FMS COMMUNITY NEWSLETTER # 45
August 16, 2003


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Editor of the Moment: Mary McKennell
______________________________________________________
Scheduled rest is a simple technique that can help reduce symptoms and
make life more stable. Read about it in this week's article at the
CFIDS/Fibromyalgia Self-Help program website:
http://www.CFIDSselfhelp.org .
AOL: <a href "http://www.CFIDSselfhelp.org"> Read it here </a>
Also, we are currently accepting sign-ups for the Fall quarter session
of the CFIDS/Fibromyalgia Self-Help Course. The course, which begins
September 15, is an 8-week email discussion group that focuses on
practical strategies for managing common problems of CFIDS, fibromyalgia
and related illnesses. The cost of the course, which includes a copy of
"The CFIDS & Fibromyalgia Self-Help Book," is $25. Visit our website to
learn more and to register.
Bruce Campbell, Ph.D., Director
http://www.CFIDSselfhelp.org
*******************************************************************
EDITOR’S CORNER:
My corner of the world is HOT! Looking at the weather picture around the
country and even internationally that seems to be the key word right
now. I live in Southern California where it is 105 outside today. I am
feeling very grateful for the fact that we can afford to run our air
conditioner and that we are not having energy problems. My personal
energy is running on low due to an unwelcome visit from bronchitis. The
plus side is that it has kept me at home this week and enabled me to get
another newsletter out this month. I noticed that I have had something
about tea and the immune system in almost every newsletter since I have
been editor. I have no convinced myself that my iced tea is okay so I
skipped the tea slant this time around. However, I did come up with
some other articles on the immune system.

The heat must be what drew me to the article on sunglasses. I have to
wear sunglasses or else I get a headache immediately. Unfortunately I am
always misplacing my sunglasses. I buy several pair, hoping that I will
be able to find at least one pair when I need it. Sometimes it works!
But if you have fibro fog problems you are familiar with this kind of
plight. So it’s good to know whether we need to spend a lot of money to
protect our eyes.

I hope that you will take a closer look at the information on the NICIA
week. My t-shirt came in the mail this past week and I love it! The back
of the shirt has a list of Top 10 Things to Not Say to A Chronically Ill
Person. The #1 item on the list is one we are all familiar with and get
very tired of hearing, "But you look so good!" Unfortunately I don’t
work in an environment where t-shirts are appropriate attire so I can’t
advertise my feelings there. You can go to the web site and see the
other nine items that are listed.

Thanks to two people who contributed material for this newsletter. If
you have a bent for writing and would like to submit something of your
own please feel free to send it to me for review. We welcome original
material.

The article by Rosalind Joffe touches on an area that does not have a
lot of literature. Coping with chronic illness in the work place is a
challenge that I face along with deciding who should know what about my
health. I found the article as well as her website illuminating.
Anne-Marie Vidal’s article on not allowing pain to destroy is a good
reminder that we do not have to let our illness define us.
*******************************************************************
How Sunglasses Work
Whether you're hitting the surf or the slopes or just spending a
day on the lake, sunglasses are a must-have accessory. A good
pair of sunglasses can protect your eyes from harmful UV rays
and eliminate irritating glare.
Find out if those $10 sunglasses really are as good as the
high-cost ones.
http://travel.howstuffworks.com/sunglass.htm
AOL: <a href" http://travel.howstuffworks.com/sunglass.htm"> Read it
here </a>
************************************************************************


NATIONAL INVISIBLE CHRONIC ILLNESS AWARENESS WEEK

The Mission of National
Invisible Chronic Illness Awareness Week

National Invisible Chronic Illness Awareness Week, September 22-28,
2003, is a designated time, worldwide, in which people who live with
chronic illness, those that love them, and organizations are encouraged
to educate the general public, churches, healthcare professionals and
government officials about the affects of living with a disease that is
not visually apparent
Through programs and resources, we seek to recognize the daily
challenges of more than 100 million adults and children who live with an
invisible illness. It is our mission, to encourage and offer compassion
through acknowledging that despite how "well" they may look, they live
with the ups and downs of a chronic condition. We seek to educate those
who do not live with illness on how to reach out to and encourage those
with health difficulties, including what to say and not say, as well as
how to meet practical needs.

Overall, it is our hope that people who live with invisible chronic
illness can legally park in a handicapped parking spot without receiving
skeptical looks, that friends and family acknowledge that invisible
illnesses are real, and how to not just survive, but truly live--and
even celebrate life-- despite illness, encouraging others on the same
detour in life.
For more information about how to be involved:
http://www.mychronicillness.com/invisibleillness/advocate.htm
AOL: <a href "
http://www.mychronicillness.com/invisibleillness/advocate.htm"
Read it here </a/
**********************************************************

PAIN DOES NOT HAVE TO DESTROY US
Submitted by Anne-Marie Vidal
Whenever I need a reminder that chronic pain while inhibiting need not
destroy, I visit the Wellness Train site run by Mermie Brunnet and I am
overwhelmed at the quiet strength and truth that helps me deal with an
array of chronic illnesses. With hundreds of visitors a day the
reputation of
the Wellness Train continues to grow as visitors seek comfort from its
unique combination of spiritual, common sense, self-help approach to
coping
with chronic illness. Below is the transcript of a conversation Mermie
and I
had this spring. I have continued to visit theTrain at:
http://www.100megsfree.com/wellnestrain/homepage.html for reminders of
how to deal with illness. To read the Interview visit
http://www.ourfm-cfidsworld.org/html/mermie_brunnet.html
AOL: <ahref "http://www.ourfm-cfidsworld.org/html/mermie_brunnet.html">
Read it here <a/>

********************************************************

7 HABITS
For Regaining Power in the Workplace With Chronic Illness

1. Focus On What You Can Control. You may not be able to control the
course of your illness. You can control the direction you take and the
choices you make regarding that illness in the workplace. View your
chronic illness as a challenge to meet, not an obstacle in the way.

2. Ignore The Nay Sayers. Many people will tell you that work is
stressful and that rest is best for people with chronic illness. Ignore
them. Unpleasant work or too much work can be bad for anyone’s health
but stress or lack of rest does not cause chronic illness. Yes, you have
more challenges now than you did before, but throwing in the towel is
not the only option.
Shape your work environment to meet your needs and you can’t harm
yourself.

3. Come Out Of The Closet. Chronic illness is nothing to be ashamed of.
Keeping it a secret depletes your precious energy and gets in your way.
Maintain your right to privacy and be judicious with your information,
but don’t take on the burden of pretending that you don’t have a chronic
illness. Be as public as you need to be and as private as you want to
be.

4. Don’t Just Survive - Thrive. It’s easy to feel that survival is
enough. And most people who love you won’t expect more from you than
that. But chronic illness or not, you weren’t born for mediocrity.
Raising the bar doesn’t mean doing more than you can; it means aim high
and seek what you need to thrive. Reach beyond relief; go for the
satisfaction.

5. Control The Message. Other people on the job will be looking to you
to set the tone, and you can influence the way they respond to your
illness. Design and control your message: What and how much do you want
to say? Who do you want or need to say it to? When and where do you want
to talk? Get out in front of the conversation.

6. Don’t Let Your Illness Define Who You Are. Some people might try to
paint you as a martyr; others may consider you less worthy of
recognition or promotion. Neither extreme works to your advantage; each
gets in your way. The message you want to convey is that your chronic
illness is simply one of several cards in your deck; just like everybody
else.
Having a chronic illness is neither a source of shame nor a source of
pride.

7. Look for the silver lining. Although you may not believe it now,
workplace success in
the face of illness is transforming. Many of us have found new strength
and confidence – qualities we never knew we had – as a result of our
illnesses. We have used this new found power to face other life
challenges. It need not all be about the bad news.
Rosalind Joffe

Rosalind Joffe coaches individuals to thrive in the workplace. Drawing
on 25 years of work experience, living with chronic illness, she helps
others prosper in their work
©2003 Rosalind Joffe. All rights reserved.
rosa-@common-goals.com
www.CommonGoals.com
************************************************************************
*****

POTENTIAL MARKER FOR CFS
Could the tilt-test formula be a diagnostic marker for Chronic Fatigue
Syndrome (CFS)? Researchers in Israel believe so.
Researchers in Israel have tested the haemodynamic instability score
(HIS), a formula that uses measurements taken during a head-up tilt
test, to see if it can accurately distinguish patients with CFS from
controls. The HIS relects blood pressure and heart rate changes during
the tilt test, which is used to determine the functioning of a patient's
autonomic nervous system. A majority of people with CFS display some
degree of autonomic dysfunction.
A prospective controlled study of 40 CFS patients compared their HIS
scores to 278 non-CFS subjects with conditions that included FM,
syncope, generalized anxiety disorder, essential hypertension, non-CFS
chronic fatigue and Familial Mediterranean Fever. 59 healthy subjects
were also compared. The results showed that the HIS was an effective
tool in differentiating CFS patients from the other study participants.
Specifically, 90.3% of the CFS patients who completed the tilt test
scored above the threshold of HIS. The authors write that their results
suggest a definable, CFS-characteristic autonomic dysfunction may exist.

Study reference: Naschitz JE et al. "The head-up tilt test with
haemodynamic instability score in diagnosing chronic fatigue syndrome."
Q J Med. 2003; 96:133-142.
(Source: The CFS Research Review, Spring 2003. Published by the CFIDS
Association of America, Inc.)
Published by Pro Health, Inc., ImmuneSupport.com

********************************************************************

Brain Pain: Illnesses May Be Misdiagnosed
Neurosurgeons Disagree On Skull Surgery
CHICAGO -- About 5 million Americans have been told they have
fibromyalgia or chronic fatigue syndrome, but there is a controversy
over the diagnosis. Many of these patients may have an entirely
different condition that can be helped, reported WMAQ-TV in Chicago.
Brain Pain In the case of Inga Aragon, she had mysterious headaches that
began when she was in second grade and got worse over the years. "(The
headache) started at the base of my head in the back," said Aragon "and
it would sort of move up to the front."
The headaches affected Aragon profoundly.
"I left college because of it," Aragon said. "I had the eyes tearing and
vomiting -- and all that fun stuff." Aragon could neither read nor use
her talent of drawing because looking down made the pain worse. Nobody
could explain why. I went to tons of doctors," Aragon said. "All kinds
of doctors, and no one could figure it out." Then three men in Aragon's
life came to her rescue, she said.
First she married Jason, who provided support.
Then her father, suffering some of the same symptons, began to do
research. Together, they found Dr. Dan Haffez, a neurosurgeon at St.
Joseph Hospital in Chicago, who diagnosed Aragon and her father with a
hereditary brain defect known as chiari malformation. "The skull is a
little small for the brain," Haffez explained. "And a portion of the
brain descends into the upper spinal canal."
Symptoms of chiari malformation can include pain, dizziness and
weakness. But symptoms alone can be deceiving because they mimic two
incurable conditions -- chronic fatigue syndrome and fibromyalgia.
"It's very possible that 20 to 25 percent of fibromyalgia sufferers may,
in fact, have a problem emanating from the cervical spinal cord, and
that problem may be caused by chiari malformation," Haffez said. "Or it
may be caused by a disk. Or it may be caused by a narrowing of the
spinal canal. The numbers can be quite staggering."
Haffez is one of the country's leading neurosurgeons who believes chiari
malformation is underdiagnosed. If it's true, then it means that
thousands of patients may be missing out on a cure, because chiari
malformation can be corrected with surgery.
In Aragon's operation, Heffez hollowed out some of the back of her
skull. That created enough room for her brain, so it would stop
squeezing down her spinal cord.
The American Association of Neurological Surgeons worries that some
patients may be getting the surgery even though they don't need it. The
association "does not recognize the use of cervical decompression
surgery as a treatment alternative for chronic fatigue syndrome."
Haffez said he believes the surgery is controversial because "the lay
message is that people are doing surgery, chiari-type surgery, in order
to treat fibromyalgia or chronic fatigue syndrome. Nothing could be
further from the truth."
Haffez believes the controversy would end with better diagnosis of
chiari malformation. He said doctors need to go past the symptoms and
look for more subtle clues in brain scans, then perform a meaningful
neurological exam that can tie all the elements together. "There's a
certain pattern of abnormalities that will point you to this particular
area of the nervous symptom," Haffez said.
Although other neurosurgeons say the diagnosis is not easy, the
operation worked for Aragon and her father. The pain disappeared for
both of them.
"I went back to school," Aragon said. "I am working 40-hour weeks now. I
just couldn't do those things before. I'm really excited."
Studies show that about 85 percent of patients who undergo the surgery
either have significantly less pain or are completely cured.

Additional Resources:
National Institutes Of Health: Chiari Malformation Information Page
http://www.ninds.nih.gov/health_and_medical/disorders/chiari_doc.htm
Dr. Dan Heffez's Web site
http://www.nfra.net/Dr.%20Heffez%20Information.htm
World Arnold Chiari Malformation Association
http://www.pressenter.com/~wacma
--------
(c) 2003 The Boston Channel
URL: http://www.thebostonchannel.com/health/2378751/detail.html

**************************************************************
                                                        DRY MOUTH
Dryness of the mouth, nose or eyes can happen in otherwise normal
persons, but more than 25% of fibromyalgia (FM) patients have this
symptom. Dryness occurs when glands do not produce the normal amounts or
quality of tears to lubricate the eyes or saliva to lubricate the mouth.
This problem is commonly associated with rheumatoid and other types of
arthritis and is called Sjogren's syndrome. There is no single known
cause.
Although dryness is mainly uncomfortable, the loss of normal lubrication
for the eyes can increase risk of infection. The loss of normal saliva
and lubrication in the mouth increases the chance of tooth decay. See
your opthamologist and/or dentist for treatment.
(Source: The Fibromyalgia Handbook: A 7-Step Program to Halt and Even
Reverse Fibromyalgia, by Harris H. McIlwain, M.D., and Debra Fulghum
Bruce, M.S.)
Published by Pro Health, Inc., ImmuneSupport.com

****Editor’s Note: If dry mouth is a major irritant for you try the
Biotene products. The gel that they put out is called Oral Balance and
has been very beneficial for me. I get no kick-backs for this free
advertisement.
*****************************************************************
Happiness Shouldn't Cause Cavities: Your meds can cause tooth decay
by Ed Tate III
The drugs that gave you back your grin may be wreaking havoc with your
teeth. More than 170 million prescriptions for antidepressants are
written each year in the US. Now, researchers confirm a common side
effect: dry mouth.
Dry mouth may affect up to 20% of those taking selective serotonin
reuptake inhibitors such as Prozac, Paxil, and Zoloft and up to 55% of
those taking older tricyclic antidepressants. Dry mouth can set the
stage for tooth decay, gum disease, oral infections, and other problems.
"It's not just the reduced quantity of saliva; the quality is also
important," says researcher Joseph J. Keene Jr., DDS, of Southern
Illinois University's School of Dental Medicine. Changes in saliva can
mean that debris adheres to the teeth more readily, contributing to
possible dental problems.
The greatest risk for dry mouth is reported with older antidepressants
such as amitriptyline (Elavil), amoxapine (Asendin), and clomipramine
(Anafranil), as well as the newer drug mirtazapine (Remeron).
Antidepressants taken alone and especially with other medications
producing dry mouth may raise your risk of tooth decay if preventive
measures are not taken.
"Do not discontinue or change antidepressant therapy on your own,"
emphasizes Keene. "If dry mouth is severe, consult with your physician
for a possible drug-replacement therapy for depression." If it's mild,
you can prevent dental problems with some simple measures.
Dry Mouth Rx
Thoroughly brush your teeth after every meal using fluoride toothpaste.
Floss daily.
Use mouthwashes made for dry-mouth sufferers, and avoid those containing
alcohol, which is drying.
Drink more water. Prevention recommends eight 8-oz glasses a day. Most
Americans get far less.
Try using sugarless chewing gums and candies, particularly those made to
stimulate saliva production.
See your dentist twice a year.
http://www.prevention.com/cda/feature2002/0,4780,5582_P,00.html

*****************************************************************
A metabolic basis for fibromyalgia and its related disorders: the
possible role of resistance to thyroid hormone
Journal: Med Hypotheses. 2003 Aug;61(2):182-9.
Authors: Garrison RL [1], Breeding PC.
It has long been recognized that the symptom complex of fibromyalgia can
be seen with hypothyroidism. Hypothyroidism may been categorized, like
diabetes, into type I (hormone deficient) and type II (hormone
resistant).
Most cases of fibromyalgia fall into the latter category. The syndrome
is reversible with treatment, and is usually of late onset. It is likely
more often acquired than due to mutated receptors. Now that there is
evidence to support the hypothesis that fibromyalgia may be due to
thyroid hormone resistance, four major questions appear addressable.
First, can a simple biomarker be found to help diagnose it? Second, what
other syndromes similar to Fibromyalgia may share a thyroid-resistant
nature? Third, in non-genetic cases, how is resistance acquired? Fourth,
what other methods of treatment become available through this new
understanding?
Preliminary evidence suggests that serum hyaluronic acid is a simple,
inexpensive, sensitive, and specific test that identifies fibromyalgia.
Overlapping symptom complexes suggest that chronic fatigue syndrome,
Gulf war syndrome, premenstrual syndrome, post traumatic stress
disorder, breast implant silicone sensitivity syndrome, bipolar
affective disorder, systemic candidiasis, myofascial pain syndrome, and
idiopathic environmental intolerance are similar enough to fibromyalgia
to merit investigation for possible thyroid resistance.
Acquired resistance may be due most often to a recently recognized
chronic consumptive coagulopathy, which itself may be most often
associated with chronic infections with mycoplasmids and related
microbes or parasites. Other precipitants of thyroid resistance may use
this or other paths as well.
In addition to experimentally proven treatment with supraphysiologic
doses of thyroid hormone, the thyroid-resistant disorders might be
treatable with anti-hypercoagulant, anti-infective, insulin-sensitizing,
and hyaluronolytic strategies.
Source: www.Co-Cure.com

*********************************************************************

NEW COMPOUND THAT ACTS ON PERIPHERAL RECEPTORS MAY BE
PROMISING TREATMENT FOR SOME NERVE PAIN
Results of a new study in mice and rats show that a compound which acts
on a specific type of cell receptor found only outside the central
nervous system decreases the animals' pain responses. But the
researchers caution that studies investigating the safety and efficacy
of this compound in humans have yet to be done.
The scientists hope this approach may lead to the development of
pain-relief drugs that lack the debilitating central nervous system side
effects limiting the effectiveness of currently available
pharmaceuticals.
"Chronic pain is one of the most significant disease states affecting
Americans, in terms of economic and social impacts," says Dr. Nora D.
Volkow, Director of the National Institute on Drug Abuse. "And,
unfortunately, therapeutic options for the treatment of chronic pain are
inadequate, partly because a number of drugs that can be used to treat
pain have unpleasant side effects that limit their effectiveness, and
partly because some of them have the potential for addiction and abuse."
The study, funded by NIDA, part of the National Institutes of Health,
will be published online the week of August 11 in the "Proceedings of
the National Academy of Sciences".
Dr. T. Philip Malan, Jr., of the University of Arizona, Dr. Alexandros
Makriyannis, of the University of Connecticut, and their colleagues,
studied the activity of a new compound called AM1241, which acts on CB2
cannabinoid receptors. "This is one of the two types of receptors on
which THC, the active ingredient in marijuana, acts," Dr. Malan says.
"The CB2 receptors are in peripheral sites with immune functions, while
the CB1 receptors are in the central nervous system -- the brain and
spinal cord. The beauty of having a compound that acts on the CB2
receptors is that you can get pain relief without the central nervous
system side effects of THC, such as sleepiness and anxiety."
The scientists tested the chemical on mice and rats with neuropathic
pain, a complex chronic pain state resulting from nerve injury or
disease. They found that this compound increased the ability of the
animals to withstand chronic pain that mirrored human models of
neuropathic pain.
"Although this is far from being in clinical trials in humans, any new
avenue to treat pain is a very positive step," Dr. Malan says. "Almost 6
million people in the United States may experience neuropathic pain. At
almost any given time, about 1 person in 4 is experiencing some type of
pain and about 1 person in 8 has some type of chronic pain. Pain costs
the U.S. economy $120 billion to $180 billion per year. Even though we
have therapies, many people continue to experience pain despite
receiving treatment. This may be partly because the side effects of many
of the drugs we can use prevent patients from using the dose that
provides the most intense relief."
The next step, he says, is to test this compound in animals to assess
its potential toxicity. "We don't even know how it works. It may act on
peripheral nerves, but CB2 receptors have not yet been found there; it
may act in some way to inhibit the release of chemicals like
prostaglandins from immune cells that increase sensitivity to pain; or
they may cause immune system cells to release substances that block the
pain response."
AM 1241 was developed by Dr. Makriyannis.
The National Institute on Drug Abuse is a component of the National
Institutes of Health, U.S. Department of Health and Human Services. NIDA
supports more than 85 percent of the world's research on the health
aspects of drug abuse and addiction. The Institute carries out a large
variety of programs to ensure the rapid dissemination of research
information and its implementation in policy and practice. Fact sheets
on the health effects of drugs of abuse and information on NIDA research
and other activities can be found on the NIDA home page at
<http://www.drugabuse.gov>.
Source: www.Co-cure.com
*******************************************************************

FM AND COMPROMISED IMMUNE SYSTEM
The immune system may be compromised in FMS sufferers. Natural Killer
(NK) cells seek out and destroy foreign invaders in our bodies. When FMS
patients' NK cells were tested by I. Jon Russell, M.D., they were found
to be in normal amounts, but their activity was low. Researchers do not
know why this is so, but serotonin may influence the activity of these
NK cells.
A high incidence of immune-reactive proteins have been found in the skin
of FMS patients. These are not normally seen in a healthy person's skin.
In other words, proteins are leaking through the blood vessel walls and
accumulating in surrounding tissues, which often occurs in conditions
that have an immunologic component.
(Source: Taking Charge of Fibromyalgia, by Julie Kelly, M.S., R.N., and
Rosalie Devonshire, M.S.W.)

**********************************************************************

Michael E. Rosenbaum, M.D., on Treating Chronic Fatigue Syndrome and
Fibromyalgia
ImmuneSupport.com


Michael E. Rosenbaum, M.D., is a pioneer in Nutritional Medicine with 25
years experience in alternative healthcare, specializing in the
treatment of Chronic Fatigue Syndrome, fibromyalgia, Myofascial Pain,
endocrine and metabolic disorders, and allergies. He is currently in
private medical practice in Corte Madera, California.
Early in my career, about thirty years ago, I underwent a period of
extreme stress and exhaustion. Even in those days, I had an intuitive
leaning toward natural healing and turned to diet and nutrients for
rejuvenation. I had been fascinated by nutritional therapeutics way back
in the early seventies when there was a relative scarcity of available
nutritional supplements. I was influenced by the works of leading
naturopathic doctors of the time, especially Paavo Airola who wrote
seminal books including "Are You Confused" and "How to Get Well".
I was introduced to nutritional medicine by joining the Orthomolecular
Medical Society (OMS), one of whose founders and the President Emeritus
was Linus Pauling. It was an exciting time for this burgeoning young
field. I recall the almost palpable electricity in the air at
nutritional medical meetings as new findings concerning nutritional
therapeutics were reported. We were all so hungry for this information.
We felt that we were participants in a fundamental health revolution
that emphasized healing over symptom suppression. Eventually, I became
President of the OMS and was privileged to be able to contribute to the
evolution of orthomolecular medicine.
Healthwatch (HW): You are a pioneer in nutritional medicine with over 25
years of experience in alternative healthcare. How did you come to value
nutritional and alternative approaches as being effective in treating
your patients with Chronic Fatigue Syndrome (CFS)?
Dr. Rosenbaum: I became interested in CFS soon after the article in the
Annals of Internal Medicine describing the Incline Village epidemic was
published by Cheney and Peterson in January, 1985. Subsequently, I began
to see more and more patients with CFS and what is now called
fibromyalgia. The diagnosis, management and disability insurance support
of patients with these very real fatigue disorders now constitute about
75% of my medical practice. In 1992, I crystallized my long experience
with CFS in a book that I co-authored with Murray Susser, M.D., entitled
Solving the Puzzle of Chronic Fatigue Syndrome (Life Sciences Press). We
advanced the concept that CFS is a multifactorial condition with the
possibility of multiple coexisting infections and endocrine imbalances.
HW: About how many CFS and fibromyalgia (FM) patients have you treated?
Do you have a standardized treatment protocol for your CFS and FM
patients?
Dr. Rosenbaum: Because of its inherent variability, it is unrealistic to
create a rigid standardized treatment protocol for CFS. Although
symptoms frequently overlap among CFS patients, each CFS patient is
different and manifests a unique symptom blueprint. In the treatment
chapter of my book, four steps were proposed as part of a general
treatment approach:
Step 1: Treat mixed infections especially those that are readily
apparent and treatable as bacterial and/or fungal sinusitis or
enteritis.
Step 2: Treat allied mixed conditions which often occur in CFS patients.
These include food and inhalant allergies and sensitivities, mold
exposure, heavy metal toxicity; adrenal, thyroid and sex hormone
endocrinopathies.
Step 3: A) Inactivate the core intracellular microbes that may cause the
disease including herpes family viruses, enteroviruses, mycoplasma
species and Chlamydia pneumonia.
B) Normalize the immune dysregulation that appears to characterize CFS,
including abnormally high T-cell activation and a shift in the
predominant immune response from T helper-2 which emphasizes antibody
responses to allergens and autoimmune reactions to a T helper-1 mode,
which emphasizes the eradication of intracellular viruses and bacteria.
Step 4: Heal nervous system problems involving mental alertness,
cognition and mood disorders.
HW: What are your treatment recommendations regarding improving sleep,
low energy, pain, and depression among your CFS and FM patients?
Dr. Rosenbaum: A menu of medications, nutrients and herbs help the
treatment in each step described above. The following nutrients and
alternative approaches have worked best in my practice:
Energy: B Complex vitamins, especially vitamins B1 and B12; NADH – a
stabilized form of vitamin B3, Coenzyme Q10. The above vitamins all
participate in the formation of ATP energy packets. For muscle energy,
creatine, carnitine and branched chain amino acids are often very
useful.
Cognition: Raising brain acetyl choline with tyrosine, N-acetyl
carnitine and DMAE; stabilizing brain cell membrane functions with
phosphatidyl serine.
Anxiety: Magnesium, relaxant herbs.
Depression: amino acid neurotransmitter precursors phenylalanine,
tyrosine and tryptophan or 5 HTP. The prominent methylating agent SAMe
is an especially potent antidepressant also useful in reversing chronic
nerve damage. Sleep: It is important to preserve stage 4 deep or ‘slow
wave sleep’. Stage 4 sleep is interrupted by benzodiazepines like
lorazepam that are frequently used by CFS patients. Tricyclic
antidepressants like elavil and sinequan are also excellent sleep
inducers and enhance stage 4 sleep but can impair dreaming during REM
sleep and cause weight gain.
These are very useful medications in spite of their adverse effects upon
sleep architecture. Sonata does not disrupt any of the sleep stages and
is particularly useful with middle of the night awakening due to its
rapid disappearance from the blood stream.
I have found that a cocktail of calcium 600 to 800 mg and magnesium 300
to 500 mg taken before bedtime has a relaxant effect that is very useful
for sound sleep and to prevent restless legs. Melatonin and serotonin
inducers like tryptophan and 5 HTP are also very useful. Too much
tryptophan can cause bizarre and unpleasant dreams. GABA which occupies
GABA receptors helps allay anxiety and induces sleep. Usual dose are 500
to 1500 mg.
Pain:
Muscle pain:
--Nutrients: MSM at high doses of 8 to 12 grams a day. DLPA at doses of
one to three grams a day increases endorphins.
--Drugs: Ultram (generic- tramadol) is my favorite. It has very low
addiction potential and seems to work well. It is energizing and can
cause insomnia if taken too late in the day.
Joint aches:
--Nutrients: all antioxidants which are anti-inflammatory. Fish oil
supplements – especially those with a high EPA content, are
anti-inflammatory.
--Drugs: NSAIDs if tolerated. These need to be carefully monitored and
can cause a wide variety of adverse effects.
HW: What do you believe are the most common factors for these illnesses
– why do you think so many CFS patients also have FM, and vice-versa?
Dr. Rosenbaum: About 80-90% of CFS patients have FMS (fibromyalgia
syndrome). I believe that FMS has multiple causes including chronic
infections, physical and emotional trauma and connective tissue
inflammatory diseases. CFS is just one potential cause of FMS.
There are similarities in both conditions including low brain serotonin
and low vitamin B12 levels in cerebrospinal fluid. Both conditions
exhibit abnormalities in immune cytokines with an elevation of
proinflammatory cytokines and a decrease in exercise and a frequent
profound deficit in slow wave sleep.
HW: You participated in a 2001 clinical research study "Improved Immune
Activation Markers in Chronic Fatigue and Immune Dysfunction Syndrome
(CFIDS) Patients Treated with Thymic Protein A." Would you talk a little
bit about this study, and the significance of the results for the
treatment of CFS patients?
Dr. Rosenbaum: Thymic protein A is a potent T helper -1 stimulant. I
have focused much of my attention in recent years on the effects of
diet, individual nutrients and herbs upon immunity in general and upon
the aberrant immune response in CFS patients. The literature on the
immune response in CFS patients indicates a trend toward a decline in
the response of Natural Killer (NK) and T helper-1 cells to customary
immune stimuli. Many of us in the field have been searching for ways to
restore T helper immune balance.
Thymic protein A (TPA) appears to be such an immune modulator. It is a
native thymus peptide which is necessary for the activation of T
helper-1 cells. I was impressed by the fact that it is possible to take
a potent T helper-1 stimulant by convenient sublingual administration.
THP is grown in cell culture from a single bovine cell obtained about
ten years ago. I was privileged to participate in a study on CFS
patients who had been ill for at least one year and whose symptoms and
treatment program had plateaued. These patients were treated with one
packet of TPA containing 4 mcg. of TPA administered sublingually three
times a day for three consecutive months and were examined at baseline,
six weeks and three months. Blood tests for CFS biomarkers included T
cell numbers and activation markers, RNAase, 2,5A synthetase and NK cell
activity. Quality of life questionnaires were filled out weekly.
The results were encouraging. T-Cell activation markers were reduced in
about 2/3 of the patients. There was an overall trend toward a reduction
in the RNAase anti-viral enzyme system. Substantial improvements were
noted in ‘Quality of Life" symptom scores especially with regard to
anxiety, depression, short-term memory and non-restorative sleep. There
was an improvement in the incidence of canker sores in nearly 100% of
the participants who had canker sores before trying TPA. I suspect that
the improvements in blood tests and symptom scores would have been even
more significant if the trial were to have been extended longer than
three months.
HW: What do you think are the most promising breaking developments in
CFS and FM research?
Dr. Rosenbaum: Aside from the exciting efforts to help normalize the
dysregulated immune response in CFS, I am encouraged by new treatment
approaches to target the microbes associated with CFS including the
herpes family viruses and intracellular bacteria like mycoplasmae and
Chlamydia pneumonia. The recent availability of oral hyperimmunized
colostrum and transfer factor products which target a broad range of
these microorganisms is an exciting advance.
HW: What do you think the future looks like for CFS and FM patients? Are
we moving forward in dealing with these diseases – as patients,
practitioners, and as a society?
Dr. Rosenbaum: CFS is a multidimensional disorder. There is, as yet, no
simple and definitive diagnostic test or magic bullet cure. In spite of
this complexity, I do believe that the future for the identification and
control of CFS appears brighter. Laboratory tests are slowly honing in
the identification of subtle infections and T Cell immune dysregulation.
Extremely potent immune-modulating agents are available including
concentrated mushroom and thymic extracts that were not sold in stores
just a few years ago.
Two other dimensions of CFS are receiving increasing attention:
1)The role of dysautonomias manifested by abnormal regulation of pulse,
blood pressure and body temperature and, 2)The role of hypercoagulopathy
- an increased tendency of the blood in CFS patients to impede blood
flow to the brain and muscles and to sequester potentially harmful
microorganisms and shield them from immune surveillance and destruction.

The puzzle pieces of Chronic Fatigue Syndrome are gradually forming
patterns that will allow for more ready diagnosis and treatment in
coming years. HW
www.immunesupport.com
************************************************************

GUARDING AGAINST WEST NILE VIRUS
Your best bet to prevent acquiring West Nile virus and other
mosquito-borne illnesses is to take precautions to avoid exposure to
mosquitoes. Steps you can take to help control West Nile virus include
the following:
--Eliminate standing water in your yard. Mosquitoes breed and multiply
in standing water.
--Unclog roof gutters.
--Empty unused swimming pools.
--Change water in birdbaths at least weekly.
--Remove old tires or any unused containers that might hold water and
serve as a breeding ground for mosquitoes.
--Keep an eye out for sick or dying birds and report them to your local
health department.
To reduce your exposure to mosquitoes:
--Avoid unnecessary outdoor activity when mosquitoes are most prevalent,
such as dawn, dusk and early evening.
--Wear long-sleeved shirts and long pants when going into
mosquito-infested areas.
--Apply an insect repellent.
(Source: Mayo Clinic, www.mayoclinic.com)
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*****

Mystery aches: Is it your heart med?
by Sarí Harrar

Statins--the wonder drugs that are helping to protect millions of
Americans against heart attack and stroke--may have a hidden downside.
Warning signals: soreness, aches, pain, weakness, fatigue, difficulty
walking or getting out of bed.
The cause: muscle or nerve damage. In a small study, researchers found
that there may be a link between statins and severe muscle damage--of a
sneaky sort that eludes the standard blood test (creatine kinase) for
muscle breakdown. Researchers in large cholesterol clinics think that up
to 1 in 10 people who take statins may have a mild form of this muscle
toxicity. They may just feel tired, or have trouble getting out of a low
chair.
Meanwhile, a huge Danish study found that long-term statin users had a 4
to 14 times higher risk of peripheral neuropathy, nerve damage that can
cause weakness, pain, and trouble walking.
Here's what to do if you take a statin:
Consider Coenzyme Q10 (CoQ10). Statins may deplete this natural
antioxidant that helps your body's cells produce energy. CoQ10
supplements could help; experts are cautiously optimistic. Discuss the
best dosage with your doctor.
Side effects? Call the doc. Don't stop your statin on your own. Your
doctor may order tests, switch your meds, or suggest diet and exercise
changes.
http://www.prevention.com/cda/feature2002/0,4780,5681,00.html

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*
MULTIPLE CHEMICAL SENSITIVITIES
According to Jacob Teitelbaum, M.D., "Clinical ecologists can be
especially helpful for people who have multiple chemical sensitivity
(MCS) syndrome. I view this as a subset of Chronic Fatigue Syndrome
(CFS), where the body has given up and is reactive to almost everything
in the environment.
Many people with CFS have multiple allergies and sensitivities to
environmental chemicals or different medications. Although this is
common, it is not what I am describing here. Patients with chemical
sensitivities are those who can't even live in a normal house because
they become deathly ill if a new carpet is put in, if anybody sprays for
pests, or if they come in contact with any of the thousands of chemicals
we normally use. For those people, I would recommend an excellent book
by Sherry Rogers, M.D., called Tired or Toxic (Prestige Publishing, ISBN
No. 0-9618821-2-3)."
(Source: From Fatigued to Fantastic! A Manual for Moving Beyond Chronic
Fatigue and Fibromyalgia, by Jacob Teitelbaum, M.D.)
www.ImmuneSupport.com

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***

ANTIDEPRESSANTS MAY PROTECT AGAINST HIPPOCAMPAL VOLUME LOSS
Laurie Barclay, MD
Aug. 1, 2003 — Antidepressants may protect against hippocampal volume
loss associated with depression, according to the results of a small
trial published in the August issue of the American Journal of
Psychiatry. The amount of volume loss was predictable from the number of
days depressed versus the number of days receiving antidepressant
treatment.
"Our results suggest that if a woman takes antidepressants whenever she
is depressed, depression would have less effect on the volume of her
hippocampus," lead author Yvette I. Sheline, MD, from Washington
University School of Medicine in St. Louis, Missouri, says in a news
release. "It is the untreated days that seem to affect hippocampal
volumes."
Using high-resolution magnetic resonance imaging (MRI), the
investigators measured hippocampal volume in 38 female outpatients with
major depression and in 38 controls matched for age, education, and
height. On average, the depressed women had a previous history of five
depressive episodes, only some of which were treated with antidepressant
drugs. Each woman was interviewed by two independent interviewers to
determine the duration of each depressive episode and of antidepressant
treatment.
Hippocampal volume was smaller in depressed women than in controls.
Longer episodes during which depression was untreated with
antidepressants was directly correlated with decreases in hippocampal
volume.
"We've shown in other studies that people with hippocampal damage also
have problems with certain memory tests," Dr. Sheline says. "Large
epidemiology studies have shown that major depression is a risk factor
for the later development of Alzheimer's disease. So it seems clear that
volume loss in the hippocampus can have very negative effects, not to
mention the devastating problems caused by depression itself."
The mechanism of hippocampal atrophy is not clear, but it may involve
cortisol or other neurotransmitters released during depression damaging
neurons or synapses. Animal models also suggest that antidepressant
drugs may protect against stress-induced hippocampal volume loss. This
study did not distinguish the effects of specific antidepressants.
According to the investigators, cumulative hippocampal volume loss with
repeated depressive episodes mandates early recognition and treatment.
"Many psychiatrists already recommend that some patients who are prone
to depression remain on antidepressants permanently to protect against
depression," Dr. Sheline says. "These apparent neuroprotective effects
provide a further argument for at least strongly considering remaining
on antidepressants."
The National Institute of Mental Health and the Division of Research
Resources of the National Institutes of Health supported this research
through grants.
Am J Psychiatry. 2003;160(6):1516-1518
Reviewed by Gary D. Vogin,
http://www.medscape.com/viewarticle/459517?mpid=17177&WebLogicSession=Pz
3D7ZT9Hkzy7iCCRv54UDY6NPIIyH1AAgaL8LiOGmv2QlK0Mpmw|6818469695563490190/1
84161395/6/7001/7001/7002/7002/7001/-1
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YEAST OVERGROWTH CREATES HAVOC IN THE IMMUNE SYSTEM
ProHealthNetwork.com

08-04-2003

Candida albicans is yeast normally found in small amounts in the warm
interior membranes of the mouth, skin and digestive tract of healthy
individuals. Typically, Candida does not cause any health problems as
its growth is kept under control by the immune system and other
"friendly" bacteria in the body. However, there are conditions that may
disrupt the balance of bacteria and cause the overgrowth of Candida,
producing an infection.
This type of infection is called Candidiasis, and can range from
superficial conditions such as sores in the mouth (oral thrush), vaginal
yeast infections in women and diaper rash in infants, to dangerous
invasive infections of the blood stream.
Candida infections occur when the immune system is weakened by disease,
stress or medication. Other factors that may prompt Candida overgrowth
include high blood sugar levels, excessive alcohol intake, use of birth
control pills, low stomach acidity, and a poor diet high in fat.
Extended use of antibiotics can also play a significant role in the
development of a Candida infection. Patients with medical conditions
that require treatment with broad-spectrum antibacterial medications can
have lower bacteria levels throughout the body, as antibiotics easily
destroy friendly bacteria in the intestinal tract. Friendly bacteria are
known as probiotics, and benefit the body by helping to digest protein
and improve bioavailability and usage of vitamins and minerals. More
importantly, friendly bacteria support the immune system by activating
antibodies that protect the body from bacterial infection and disease.
If the balance of intestinal flora is upset and pathogenic yeast such as
Candida becomes the dominant occupant of the intestinal tract, friendly
bacteria may no longer effectively produce the antibodies and nutrients
the body needs to be healthy. Once growth of Candida becomes unregulated
and pathogenic it will begin to release large amounts of toxins that
have harmful effects on tissues and organs, which in turn produces
symptoms such as excessive fatigue, bowel and digestive problems, gas
and bloating, food and mold allergies, skin rashes, depression and
thyroid problems.
How is Candida Treated?
According to the Mayo Clinic, a physician will typically prescribe an
antifungal medication such as nystatin to lower levels of Candida. The
normal course of treatment usually lasts about 10 to 14 days.
However, prolonged treatment may result in the yeast becoming resistant
to the medication. At that time, a drug called Amphotericin B (Amphocin)
may be used when other antifungals are no longer effective. Safety may
be an issue for some as certain antifungal medications may also have
harmful effects upon the liver. As a result, a physician is likely to
monitor liver function through blood tests, especially if the patient
has a history of liver disease.
Modifying a patient’s diet is also an important strategy in combating a
Candida infection. As Candida thrives on sugar and simple carbohydrates,
it is recommended that patients eliminate high sugar foods such as
sodas, fruit juices, sweet desserts, high carbohydrate foods and other
refined foods from their diet.
Additionally, increasing levels of probiotic bacteria will also help
reduce the amount of Candida and return the balance of intestinal flora
to normal. Probiotic bacteria such as Lactobacillus acidophilus
naturally produce inhibitory factors that limit the overgrowth of yeast.
Probiotics can be most easily obtained by consuming sugar-free yogurt or
by taking oral supplements.
Many integrative health care professionals utilize targeted transfer
factors and/or natural egg-derived products containing transfer factor
for powerful immune support by promoting a healthy digestive tract with
targeted immune factors. These immune factors and humoral cofactors are
formulated to provide the body with millions of naturally produced
immunoglobulin that help support the immune system. Transfer factor
proteins and humoral cofactors harvested from the yolks of immunized
chicken eggs can provide the body with the information and nutrients it
needs to promote normal immune function.
The immune cofactors are isolated and purified using numerous rigorous
techniques, and processed into a fine grain powder for consumption.
Meticulous testing then ensures that the appropriate and effective
levels of each immune factor are present.
In a study presented at the 10th International Symposium on Transfer
Factor1, Italian Researchers from the University of Bologna (Italy)
tested two transfer factor (TF) preparations on 15 patients suffering
from chronic mucocutaneous Candidiasis. The first preparation was an in
vitro produced transfer factor specific to Candida albicans antigens,
and the second included TF extracted from pooled buffy coats of blood
donors. The researchers assessed cell-mediated immunity (CMI) of each
patient using the leukocyte migration inhibition test (LMT) and
lymphocyte stimulation test (LST). The aim of the study was to evaluate
transfer factor treatment and the incidence of positive tests before,
during, and after therapy.
Eighty-seven LMT evaluations were performed for each antigen dose, and
researchers found 58.9% (33/56) of the tests were positive during
non-treatment or non-specific transfer factor treatment, while 83.9%
(26/31) were positive during specific transfer factor treatment. Only
during specific TF treatment was a significant increase of reactivity
against the Candida antigen noticed, when compared with the period of
non-specific treatment. Clinical observations were also encouraging as
all but one patient experienced significant improvement during treatment
with specific TF. The researchers concluded orally administered specific
TF increases the incidence of reactivity against Candida antigens.
Reference:
1. Masi, M., De Vinci, C., Baricordi, O.R. "Transfer factor in chronic
mucocutaneous candidiasis." Biotherapy. 1996; 9(1-3)97-103.
http://www.prohealthnetwork.com/library/bulletinarticle.cfm?ID=1411&PROD
=PH179&SLP=yes#baseref#/library/print.cfm?ID=#id#
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EXTRA STRESS STRESSES IMMUNE SYSTEM, TOO
By Jacqueline Stenson

NEW YORK (Reuters Health) - Research has indicated that chronic stress
can take a hefty toll on a person's health, and a new study offers one
potential reason why.

Investigators found that older people under chronic stress had
higher-than-normal elevations of interleukin-6 (IL-6), an immune-system
protein in the blood that promotes inflammation. IL-6 has been linked
with various age-related conditions such as heart disease, diabetes,
osteoporosis, frailty and certain cancers.

"This is how chronic stress can really affect health," said study author
Dr. Janice K. Kiecolt-Glaser, a professor of psychiatry at Ohio State
University in Columbus.

"The take-home advice from this study is that it's really important to
try to deal with stress," she told Reuters Health. "The older you are,
the more it really matters."

Over the course of the six-year study, IL-6 levels increased an average
of four times faster among men and women who were caring for spouses
with dementia than among people who were not caring for ill spouses. The
study participants ranged in age from 55 to 89 at the beginning of the
study, with an average age of 71.

The 119 caregivers reported spending about 10 hours a day on average
caring for a spouse when the study began, Kiecolt-Glaser and colleagues
note in the online early edition of the Proceedings of the National
Academy of Sciences.

Tests conducted periodically throughout the study period showed that the
caregivers experienced consistently higher levels of stress and
loneliness than the 106 non-caregivers.

In the cases where spouses died during the study, caregivers continued
to have high IL-6 levels, even several years later.

All of the study participants were healthy at the outset of the study,
and the caregiving and non-caregiving groups had similar levels of
chronic health problems during the follow-up period.

However, it's likely that the caregivers would go on to develop a
greater number of illnesses due to their higher IL-6 levels,
Kiecolt-Glaser said.

"These data provide important evidence of a key mechanism through which
chronic stressors may have potent health consequences for older adults,
accelerating risk of a host of age-related diseases," the researchers
conclude in their paper.

SOURCE: Proceedings of the National Academy of Sciences
2003/doi/10.1073/pnas.1531903100.

Last Updated: 2003-06-30 17:00:18 -0400 (Reuters Health)

http://message.realage.com/HB/HBArticle.aspx?cid=14520&pid=1440
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Myths About Anger
Myth: Anger is instinctive.
Reality: As a response, anger is primarily a learned behavior that
people exhibit largely because they’ve been able to get away with doing
so. Peoples' responses to anger-provoking situations are typically more
learned than instinctive responses.

Myth: Activities like punching a pillow help to get rid of angry
feelings.
Reality: Research shows that aggression usually inflames rather than
releases anger. A person hitting a pillow as a response to an angering
situation is likely to feel more angry after doing so than they were
before hitting it. In addition, new research on anger is beginning to
suggest that we have a much more complicated with managing our anger
than the binary model of either keeping it in or letting it out. One
group of researchers observe six distinct ways of coping with anger:
direct anger-out, assertion, support-seeking, diffusion, avoidance, and
rumination

Myth: Expressing anger is healthy.
Reality: Getting accustomed to expressing anger may actually set up a
pattern of such expression, and research findings seem to indicate that
being a chronically angry or hostile person is bad for your heart. Many
studies (but not all) have found that high anger and hostility are
associated with an increased risk of coronary heart disease and
mortality, hypertension, blood pressure and other heart-related
problems. There are mitigating factors however, which is good news for
anyone struggling to change patterns of chronic hostility. It appears
that a strong social support network and even pet ownership protect an
individual somewhat from the negative health effects of chronic anger.
Another recent study in the International Journal of Behavioral Medicine
(Vol. 6, No. 3) found that people who learned to cope with their anger
constructively had lower resting blood pressure than people with fewer
coping skills.

Myth: Men get mad, women get depressed.
Reality: Both men and women get angry with equal intensity and
frequency, for similar reasons, but men are more likely to express anger
through aggressive responses while women report using a wider range of
anger coping styles, especially more social support-seeking and more use
of anger diffusion strategies than men. However, women do tend to rate
their emotional distress as more intense than men, and with the
exception of middle-aged and older adults, women reported that they
experienced distress for a longer duration than men.

Myth: Anger has a protective function.
Reality: Not necessarily. There's a way in which anger actually connects
you to people you don't like while it simultaneously alienates you from
those you do. And displays of anger don't necessarily cause others to
think that you're powerful or in control of a situation either; anger
can just as easily be regarded as proof of being out of control as it
can be used for the opposite view.



All Rights Reserved, Cortext.Com

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Panic Attacks versus Panic Disorder
M. Katherine Shear, MD
Up to 10% of the population experience sporadic panic attacks. These
attacks are characterized by sudden onset and rapid escalation of
somatic symptoms referable to the autonomic nervous system (e.g., chest
pain, shortness of breath, heart palpitations, and dizziness) along with
fear or apprehension. Panic attack is diagnosed when at least four of 13
symptomatic criteria occur unexpectedly and peak within 10 minutes (see
Table 1). Panic attacks typically last 10 to 20 minutes, but they can be
shorter.
The pathognomonic feature of panic disorder is recurrent unexpected
panic attacks. Between panic attacks, persons with panic disorder are
beset by fear of the attacks and their consequences or implications.
Panic disorder is more common in women and has an average-age-group
onset of early adulthood.
Panic disorder may be accompanied by agoraphobia, a fear of situations
in which the person would feel trapped or alone should a panic episode
occur. Such situations typically include travel far away from home, on
public transportation, or via bridges or tunnels; crowded places such as
supermarkets, restaurants, theaters, churches, or shopping malls;
standing in line; and being alone. Agoraphobia is characterized by
avoidance of these situations. In its most severe form, sufferers can be
housebound. In addition, persons with panic disorder are at risk for
developing major depression, with over half meeting lifetime criteria
for major depression.
Panic Disorder in Medical Guise
Persons with panic disorder are more likely to present for medical
treatment than for mental health treatment. Panic disorder has four
common clinical presentations in general medicine: (1) physical symptoms
(e.g., heart palpitations, chest pain, shortness of breath,
gastrointestinal complaints, headache, dizziness), (2) anxiety and
tension, (3) hypochondriacal concerns, and (4) certain diagnosed medical
conditions, such as migraine, asthma, chronic obstructive pulmonary
disease (COPD), and labile hypertension.
Panic disorder is often seen in patients referred for cardiologic
complaints, especially atypical chest pain or chest pain despite
angiographically normal coronary arteries. Because cardiovascular
symptoms are prominent during panic attacks, panic disorder should be
considered in patients with intractable cardiac symptoms. Several
studies have shown that men with phobic anxiety are at higher risk of
cardiovascular mortality from fatal myocardial infarction and sudden
cardiac death. Idiopathic clinical and subclinical cardiomyopathies have
been associated with panic disorder, possibly related to increased
adrenergic activity. Panic attacks are associated with transient
increased blood pressure, so this diagnosis should be considered in
patients with labile hypertension. Panic disorder has been found in
about 16% of patients with implantable cardioverter defibrillators.
There is an association of respiratory illness with panic disorder.
Patients with asthma have a higher incidence of panic disorder, and the
presence of panic disorder predicts a poorer clinical course in asthma.
A history of childhood respiratory illness is more common in patients
with panic disorder than in those with other psychiatric disorders. In
adults, COPD is associated with panic disorder.
Specifics on Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is the most common anxiety disorder
seen in primary care settings. Lifetime prevalence rates of GAD range
from 4% to 7%, with nearly a 10% prevalence in women older than 40
years.[1] The defining characteristic of GAD is persistent, excessive,
and uncontrollable worry about everyday life situations. GAD often
presents as sleep disturbance or somatic symptoms such as muscle aches
and tension headaches.[2]

Pharmacologic Treatment
The FDA has approved venlafaxine for use in GAD, and most experts
consider this agent to be the first-line treatment. Venlafaxine also
relieves anxious and depressive symptoms in GAD patients with comorbid
major depressive disorder. Selective serotonin reuptake inhibitors have
also been found to be effective in GAD.[3]
Benzodiazepines have been used to treat GAD, and at least one study
suggests that their use does not lead to tolerance. However, these drugs
are generally not used as first-line treatment. Many patients with GAD
also have depression, which benzodiazepines do not relieve.
Psychological Treatment
Cognitive-behavioral therapy for GAD has been less well studied than
that for other anxiety disorders[4] but appears promising. An
intervention that targets worry has shown good results that were
maintained at 6-month and 12-month follow-up. Because of the chronic
nature of GAD, the efficacy of combining psychodynamic therapy with
cognitive-behavioral techniques has been suggested, and a preliminary
evaluation of psychodynamic treatment of GAD showed positive results
with this approach. A randomized trial of integrated interpersonal and
cognitive-behavioral therapy, which is currently under way, suggests
improved efficacy over either therapy alone.
WebMD Scientific American® Medicine 2003. © 2003 WebMD Inc.
All rights reserved.

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Low Fasting Serum Triglyceride Level as a Precocious Marker of
Autoimmune Disorders

Silvia Iannello, MD, Antonina Cavaleri, MD, Paolina Milazzo, MD, Santi
Cantarella, MD, Francesco Belfiore, MD
Abstract and Introduction
Abstract
The authors recently reported the occurrence of low fasting serum
triglyceride (TG) and high free fatty acid (FFA) levels in idiopathic
pulmonary fibrosis. TG estimation in diverse groups of patients with
autoimmune disease or hyperactive immune response confirmed the
occurrence of a similar decrease of TG. In some patients, serum FFA
level was also evaluated. TG value in lean and obese patients was
compared with that in lean (n = 108) and obese (n = 208) control
subjects without autoimmune disease. In patients affected by autoimmune
chronic thyroiditis with enhanced concentration of antithyroglobulin
antibodies and without thyroidal failure (n = 24), lean and obese
patients had reduced TG (-69/%, P < .01 and -52%, P < .0001,
respectively). Both lean and obese patients affected by chronic active B
or C hepatitis (n = 26), with autoantibodies and without signs of
hepatic insufficiency or cirrhosis, presented reduced TG (-57%, P < .01
and -61%, P < .001, respectively). A marked TG decrease (-73%, P < .001)
was observed in the lean patients affected by lupus-like syndrome (n =
7). The lean and obese patients with systemic lupus erythematosus or
rheumatoid arthritis (n = 11) showed TG decrease (-66%, P < .01 and
-55%, P < .05, respectively). In patients affected by anamnestic allergy
or atopic dermatitis/asthma (n = 66), both lean and obese, TGs were
reduced (-67%, P < .0001 and -62%, P < .001, respectively). In isolated
cases of diverse autoimmune diseases (scleroderma, APECED [autoimmune
polyendocrinopathy, candidiasis, and ectodermal dystrophy], urticaria or
urticarial vasculitis, Reiter or Sjogren syndromes, ulcerative colitis
or Crohn's disease, multiple sclerosis or Guillain-Barré syndrome) (n =
14), decreased TG was also observed both in the lean and obese subjects
(-59%, P < .01 and -57%, P < .01, respectively). Concerning FFA (n =
69), value in lean patients (n = 22) vs that in lean controls (n = 18)
was increased (520 ± 31 vs 299 ± 30 mcEq/L, +74%, P < .001), whereas
value in obese patients (n = 18) vs that in obese control subjects (n =
11) was decreased (542 ± 34 vs 774 ± 62, -30%, P < .01). This opposite
behavior of FFA in lean and obese patients needs to be confirmed. Data
in this study seem to indicate that low TG value may be a precocious
marker of autoimmunity or immune system hyperreactivity
Full article can be found at:
http://www.medscape.com/viewarticle/459414?WebLogicSession=Pz3Bopx0d41rY
3RRnTuVO7J3CecuizqF8ZWyp1n1S15nt7Yu7nQm|6818469695563490190/184161395/6/
7001/7001/7002/7002/7001/-1

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LAUGHTER: THE BEST MEDICINE?
Hannah Keeley
Those famous words sung by Donald O’Conner in "Singin' In The Rain" may
well be the new mantra for the medical community: "Make ’em laugh." Not
since 1979, when Norman Cousins laughed himself out of a
life-threatening disease in his book Anatomy of an Illness (Norton,
W.W.& Company, Inc.), has the health community been so excited about
humor.
Researchers may not be jumping up and down or spinning in circles on the
floor, but they’re still all smiles. And from the results of some recent
studies on the effects of humor on pain tolerance, they have every
reason to be.
Although we’ve known for ages that laughter is good medicine, Sherry
Hilber, founder and president of RxLaughter, has the numbers to prove
it. RxLaughter is the name of the ongoing UCLA study currently testing
the effects of humor on pain tolerance in children. Because their immune
systems are still developing, children make ideal subjects.
By measuring the physiological responses of ill children when viewing
funny video clips, the results are already demonstrating significant
healing power in laughter, both physically and emotionally, and Hilber
is tickled pink over the results. "What a tool this could be!" she
exclaims. "Children who are ill may be able to have improved immune
systems."
The Problem with Free Laughter
Although confident of the power of humor, Hilber discovered funding
RxLaughter was no laughing matter. Until scientists can figure out how
to put a barrel of laughs in a bottle of pills, drug companies will
never benefit financially from funding laughter research. Such research
might actually reduce the need for pain killers, which would be a shot
in the financial foot of drug companies.
"It’s much easier to focus on the negative," explains Hilber.
But Hilber sensed the entertainment industry might be willing to laugh
along with her research. And a call into Comedy Central, a cable comedy
network, yielded the funding. Tony Fox, senior vice- president of
corporate communication there, saw the business opportunity that lay in
supporting the study.
"I saw the possibilities for the network, and I was definitely on board
with the idea of discovering physical evidence that comedy is good for
you."
Prescribing Guffaws
There’s no need to convince Dr. Robert Brunston, a surgeon practicing
out of Biloxi, Mississippi, of the medicinal effects of laughter.
Brunston jokes with his patients and believes there’s power behind a
positive attitude.
"In my experience, patients who have a better attitude and are more
upbeat need fewer sedatives and narcotics, get out of bed more
frequently, and go home quicker."
Brunston suggests that humor alters specific neurotransmitters that
effect the biochemistry of the brain. This causes patients to interpret
the pain as a less intense signal.

An Everyday Dose

But who says you need to be sick to profit from a good case of the
chuckles? Maybe in addition to our apple a day, we should all enjoy a
good joke or two. There have been several studies demonstrating that
humor helps in everything from relieving allergy symptoms to creating
healthy hearts. But does comedy actually go hand-in-hand with good
health?
"Absolutely," says Ann Weeks DNS, RN. "Not only does humor help with
problems, but consumers of humor actually stay healthy longer." And if
anyone should know, it would be Weeks, who is president of the
Association for Applied and Therapeutic Humor and employs humor in her
private practice.
And she’s not laughing alone. Researchers at Vanderbilt University,
Nashville, Tennessee, are in it for the laughs, too. They’ve been taking
a close look at laughter and have found, says Jo-Anne Bachorowski, a
psychologist who recently published a study on laughter, that it can be
a tool for quelling anger, building relationships, and relieving
tension. According to the Vanderbilt study, humor can even boost the
immune system while increasing respiration, which can contribute to
relaxation. And when the laughter keeps coming, relationships benefit
too.
Perhaps science is just now catching on to what the Word of God has told
us for ages. "A cheerful heart is good medicine" (Prov. 17:22). Take two
belly laughs and call me in the morning.
http://www.lifeway.com/lwc/article_main_page/0%2C1703%2CA%253D152905%252
6M%253D200118%2C00.html
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***
TAKE TIME
1. Take time to Think - It is the source of power.
2. Take time to Play - It is the secret of youth.
3. Take time to Read - It is the foundation of knowledge.
4. Take time to Worship - It is the highway of reverence and washes the
dust of earth from our eyes.
5. Take time to Help and Enjoy Friends - It is the source of happiness.
6. Take time to Love - It is the one sacrament of life.
7. Take time to Dream - It hitches the soul to the stars.
8. Take time to Laugh - It is the singing that helps with life's loads.
9. Take time to Plan - It is the secret of being able to have time for
the
first eight things.
Unknown

 

 

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