis syndrome
"Inflammatory mediators, adhesion molecules of neutrophils and monocytes, have been shown to be increased in the plasma of patients presenting with acute coronary syndromes. Anaphylaxis is a systemic, immediate hypersensitivity reaction caused by rapid IgE-mediated release of mediators from mast cells and basophils. Kounis syndrome is the coincidental occurrence of these two distinct conditions accompanied by clinical and laboratory findings of angina pectoris caused by inflammatory mediators released during an allergic insult. Allergic angina can progress to acute myocardial infarction, which is termed 'allergic myocardial infarction'. There are several causes reported to be capable of inducing Kounis syndrome. These include a number of conditions, several drugs, foods and insect stings, among others. In this article, the clinical aspects, diagnosis, pathogenesis, incidence and epidemiology, related conditions and therapeutic management of this important syndrome are discussed."

"We present three cases of anaphylactic acute coronary syndrome that display different clinical variants of this phenomenon. The main pathophysiological mechanism of the allergic anginal syndromes is the inflammatory mediators released during a hypersensitivity reaction triggered by food, insect bites, or drugs. It is important to appropriately recognize and treat Kounis syndrome in patients with exposure to a documented allergen."


Sunday, February 26, 2017

Problems with the Medical System in the US

In the US, we pay more for our medical care compared to every other country, yet we as a nation keep getting sicker. We have higher rates of many diseases than countries that spend just a fraction of what we do on medical care. The infant mortality rate in the US is embarrassingly high- we rank among third world nations. Something is deeply wrong at the heart of this system- well, many things, on pretty much every level. People are getting sicker, many patients have complex health issues that often go undiagnosed and untreated for years, doctors and other medical personnel are burned out. Many "new" diseases are being "discovered", known diseases that were once rare are becoming more common, and for those of us in this boat it is especially obvious that this medical system is not set up to handle any of this.

The Big Picture:

Being American Is Bad for Your Health
"Americans under age 75 fare poorly among peer countries on most measures of health. This health disadvantage is particularly striking given the wealth and assets of the United States and the country's enormous level of per capita spending on health care, which far exceeds that of any other country."

Living Sick and Dying Young in Rich America
"But it’s not just that Americans are getting sicker—it’s that young Americans are getting sicker. A 2013 report by the National Research Council and Institute of Medicine (NAC/IOM) echoes the shock of that fact. “The panel was struck by the gravity of its findings,” it reads. “For many years, Americans have been dying at younger ages than people in almost all other high income countries.”

The US Health Disadvantage Relative to Other High-Income Countries: Findings From a National Research Council/Institute of Medicine Report
"The United States spends more on health care than does any other country, but its health outcomes are generally worse than those of other wealthy nations. People in the United States experience higher rates of disease and injury and die earlier than people in other high-income countries. Although this health disadvantage has been increasing for decades, its scale is only now becoming more apparent."

"The scope of the US health disadvantage is pervasive and involves more than life expectancy: the United States ranks at or near the bottom in both prevalence and mortality for multiple diseases, risk factors, and injuries."


Shorter Lives, Poorer Health: Panel on Understanding Cross-National Health Differences Among High-Income Countries
(This is the report made by National Research Council and The Institute of Medicine that is referenced in the articles above.)

What vets know and physicians don't
Bias, Prejudice, and Abuse of Patients:

Being a Good Girl Can Be Hazardous to Your Health

We Cannot Continue to Let Doctors 'Gaslight' Chronic Illness Patients

For people with disabilities, doctors are not always healers
"As with James, patients may have unnecessary tests ordered because of their disability. Doctors and nurses label this approach “veterinary medicine.” In other words, just as for an animal that can’t speak for itself, they order tests rather than talk to patients who are perceived as being “slow” or “difficult.” These patients often receive inadequate care: Either doctors can’t see past the disability and attribute all problems to it, or they fail to acknowledge the true impact of these impairments.

Numerous reports have documented that people with disabilities have poorer health and receive inferior health care."


The Danger of Treating ER Patients as Drug Seekers
"Recently the news has been covering the story of Barbara Dawson, a Florida woman who was arrested after she refused to leave a hospital that would not treat her for abdominal pain. While being escorted from the hospital in handcuffs, she collapsed in the parking lot and later died."

Detroit EMT fired for refusing to help save distressed 8-month-old baby that died next day


Systemic Problems (shortages, incompetence, etc)

Drug Shortages Forcing Hard Decisions on Rationing Treatments
"In recent years, shortages of all sorts of drugs — anesthetics, painkillers,antibiotics, cancer treatments — have become the new normal in American medicine. The American Society of Health-System Pharmacists currently lists inadequate supplies of more than 150 drugs and therapeutics, for reasons ranging from manufacturing problems to federal safety crackdowns to drug makers abandoning low-profit products. But while such shortages have periodically drawn attention, the 
rationing that results from them has been largely hidden from patients and the public."

The Breakdown in Biomedical Research
"Contaminated samples, faulty studies and inadequate training have created a crisis in laboratories and industry, slowing the quest for new treatments and cures"

A doctor with a chronic health condition describes just how hard it can be to get a routine prescription filled for a long-term medication.

Bacteria infected 10 infants at UC Irvine hospital, but the public is just finding out

Evidence of the Superiority of Female Doctors
Not all medical care is equal in quality, and steps could be taken to improve the quality of doctor care, which would limit mortality and morbidity.

The System is Also Not Working Well for Many Doctors and Other HCPs

Why Doctors Kill Themselves TED talk

Let Doctors Be Doctors
There is starting to be a movement by doctors and other health care personnel to move away from the intensive use of EHR (electronic health records) , particularly in settings such as the ER in which the need to keep up with the EHR can be dangerously distracting for providers.  There are many other reasons why this is an issue, and they are covered in a funny parody song by ZDoggMD (a med student, possible doctor now, and the founder of the Let Doctors Be Doctors movement (he also does a mean Darth Vader as Doc Vader).

Are clinical practice and public health policies actually supported by current evidence?

"For all the truly wondrous developments of modern medicine—imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few—it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable—or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades."

Pharma's Undue Influence on Clinical Practice

Transparency in medicine Dr Wen

Pharmaceutical advertisements in leading medical journals: experts' assessments.
"In the opinion of the reviewers, many advertisements contained deficiencies in areas in which the FDA has established explicit standards of quality. New strategies are needed to ensure that advertisements comply with standards intended to promote proper use of the products and to protect the consumer."

Accuracy of pharmaceutical advertisements in medical journals.
"Doctors should be cautious in assessment of advertisements that claim a drug has greater efficacy, safety, or convenience, even though these claims are accompanied by bibliographical references to randomised clinical trials published in reputable medical journals and seem to be evidence-based."

Medical Costs and Insurance

The case of the $629 Band-Aid — and what it reveals about American health care
We have all experienced the bizarrely high prices charged for many medical services and devices, and I think we can all relate to the parent who wrote this article about the absurdity of medical pricing.

A Giant Pain in the Wallet
How an effort by the FDA to evaluate drugs that have been on the market since before testing was required has allowed pharmaceutical companies to price-gauge patients.

The U.S. Health Care System: An International Perspective
"This fact sheet will compare the U.S. health care system to other advanced industrialized nations, with a focus on the problems of high health care costs and disparities in insurance coverage in the U.S. It will then outline some common methods used in other countries to lower health care costs, examine the German health care system as a model for non-centralized universal care, and put the quality of U.S. health care in an international context."

"The OECD found that in 2013, the U.S. spent $8,713 per person or 16.4 percent of its GDP on health care—far higher than the OECD average of 8.9 percent per person. Following the U.S. were the Netherlands, which allocated 11.1 percent of its GDP, then Switzerland also at 11.1 percent, and Sweden, which allocated 11 percent of its GDP to health care in 2013. In North America, Canada and Mexico spent respectively 10.2 percent and 6.2 percent of their GDP on health care."

"On a per capita basis, the U.S. spends more than double the $3,453 average of all OECD countries."


The Reason Health Care Is So Expensive: Insurance Companies
"But the thing that few people talk about, and that no serious policy proposal attempts to fix—the arrangement that accounts for much of the difference between health spending in the U.S. and other places—is the enormous administrative overhead costs that come from lodging health-care reimbursement in the hands of insurance companies that have no incentive to perform their role efficiently as payment intermediaries."

"Because insurers are paid a fixed percentage of the claims they administer, they have no incentive to hold down costs. Worse than that, they have no incentives to do their jobs with even a modicum of competence."




Are Things Changing?

What Veterinarians Know That Physicians Don't
This is a TED talk given by Barbara Natterson-Horowitz (Professor of Medicine in the Division of Cardiology at UCLA Medical School), in which she argues that human medical treatment could be improved if doctors thought of patients as "human animals".  She argues that while animal bodies are can be very different from each other, thinking in terms of similarities could open up many options and treatments that are routinely used on animals but no one ever thought to try for humans.  This change in paradigm may not be so easy to manifest, as there is a rampant culture of "human exceptionalism" in conventional medicine and a corresponding arrogance on the part of MDs that can interfere with doctors providing the best care.

IBM's Watson learning to diagnose cancer