What's the deal with the flu shot recommendations?
Tuesday, November 25, 2008 Filed in:
Medical
The flu season is approaching and
people are starting to ask about getting the flu shot. The
CDC recommendations came out a couple months ago and
claimed that there are 36,000 deaths annually from the flu so
everyone should get flu shots. I’ve become a bit skeptical of
these recommendations.
Do you remember back in 2004 when one of the factories (Chiron) that made flu shots had a problem and had to junk its entire output for the year? At that point, there was only enough demand to justify 2 companies making the entire amount for the whole country. One factory can't meet its amount for the year and then suddenly there's not enough and all the "health authorities" go into a tizzy about the lack of flu shots. Fewer people got vaccinated and nothing much in reality changed: no bump in flu deaths or anything.
Now, in order to reduce the risk of this happening again, we need to have more places making it, but in order to get that to happen, there has to be more demand. How do you do that? Expand the criteria for who needs one and then stir up the fear about flu so the people are frothing at the mouth to get a shot. So, rather than shot recommendations based on valid health concerns, the recommendation becomes based on economic concerns.
Frankly, the original recommendations for flu vaccine are the only ones that are supportable: for people for whom a flu would be enough to push them over the edge (frail, nursing homes, etc.) and the people who care for them. Everyone else was gravy for the vaccine makers. Expanding the definition of who needs it to "chronic disease" and huge swaths of ages covers a much bigger chunk of the population and ensures enough of a demand to justify more manufacturers.
As far as the recommendation for children and pregnant women, it's unconscionable to inflict further vaccines onto an already overburdened childhood vaccine schedule when the justification is ensuring a demand for flu shots. Even worse is giving thimerasol-containing vaccine to pregnant women: the developing fetal brain is particularly vulnerable to the ethyl mercury in the vaccine.
Even for the targeted population, the shot is of questionable utility. The virus that the flu shot protects against covers only a small proportion of the things people get sick with and call "the flu", and the match between the vaccinations and the strains that go around every year aren't very good: after the season is over they invariably say "well, it was only a partial match for what actually went around." One study demonstrated that the vaccine only reduced the severity of the flu but slightly increased the incidence of it in the people who got the vaccine.
This article summarizes the data on the effectiveness of the vaccine in adults as only 30% effective in preventing flu-like illness and didn’t affect the hospitalization rate overall nor the amount of time off work. In the elderly (65 and over), this article shows that in the community (most people who would be reading this, as opposed to institutionalized in a nursing home or hospital) the flu vaccine is not significantly effective against the flu, flu-like illness, or pneumonia. However, for people who are institutionalized, there does seem to be a clear benefit.
Now, I know people still like to reduce their risks of getting something that may knock them out for a week or so, so for a couple years I tried to get the vaccine, but I wasn't willing to put mercury into people's bodies to do it. To that end I tried to pre-order "preservative-free" vaccine for the upcoming flu season (buying flu vaccine is like getting rock concert tickets: the sales open and everyone rushes to snatch stuff up), but every time all the preservative-free stock was snatched up leaving only the exact same stuff with thimerasol in it left available (and this is before the stuff has even been made: why can't they just change the supply to meet the demand?). The first year I discovered that at the end of the season there was some preservative-free stuff left over, which I got and made available. I haven't been able to get it since, so I gave up.
So if you are determined to get the vaccination, I would try to get the preservative-free stuff (which Kroger claimed to have last winter). Otherwise, being sure you have enough vitamin D (check a 25-OH vitamin D level and get it well into the normal range, I like to get it to 50 ng/dl or more) and take vit C at least daily.
Am I recommending not to get the vaccine? No, I'm just trying to add some perspective so people can make their own decisions. For most people it isn't a matter of life and death and it comes down to if it will make your life easier. Read the fourth paragraph before this one (especially the last sentence) and make your decision.
If you want some perspective of the risk of death from influenza, it's a little obfuscated by combining it with deaths from pneumonia (which is much deadlier in general than influenza) in the data available from the CDC for 2002 here, but let's do the best we can. Incidentally, this report gives the total number of flu/pneumonia deaths for 2002 as 65,681, so I have to say I'm skeptical of the number of influenza deaths given in the CDC/MMWR report (35,000) and, indeed, looking at the references it cites, it appears the authors misread the article and used the number for chronic disease-related deaths rather than the influenza-related deaths which is less than 1/3 of the number: 8,097. This, then, implies that less than 1/4 (actually only 12.3%) of the flu/pneumonia deaths are actually from the flu, so we'll use this number.
So, in the age 1-4 group (for which universal annual flu vaccination is recommended) the combination for flu and pneumonia accounted for 110 deaths in 2004, while the US population aged 1-4 was nearly 16 million. Thus, assuming _all_ the deaths were from flu, there would be ~150,000 children vaccinated to prevent one death (assuming that vaccinations would be 100% effective in preventing death from the flu, which is unlikely considering the matches generally are 50% or less). Far more likely, less than 25% of the kids' deaths were from the flu and it is less than 50% effective in preventing death from the flu, so we're looking at over 1,200,000 1-4 year olds vaccinated to prevent a single death. To break it down to purely economic terms, that's over $20 million to prevent one death, not a good use of funds when there are more cost-effective ways to prevent deaths for children aged 1-4. Then, consider the incidence of side-effects of the vaccinations: is the incidence less than 1 in 1,200,000? The vaccine adverse event reporting system is designed to minimize the reporting of these events as being vaccine related, and with the data available here we can calculate that with 62 million flu doses distributed and 1400 adverse events, there's about 1 adverse event per 45,000 doses. This means that in order to save that 1 life we have to tolerate 27 adverse events on the way. Yes, most adverse events aren't life threatening, but (overall for all vaccines since the data isn't broken down by vaccine) 15.8% were in 2001, so we're looking at 4 additional hospitalizations or deaths on the way to maybe preventing one death. Even this article demonstrated that there is “little evidence” of benefit of vaccination in children under 2.
For the next recommended universal vaccination group >50, some segments have vanishingly small amounts of flu deaths: it's not in the top 10 causes of death for 55-64 y.o. americans and not in the 45-54s either, so we can safely assume that it's a minor risk (<0.4% of deaths) for the entire 50-64 age range. There's 45 million people who won't significantly impact their risk of death with a flu shot.
FInally, we're getting to the age range who shows some risk: 65 and older. 3.2% of deaths (59,000) are in the flu/pneumonia category, so a drastically smaller amount of over 65s, perhaps 15,000 died of flu in 2002. But remember that when you die, you have to die of something, so in some of these cases, flu was merely the last straw. So, with a population of 35.5 million over 65s in 2002, there's less than 1 in 2000 dying of the flu, and with the vaccine being less than 50% effective that's over 4000 vaccines (>$80,000) to prevent 1 death.
However, 4000 vaccines to prevent 1 death isn't that bad, but realizing that the flu is much more likely to kill someone who is already on the edge (among over 65s, those 85 and older were 16 times more likely to die of influenza, says JAMA), it would be much easier and more cost effective to target those people and vaccinate them and their caregivers. Which brings us back to the original recommendation for the vaccine: those likely to die from catching the flu and the people who take care of them.
So, why all the recommendations for more vaccinations? 16 million 1-4 year olds and 45 million 50-64s means the they are recommending 60 million vaccinations that aren't remotely supported by the data. It's got to be to ensure an adequate market for the vaccine. Either that or someone's making a good profit off it.
Do you remember back in 2004 when one of the factories (Chiron) that made flu shots had a problem and had to junk its entire output for the year? At that point, there was only enough demand to justify 2 companies making the entire amount for the whole country. One factory can't meet its amount for the year and then suddenly there's not enough and all the "health authorities" go into a tizzy about the lack of flu shots. Fewer people got vaccinated and nothing much in reality changed: no bump in flu deaths or anything.
Now, in order to reduce the risk of this happening again, we need to have more places making it, but in order to get that to happen, there has to be more demand. How do you do that? Expand the criteria for who needs one and then stir up the fear about flu so the people are frothing at the mouth to get a shot. So, rather than shot recommendations based on valid health concerns, the recommendation becomes based on economic concerns.
Frankly, the original recommendations for flu vaccine are the only ones that are supportable: for people for whom a flu would be enough to push them over the edge (frail, nursing homes, etc.) and the people who care for them. Everyone else was gravy for the vaccine makers. Expanding the definition of who needs it to "chronic disease" and huge swaths of ages covers a much bigger chunk of the population and ensures enough of a demand to justify more manufacturers.
As far as the recommendation for children and pregnant women, it's unconscionable to inflict further vaccines onto an already overburdened childhood vaccine schedule when the justification is ensuring a demand for flu shots. Even worse is giving thimerasol-containing vaccine to pregnant women: the developing fetal brain is particularly vulnerable to the ethyl mercury in the vaccine.
Even for the targeted population, the shot is of questionable utility. The virus that the flu shot protects against covers only a small proportion of the things people get sick with and call "the flu", and the match between the vaccinations and the strains that go around every year aren't very good: after the season is over they invariably say "well, it was only a partial match for what actually went around." One study demonstrated that the vaccine only reduced the severity of the flu but slightly increased the incidence of it in the people who got the vaccine.
This article summarizes the data on the effectiveness of the vaccine in adults as only 30% effective in preventing flu-like illness and didn’t affect the hospitalization rate overall nor the amount of time off work. In the elderly (65 and over), this article shows that in the community (most people who would be reading this, as opposed to institutionalized in a nursing home or hospital) the flu vaccine is not significantly effective against the flu, flu-like illness, or pneumonia. However, for people who are institutionalized, there does seem to be a clear benefit.
Now, I know people still like to reduce their risks of getting something that may knock them out for a week or so, so for a couple years I tried to get the vaccine, but I wasn't willing to put mercury into people's bodies to do it. To that end I tried to pre-order "preservative-free" vaccine for the upcoming flu season (buying flu vaccine is like getting rock concert tickets: the sales open and everyone rushes to snatch stuff up), but every time all the preservative-free stock was snatched up leaving only the exact same stuff with thimerasol in it left available (and this is before the stuff has even been made: why can't they just change the supply to meet the demand?). The first year I discovered that at the end of the season there was some preservative-free stuff left over, which I got and made available. I haven't been able to get it since, so I gave up.
So if you are determined to get the vaccination, I would try to get the preservative-free stuff (which Kroger claimed to have last winter). Otherwise, being sure you have enough vitamin D (check a 25-OH vitamin D level and get it well into the normal range, I like to get it to 50 ng/dl or more) and take vit C at least daily.
Am I recommending not to get the vaccine? No, I'm just trying to add some perspective so people can make their own decisions. For most people it isn't a matter of life and death and it comes down to if it will make your life easier. Read the fourth paragraph before this one (especially the last sentence) and make your decision.
If you want some perspective of the risk of death from influenza, it's a little obfuscated by combining it with deaths from pneumonia (which is much deadlier in general than influenza) in the data available from the CDC for 2002 here, but let's do the best we can. Incidentally, this report gives the total number of flu/pneumonia deaths for 2002 as 65,681, so I have to say I'm skeptical of the number of influenza deaths given in the CDC/MMWR report (35,000) and, indeed, looking at the references it cites, it appears the authors misread the article and used the number for chronic disease-related deaths rather than the influenza-related deaths which is less than 1/3 of the number: 8,097. This, then, implies that less than 1/4 (actually only 12.3%) of the flu/pneumonia deaths are actually from the flu, so we'll use this number.
So, in the age 1-4 group (for which universal annual flu vaccination is recommended) the combination for flu and pneumonia accounted for 110 deaths in 2004, while the US population aged 1-4 was nearly 16 million. Thus, assuming _all_ the deaths were from flu, there would be ~150,000 children vaccinated to prevent one death (assuming that vaccinations would be 100% effective in preventing death from the flu, which is unlikely considering the matches generally are 50% or less). Far more likely, less than 25% of the kids' deaths were from the flu and it is less than 50% effective in preventing death from the flu, so we're looking at over 1,200,000 1-4 year olds vaccinated to prevent a single death. To break it down to purely economic terms, that's over $20 million to prevent one death, not a good use of funds when there are more cost-effective ways to prevent deaths for children aged 1-4. Then, consider the incidence of side-effects of the vaccinations: is the incidence less than 1 in 1,200,000? The vaccine adverse event reporting system is designed to minimize the reporting of these events as being vaccine related, and with the data available here we can calculate that with 62 million flu doses distributed and 1400 adverse events, there's about 1 adverse event per 45,000 doses. This means that in order to save that 1 life we have to tolerate 27 adverse events on the way. Yes, most adverse events aren't life threatening, but (overall for all vaccines since the data isn't broken down by vaccine) 15.8% were in 2001, so we're looking at 4 additional hospitalizations or deaths on the way to maybe preventing one death. Even this article demonstrated that there is “little evidence” of benefit of vaccination in children under 2.
For the next recommended universal vaccination group >50, some segments have vanishingly small amounts of flu deaths: it's not in the top 10 causes of death for 55-64 y.o. americans and not in the 45-54s either, so we can safely assume that it's a minor risk (<0.4% of deaths) for the entire 50-64 age range. There's 45 million people who won't significantly impact their risk of death with a flu shot.
FInally, we're getting to the age range who shows some risk: 65 and older. 3.2% of deaths (59,000) are in the flu/pneumonia category, so a drastically smaller amount of over 65s, perhaps 15,000 died of flu in 2002. But remember that when you die, you have to die of something, so in some of these cases, flu was merely the last straw. So, with a population of 35.5 million over 65s in 2002, there's less than 1 in 2000 dying of the flu, and with the vaccine being less than 50% effective that's over 4000 vaccines (>$80,000) to prevent 1 death.
However, 4000 vaccines to prevent 1 death isn't that bad, but realizing that the flu is much more likely to kill someone who is already on the edge (among over 65s, those 85 and older were 16 times more likely to die of influenza, says JAMA), it would be much easier and more cost effective to target those people and vaccinate them and their caregivers. Which brings us back to the original recommendation for the vaccine: those likely to die from catching the flu and the people who take care of them.
So, why all the recommendations for more vaccinations? 16 million 1-4 year olds and 45 million 50-64s means the they are recommending 60 million vaccinations that aren't remotely supported by the data. It's got to be to ensure an adequate market for the vaccine. Either that or someone's making a good profit off it.
Tempus fugit: BHRT Summit 2 and Pain Release book bonuses
Thursday, November 06, 2008 Filed in:
Medical
Two interesting opportunities to Learn
Useful Things About Health (something I quite enjoy doing and
highly recommend) are coming in the next couple days: an
opportunity to get a pile of free stuff just for buying what should
be a good book (provided you do it on November 8 at Barnes &
Noble), and the second BHRT World summit.
Dr. Dan Benor, MD, (a doc I’ve been familiar with for a few years and who seems to know what he’s doing) has a book out about a simple and rapid method of releasing both physical and emotional pain, 7 Minutes to Natural Pain Release. The urgent part is that if you buy the book at Barnes & Noble on November 8, 2008, you can then use the receipt to get a pile of free bonuses: interviews with the author, audio seminars and classes on a variety of health topics, and a pile of e-books (including “Caring, Housing and Health of Your Dog”, which is what tipped me into deciding to get it on Saturday). The book is only $18, though if you decide to forego the bonuses or miss November 8th you can get it as an e-book for only $10. You can follow the link or click on the picture to see the bonuses.
The other upcoming opportunity is the second BHRT World Summit, starting November 10 and continuing through November 25 with interviews with 10 health experts about bio-idential hormones and other therapies. The interviews are aimed at the general public to educate you about some more holistic approaches to improving our health. There are 3 options for taking part: $29 to get the interviews on the days they are broadcast only, $49 to listen to them whenever you want, or $120 to listen anytime and get a transcript of all the interviews and downloadable files of all the talks so you can listen away from your computer. I got the complete package last time and, while there were a couple small points where I disagreed with the doctors, was glad I got it and even I learned a lot from the talks. You could learn a lot, too. Follow the link or click on the banner to sign up. There’s a few bonuses with this, too, so check it out.
Dr. Dan Benor, MD, (a doc I’ve been familiar with for a few years and who seems to know what he’s doing) has a book out about a simple and rapid method of releasing both physical and emotional pain, 7 Minutes to Natural Pain Release. The urgent part is that if you buy the book at Barnes & Noble on November 8, 2008, you can then use the receipt to get a pile of free bonuses: interviews with the author, audio seminars and classes on a variety of health topics, and a pile of e-books (including “Caring, Housing and Health of Your Dog”, which is what tipped me into deciding to get it on Saturday). The book is only $18, though if you decide to forego the bonuses or miss November 8th you can get it as an e-book for only $10. You can follow the link or click on the picture to see the bonuses.
The other upcoming opportunity is the second BHRT World Summit, starting November 10 and continuing through November 25 with interviews with 10 health experts about bio-idential hormones and other therapies. The interviews are aimed at the general public to educate you about some more holistic approaches to improving our health. There are 3 options for taking part: $29 to get the interviews on the days they are broadcast only, $49 to listen to them whenever you want, or $120 to listen anytime and get a transcript of all the interviews and downloadable files of all the talks so you can listen away from your computer. I got the complete package last time and, while there were a couple small points where I disagreed with the doctors, was glad I got it and even I learned a lot from the talks. You could learn a lot, too. Follow the link or click on the banner to sign up. There’s a few bonuses with this, too, so check it out.
Sample treatment outline
Saturday, October 18, 2008 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.
Featured on Fox 2 news
Saturday, October 11, 2008 Filed in:
Office
I was featured in the Fox 2 morning
news yesterday for being the “centerfold” of
Hour
Detroit’s “Top
Docs” issue. You can see my 3:40 of fame on
Fox Detroit’s website.
Top Docs issue!
Saturday, October 04, 2008 Filed in:
Office
This October’s
Hour Detroit magazine is their 9th annual Top Docs
issue, and I’m not only in it (the first and only holistic
doctor, though you could argue that Steven
Thiry is there
as he’s board certified in Holistic
Medicine, but
he’s listed under Family Practice), but there’s a
two-page spread about me. Go and read the article
here
(where you can leave
comments), or get the ready-to-print (and ad-free) version
here. You can bet I’m sending a copy
to my parents.
Keep on top of new articles!
Sunday, September 28, 2008 Filed in:
Technical
We had a little problem with spammers
hacking our mail page to send spams, so I’ve had to upgrade
the program that makes this website. With any luck, it
doesn’t look too much different, but it does have the ability
to allow you to subscribe to an RSS feed of this news page so you can find out
about new entries more easily. You can find the link to the feed at
the bottom of the sidebar on the left of the page. Depending on how
your browser is set up, clicking on that link could give you a cool
page or a bunch of intimidating-looking code. The simplest
explanation for how to use RSS I’ve seen is the video
at this
page.
Another new feature on this page is the “tags” near the bottom of the sidebar (they have a dot in front of them). These let me put up a link to all the articles that include a particular subject. So, if you’d like to see all the articles I wrote about hyperbaric oxygen, you can just click on the “Hyperbarics” link and you’ll see them all.
Finally, I’ve written enough articles here that you don’t want them all to load at once, so they are archived by year. Use the links just above the tags to browse the entries by year.
Another new feature on this page is the “tags” near the bottom of the sidebar (they have a dot in front of them). These let me put up a link to all the articles that include a particular subject. So, if you’d like to see all the articles I wrote about hyperbaric oxygen, you can just click on the “Hyperbarics” link and you’ll see them all.
Finally, I’ve written enough articles here that you don’t want them all to load at once, so they are archived by year. Use the links just above the tags to browse the entries by year.
The price of success
Saturday, September 27, 2008 Filed in:
Office
One of the problems with getting people
better is that once word spreads and more people schedule
appointments, the wait for a new appointment can get a bit long.
While having people booked 2-3 months in advance can be reassuring
to me, it does pose some problems:
- People looking for appointments can get frustrated by the wait. Fortunately, we have Gaia who can see patients sooner. We also keep a wait list for people who want to get in earlier than the appointment they schedule.
- When an appointment is months away, people often forget when the appointment is or that they ever made the appointment. So, we end up with new patient appointments with no patient. This is a problem for us (it’s hard to pay the bills when we’re not seeing patients) and it’s unfair to the other people trying to get in to see us.
Made it back alive
Sunday, September 21, 2008 Filed in:
Office
Despite the long gap since my last
post, I have not died from my trip to rural Honduras. Things at the
office have been quite busy and I don’t get so many chances
to write here.
A bunch of college students and a few doctors and other health professionals all got together and brought all the medications and supplies we could. We lived in a hacienda in bunk rooms and rode a bus 1-2 hours to the sites where the locals lined up to get help. Despite the long bumpy and dusty rides, heat, and other hardships (of which the flight back was probably the worst when a delayed flight made us lose all our connectors), we all kept good spirits and played soccer with the local kids (who were kind enough not to embarrass us).
A bunch of college students and a few doctors and other health professionals all got together and brought all the medications and supplies we could. We lived in a hacienda in bunk rooms and rode a bus 1-2 hours to the sites where the locals lined up to get help. Despite the long bumpy and dusty rides, heat, and other hardships (of which the flight back was probably the worst when a delayed flight made us lose all our connectors), we all kept good spirits and played soccer with the local kids (who were kind enough not to embarrass us).
Gone on Medical Brigade in Honduras
Sunday, July 27, 2008 Filed in:
Office
I'm going on a medical brigade in
Honduras the week of august 18:
http://www.hondurasmedical.org/
We're going to have to reschedule everyone from that week and I won't be around for the week. Sorry about the short notice, the plans just came together.
We're going to have to reschedule everyone from that week and I won't be around for the week. Sorry about the short notice, the plans just came together.
Many faces of wheat allergies
Wednesday, June 18, 2008 Filed in:
Medical
The other day I had three patients
independently and spontaneously tell me they had discovered they
are allergic to wheat.
I've seen a lot of people make huge improvements by removing foods that bother them, and frequently suggest allergy testing or an elimination diet to root out these problems. The interesting thing on this day was the diversity of the symptoms that resolved with removing wheat from these people's diets.
One patient found that when he went off wheat, his thinking became much clearer (he's been diagnosed with bipolar disorder and attention deficit) and he stopped using the lithium he had been prescribed since he didn't need it any more. In addition, his chronic runny nose and reflux symptoms went away, problems he was having with dry skin on his face resolved, he lost weight and he's performing much better at work. Upon re-challenge with wheat, he started getting a dry rash on his face which resolved with avoiding wheat again.
Another patient found that his chronic eczema and hives improved when he stopped eating wheat.
The third patient eliminated wheat and this was the only thing that improved her intense sugar cravings that had originally brought her in. She also found an improvement in her energy levels and that re-challenge with wheat makes her feel terrible and gives her a runny nose, canker sores and fatigue.
Unfortunately, I don't have consistent testing between these three people due to individual circumstances and finances. Gliadin antibodies (from conventional labs) on all three were negative (gliadin is one part of the gluten protein that can trigger gut reactions). IgG and IgE antibodies (through a conventional lab) on one patient showed moderate IgE antibodies to wheat (this is characteristic of eczema) and very low IgG antibodies to wheat. One patient had a combined IgE/IgG4 antibody test through a specialty lab that did show high levels of antibodies to wheat and gluten. I have had other patients who didn't turn up any positives to conventional IgG/IgE testing despite profound symptoms that improved with removing wheat.
On the heels of this, an article came out in American Family Physician (a journal for family docs) that maintains the doctrine that only IgE mediated reactions (which can be elicited with skin-prick testing) are food allergies and that most things that are called food allergies aren't. While that may satisfy allergists (for whom skin-prick testing is a significant part of their office income), it does little for the patients who have sensitivities to foods that don't show up on skin testing, and they are often dismissed by physicians who don't know that there is more to it than just IgE reactions. Some of the early work on food allergies was done by allergists, but the specialty has veered over to simple skin testing (which rarely shows food allergies) as the standard for allergy testing, leaving all the patients who don't show up with it out in the cold.
I've seen a lot of people make huge improvements by removing foods that bother them, and frequently suggest allergy testing or an elimination diet to root out these problems. The interesting thing on this day was the diversity of the symptoms that resolved with removing wheat from these people's diets.
One patient found that when he went off wheat, his thinking became much clearer (he's been diagnosed with bipolar disorder and attention deficit) and he stopped using the lithium he had been prescribed since he didn't need it any more. In addition, his chronic runny nose and reflux symptoms went away, problems he was having with dry skin on his face resolved, he lost weight and he's performing much better at work. Upon re-challenge with wheat, he started getting a dry rash on his face which resolved with avoiding wheat again.
Another patient found that his chronic eczema and hives improved when he stopped eating wheat.
The third patient eliminated wheat and this was the only thing that improved her intense sugar cravings that had originally brought her in. She also found an improvement in her energy levels and that re-challenge with wheat makes her feel terrible and gives her a runny nose, canker sores and fatigue.
Unfortunately, I don't have consistent testing between these three people due to individual circumstances and finances. Gliadin antibodies (from conventional labs) on all three were negative (gliadin is one part of the gluten protein that can trigger gut reactions). IgG and IgE antibodies (through a conventional lab) on one patient showed moderate IgE antibodies to wheat (this is characteristic of eczema) and very low IgG antibodies to wheat. One patient had a combined IgE/IgG4 antibody test through a specialty lab that did show high levels of antibodies to wheat and gluten. I have had other patients who didn't turn up any positives to conventional IgG/IgE testing despite profound symptoms that improved with removing wheat.
On the heels of this, an article came out in American Family Physician (a journal for family docs) that maintains the doctrine that only IgE mediated reactions (which can be elicited with skin-prick testing) are food allergies and that most things that are called food allergies aren't. While that may satisfy allergists (for whom skin-prick testing is a significant part of their office income), it does little for the patients who have sensitivities to foods that don't show up on skin testing, and they are often dismissed by physicians who don't know that there is more to it than just IgE reactions. Some of the early work on food allergies was done by allergists, but the specialty has veered over to simple skin testing (which rarely shows food allergies) as the standard for allergy testing, leaving all the patients who don't show up with it out in the cold.
