Friday, August 5, 2011
Chronic Otitis Externa can present similar to AOE, is not only long standing, but the inflammation is usually secondary to eczema, psoriasis, seborrheic dermatitis, or fungi (Candida albicans and Aspergillus). Rarely fungi only, can cause AOE. Wax in the ear can combine with the swelling of the canal skin and any associated pus to block the canal and decreases hearing. In more severe or untreated cases, the infection can spread to the surrounding soft tissues causing Malignant or Necrotic Otitis Externa. These are more likely in diabetics, immune suppression, and in the elderly. In its mildest forms, EOE is so common that some physicians have suggested that most people will have at least a brief episode at some point in life. A small percentage of people have an innate tendency toward chronic external otitis. These folks have a genetic predisposition for producing too small amount of or an inferior (too little IgA) protective wax.
Most people can avoid AOE altogether once they understand the intricate mechanisms of the disease. The skin of the bony ear canal is unique, in that it is not movable but is closely attached to the bone, and it is almost paper-thin. For these reasons it is easily abraded or torn by even minimal physical force. Inflammation of the ear canal skin typically begins with a physical insult, most often from injury caused by attempts at self-cleaning or scratching with cotton swabs, pen caps, finger nails, hair pins, keys, or other small implements. This trauma and prolonged water exposure in the forms of swimming, bathing, showering or exposure to extreme humidity, which can compromise the protective barrier function of the canal skin, allowing bacteria to flourish. Densely impacted wax, usually caused by enthusiastic use of cotton swabs, can put enough pressure on the ear canal skin to injure it and initiate infection. A sensation of blockage or itching can prompt attempts to clean, scratch, or open the ear canal, which potentially worsens and perpetuates the condition. The cotton fibers of a swab are abrasive to the thin, fixed canal skin. Self-manipulative measures to improve the condition often make it worse and are to be discouraged, in that it can result in significant injury to the ear. It is well established that the ear canal is self-cleaning. The top layer of the ear canal skin normally migrates toward the ear opening, essentially sweeping the canal on a continuing basis. In other words, a normal ear canal is self-cleaning.
Pain is the predominant complaint and the only symptom and is directly related to the severity of AOE. Unlike Otitis Media, the pain of AOE is worsened if the ear is pulled gently. Patients may also experience ear discharge and itchiness. Initially, when doctors look inside the ear with an otoscope, they observe very little abnormality. If they are astute, they may notice a decrease of the normal ear wax. However, when enough swelling and discharge in the ear canal is present to block the opening, the eardrum cannot be seen. Looking at the eardrum is very important to the doctor in that this is how the diagnosis of Otitis Media is made and to rule out a punctured ear drum. The “pus” exuding from the canal is not true pus (all white cells), but the liquid debris of wax, dead skin, and the previous drops placed within the canal for treatment.
The treatment when EOA is very mild is simply to refrain from swimming or washing ones hair for a few days, and keeping all implements out of the ear. It is a self-limiting, self-resolving condition! However, if the infection is moderate to severe, or if the climate is humid enough that the skin of the ear remains moist, spontaneous improvement may not occur.
Effective therapy for the ear canal includes acidifying and drying agents, used either singly or in combination. When severe, topical solutions (or suspensions) of eardrops are the mainstays of treatment for EOA. Effective medications include eardrops containing antibiotics to fight infection, and corticosteroids to reduce itching and inflammation. Some contain antibiotics, either antibacterial or antifungal, and others are simply designed to mildly acidify the ear canal environment to discourage bacterial growth. Some prescription drops also contain anti-inflammatory steroids, which help to resolve swelling and itching. Cortisporin (neomycin-polymyxin B-hydrocortisone), Ciprodex ear drops ( Ciprofloxacin and dexamethasone), Gentisone HC ear drops (Gentamicin and hydrocortisone), Ciproxin HC ear drops ( ciprofloxacin and hydrocortisone), Sofradex ear drops (containing Framycetin Sulphate, Gramicidin, Dexamethasone/sodium metasulphobenzoate, Phenylethanol), Kenacomb ear drops, ( triamcinolone acetonide, neomycin and gramicidin (antibiotics) and nystatin (antifungal).
Over the counter ear drops are also available, including spirit drops (alcohol solution) which dries out the ear, and drops such as Aqua Ear which contains a mixture of alcohol and acetic acid, to dry the ear and make it difficult for microbes to grow. Home remedies with half Vodka or Gin with half vinegar can also be used in a pinch. Athletes Foot OTC preparations such as a topical antifungal like 1% clotrimazole are also effective. Removal of debris (wax, shed skin, and pus) from the ear canal promotes direct contact of the prescribed medication with the infected skin and shortens recovery time. When canal swelling has progressed to the point where the ear canal is blocked, topical drops may not penetrate far enough into the ear canal to be effective. Inserting cotton (earwick) saturated with medication is frequently applied. The wick is kept saturated with medication until the canal opens sufficiently then the drops will penetrate. If the canal is significantly edematous, a foam (Pope) can be used. Antibiotic eardrops should be given for 7 days. The ear should be left open. Although the AOE generally resolves in a few days with topical washes and antibiotics, complete return of hearing and cerumen gland function may take a few weeks. Once healed completely, the ear canal is again self-cleaning. Until it recovers fully, the canal may be more prone to repeat infection from further physical or chemical insult.
Preventing acute external otitis are similar to those for treatment. Avoid inserting anything into the ear canal. (Q-tips or cotton swabs is the most common event leading to AOE.) Other measures to use after prolonged swimming in a person prone to external otitis is to dry the ear canals with a hair dryer. Alternatively, drops containing dilute acetic acid and alcohol(2:1) will do the job. Avoid swimming in polluted water. Do not wash hair or swim if very mild symptoms of AOE begin. The use of earplugs or bathing caps when swimming and earplugs while shampooing hair may help prevent EOA. Hard and poorly fitting earplugs can scratch the ear canal skin and set off an episode. A simple method of making a soft waterproof disposable earplug is with cotton balls covered with Vasoline. These coated cotton balls are NOT inserted into the ear canal, but pressed into the ear to cover the opening of the canal.
Saturday, July 2, 2011
Normal erectile function involves three synergistic and simultaneous processes: 1) neurologically mediated increase in penile arterial inflow, 2) relaxation of cavernosal smooth muscle, and 3) restriction of venous outflow from the penis.
Loss of the functional integrity of the endothelium and subsequent endothelial dysfunction plays an integral role in this issue. Pharmacological (Phosphodiesterase drugs such as Viagra) and endocrine (Testosterone) interventions help restore some function, but more is needed because of the 45% failure rate with these treatments. The incidence of ED dramatically increases in men who have endothelial dysfunction such as seen in middle age particularly those with diabetes mellitus, hypercholesterolemia, and cardiovascular disease. These diseases have in common a dysfunctional endothelium.
Penile erection is a psychoneurovascular phenomenon that depends upon cerebral stimulation, neural integrity, and a functional vascular system with healthy cavernosal tissues . It is the fit endothelium that produces the NO. Assuming the desire (libido), an intact nervous system and enough NO being produced from the endothelium, the penis will become erect and remain that way until it becomes refractory following ejaculation. Testosterone will encourage the brain if given sufficient visual and tactile clues. The intact nerves are needed not only for the brain to perceive touch, but to release the neurotransmitters to the penile arteries to dilate them. This dilatation to a large extent depends on the production of NO from the endothelium. If enough NO is released it will compensate for some lack of integrity of the neurovascularity. NO, then, is another therapy not generally used by doctors that is additive to testosterone and the phophodiesterase stimulators. Science has discovered several ways to increase NO production that will be discussed in another article.
Monday, June 6, 2011
Two doctors, three opinions are given, but the opinion that is the most important is YOURS, the patient. It is not the physician who will suffer the most if good therapies go en getting wrong, an adverse drug reaction occurs, or the operation was a success, but the patient died, but you and you family. You should be in charge of your health both preventively and therapeutically! A healing relationship with your physician is important and teamwork is key, but it should be you as the patient that is responsible for the path to take. The doctor is the knowledgeable coach or adviser, perhaps a family member, the team manager, but there is no doubt that if you are in your right mind that the decision of care should be yours! It is incumbent for you to be as knowledgeable as possible on the medical problem on hand. Information from the Internet, perhaps starting at Wikipedia, then a noncommercial website should be considered. Speaking to other patients with a similar problem, reading magazine articles or books does give a good working knowledge on your medical issue. Even getting another professional opinion from a physician who is not in cahoots with your original doc is a good idea.
Too often Primary Care Physicians function as gatekeepers; they may open the floodgates and let the patient drown in too many medical procedures and medicines. Fragmentation in medical care also is rampant today. The patient who decides what organ or area their problem lies in sees that specialist. Therefore, there is a cardiologist for their heart, a pulmonologist for their lungs, a nephrologist for their kidneys, a hematologist for their blood, and a “Big Toe doctor” for their gout. That leaves us with no one to take care of the whole person; moreover, the left hand doesn’t know what the right hand is doing. The gastroenterologist does not effectively communicate with the neurologist. If your primary care doc does not function as a knowledgeable clinical coordinator, then that responsibility by default is on you. As I try to set forth in this book, it is not how old a person is that counts, but how they feel and function when they are old. Medicine and certainly not this book alone has all the answers, but with your significant participation you will enable yourself to age gracefully and to live a full and abundant life. It is imperative then to discover THE DOCTOR WITHIN!
Other researchers determined that the amount retained by the thyroid gland is 6-7 milligrams, which, according to Dr. Abraham, is the optimal amount to keep the thyroid gland itself operating at peak performance. Keep in mind, though, that’s just for thyroid health.
Another prominent iodine researcher, Dr. Benjamin Eskin, determined that female breasts need about 5 milligrams of iodine per day. Add that to the amount your thyroid gland needs, and you come up with the 12.5 milligrams Dr. Abraham recommends.
Dr. Eskin also established that our thyroids “prefer” to concentrate the iodide form of iodine, while breasts concentrate iodine. Iodine and iodide are not always interchangeable: “Iodine” is the basic element, consisting of two “I” molecules bonded to each other (I-I); an excellent analogy is chlorine, which is two “Cl” molecules bonded to each other (Cl-Cl), while “chloride” is just one Cl molecule. “Iodide” is one of those two iodine molecules, and is almost always found with another molecule, such as potassium (potassium iodide, or K-I). In experimental animals, the thyroid glands and the skin concentrated more iodide than iodine, while the stomach concentrated more iodine. Based on these and other findings, Dr. Abraham recommends that iodine supplementation should include both forms: iodine and iodide.
Also Iodine can flush potentially dangerous elements from your system. Iodine, chlorine, bromine, and fluorine are in the same “family” of elements. Although very tiny quantities of fluoride are likely useful for human health, the amounts poured into most American public water supplies are much too high and have been correlated with higher risk of a rare bone cancer as well as bone fracture in older women. Bromide also carries some risks at high quantities, including impaired thinking and memory, drowsiness, dizziness, and irritability. But iodine can actually help your body get rid of these potentially harmful elements, as well as others like lead, cadmium, arsenic, aluminum, and mercury.
Following observations by Dr. Abraham, Brownstein conducted a study to test iodine’s ability to help rid our bodies of fluoride and bromide. Eight individuals had “baseline” measurements taken of their urinary output of fluoride and bromide. Each research volunteer took one 50-milligram “loading dose” of iodine and then proceeded to take the 12.5 milligram optimal daily dose from that point on. Only one day after starting iodine, their urinary output of bromide and fluoride increased significantly and continued at this higher rate for all 30 days of the study. Our Dr Robert Doenges, who holds the only patent on a salivary and urinary iodine analyzer, has never seen anyone who was Iodine sufficient.
Working with 10 female volunteers, Dr. Abraham conducted safety studies of the optimal 12.5 milligram iodine/iodide dose. He checked each woman’s blood pressure, weight, muscle mass, and body fat prior to starting iodine treatment, then again three months later. There were no statistically significant changes, although the body fat percentages did go down.
Dr. Abraham also took before-and-after measurements of several different markers of thyroid function, which included thyroid gland volume, TSH, total T4, free T4 (the active form of the thyroid hormone T4), and free T3. Although total T4 for the group declined significantly, both the “before” and “after” values were well within normal ranges, and there were no significant changes in free T4. The next part of Dr. Abraham’s safety study involved taking glucose, BUN, creatinine, sodium, potassium, chloride, calcium, total protein, albumin, globulin, bilirubin, alkaline phospatase, and ALT and AST (liver-function measurements) before and after three months. Although all values were within normal ranges before and after, there were statistically significant improvements in creatinine, alkaline phosphatase, and AST.
Lastly, Dr. Abraham measured hemoglobin, hematocrit, and red and white blood cells before and after three months. None of them changed significantly.
Despite this apparent safety record, if you decide to adopt “optimal-dose” iodine/iodide supplementation, it’s best to work closely and carefully with a knowledgeable physician to monitor thyroid function and general iodine safety. Dr. Abraham estimates that 14-15 milligrams of iodine/iodide daily is the upper limit for safe intake; that’s not much more than the optimal dose. Japanese researchers have found cases of hypothyroidism caused by excess iodine (20 milligrams daily).
It’s possible to be allergic to iodine, although it’s considerably less common than people usually think. It is the organified Iodine such as is used in radio-contrast that can cause problems. (For more details about iodine safety, see the October 2002 issue of Nutrition & Healing.) I have seen Iodine burns on the skin, but never allergy to inorganic Iodine.
In the 1820s, the French physician Jean Lugol combined iodine (5 percent) and potassium iodide (10 percent) along with 85 percent water. Since iodine kills germs, he used it for nearly any infectious disease, as well as many other problems, frequently with success. The combination quickly became known as “Lugol’s solution” and was adopted by practicing physicians throughout Europe and the Americas. Lugol’s solution was widely used until the 1920s. In fact it was the most commonly prescribed medicine for many hard to categorize and treat diseases in 1930-33. Then research began in earnest and many new drugs were marketed. Many physicians recommended two drops daily for good health and more on occasion to help kill germs. After doing the spot test, I tell folks to take between 2 and 10 drops depending on how fast the spot disappears. Lugols Solution is relatively inexpensive but does take a prescription and is available in some regular pharmacies and in all of the compounding ones.
And here's the most amazing thing about gymnema. Scientists were stunned when they discovered an increase in the number of "beta cells" in the pancreas of test subjects. That means gymnema could actually help repair and regenerate new pancreas cells that produce insulin!
This is unprecedented in the history of health sciences. Imagine, a single nutrient that can help lower blood sugar, support your body's ability to produce the insulin you need, and even repair your pancreas. Gymnema can do all this and more.
But as good as Gymnema and these other nutrients are, you'll really get the full effect when you take them in combination with this next ingredient…
Alpha-lipoic acid (ALA) is a powerful antioxidant. It regenerates other antioxidants in your body, such as vitamins C and E. And if you have high blood sugar, ALA can be a lifesaver. In one carefully controlled study, 74 patients were given ALA or a placebo. ALA boosted their ability to absorb and use blood glucose by 27%.
Another study shows that ALA improves your body's sensitivity to insulin. And your ability to burn blood sugar. ALA can also lower your fasting glucose levels and enable your cells to store more glucose for energy. Rather than having a blood sugar build-up. Astragalus, ginseng, gymnema, and ALA aren’t the only natural nutrients that can help balance your blood sugar...
The truth about cinnamon
It's no secret that eating too many sugary foods and refined carbs can cause your blood sugar to skyrocket. Over time, high blood sugar can damage and even kill off the "insulin receptors" on your cells. When that happens, your body's cells don't respond as well to insulin. So they don't absorb as much sugar into your muscles and fat cells, to produce or store energy.
Recently, scientists discovered that cinnamon could solve this problem. Researchers looked at 60 patients with high blood sugar. Half took a placebo. The other half took either 1, 3 or 6 grams of cinnamon daily. After just 40 days, the group taking cinnamon had reduced their fasting blood glucose by nearly a third.
There are plenty more studies that show the beneficial effects of cinnamon. But hold on a minute! Don't think that you can run out to the supermarket and grab any old cinnamon for these kind of results. Or that cinnamon supplements always do the trick. There's only one form of cinnamon that's been shown to work in human studies. It's called Cinnamomum cassia. That's the kind used in these studies. And the only kind of cinnamon you should ever buy to control your blood sugar. Some supplements just list “cinnamon bark extract.” This says to me that it’s not the same as the Cinnamomum cassia used in studies! So if you've tried cinnamon supplements and been disappointed with the results, that could be the reason why.
- Chromium — which has been shown to lower blood glucose levels. Chromium also reduces your cravings for sweets and carbs, so your blood sugar doesn't spike so high after a meal.
- Algimate® — a soluble fiber derived from seaweed. It sticks to the sugars in your digestive system. Research shows it can slow the absorption of both fats and sugars in the small intestine.
- Fenugreek — slows the absorption of sugars in the stomach. It stimulates insulin production. And it lowers cholesterol and triglycerides.
- Cordyceps — used for thousands of years as a tonic for lung, kidney and heart problems. Cordyceps became famous when two female Chinese athletes set new track and field event world records in 1993. Their coach attributed their success to high altitude training and a diet containing Cordyceps.
- Maitake — lowers blood glucose and improves cholesterol levels.
- Kudzu root — supports pancreatic cells and stimulate insulin production.
- Holy basil leaf — reduces both fasting and post-meal glucose levels. Holy Basil is high in antioxidants. Having high blood sugar is an inflammatory condition. Antioxidants are powerful anti-inflammatory nutrients.
- Jambolan seed — also thought to lower blood sugar, and have antioxidant and anti-inflammatory properties. One study showed Jambolan may even protect the pancreas by restoring protective enzymes such as glutathione back to normal levels.
- L-taurine — this sulphur amino acid is well known for protecting the heart. How? By reducing free radicals in blood fats. This translates into lower cholesterol and higher levels of "good" HDL cholesterol. Taurine also protects your eyes and actually regenerates worn-out retinal tissues.
- Ophiopogon — treats the fluid imbalance that causes many people with high blood sugar to urinate frequently and be thirsty.
- Chinese yam — strengthens the spleen and kidney function, combating the thirst and frequent urination associated with high blood sugar.
- Anemarrhena rhizome — decreases insulin resistance in those with high blood sugar. Yet it leaves people with "normal" blood sugar levels untouched.
- Henon bamboo — protects your eyes by fighting a nasty enzyme called aldose reductase. Aldose reductase destroys bloods vessels in your retina.
- Tiger lily bulb — which is used in traditional Chinese medicine to protect your heart and eyes.
Wednesday, May 18, 2011
To document the diagnosis, blood anti-transaminase, anti-myelysin and anti-gliadin studies are preformed. But they are only positive if the patient has significant bowel disease when the blood is drawn and he/she has been consuming gluten on a regular basis. The markers of HLA-DQ2 or HLA-DQ8 haplotype, which show the genetic predisposition can also be tested, but are more expensive and do not guarantee that the patient really does have the disease. According to Ken Fine, et al. (The prevalence and causes of chronic diarrhea in treated celiac sprue. Gastroenterology 1997; 112:1830-1837) the most cost effective test to diagnose celiac disease is an anti-gliadin stool test while the suspect is consuming gluten. This is the test we used to diagnose and follow the treatment results .
BRALY'S SIGN: A visible trait of Hashimotos Thyroid Disease which is common in Celiacs was first noted in Poland in 1953 and presented to the Western Europe by the English Gastroenterologist, James Braly, MD. The majority of Celiacs have a foreshortened 5th finger now designated as Braly’s Sign. (J Pediatric Gastroenterology and Nutrition 2000; volume 31 (Suppl.3): S29. New England Journal of Medicine, August 18, 1999). A positive sign is that the end of the fifth finger is shorter than the last joint of the ring finger. We used this external marker as a hallmark of the disease also in our study. In the combined experienced of the two of us and another colleague, Susan Solomon, a clinician in Raleigh N.C. we have found this marker positive in almost 85% of Celiacs that were either biopsied proven or had the positive genetic marker of the disease.
HYDROGEN BREATH TEST: This is an inexpensive, paid by insurance study that is a presumptive assessment for intestinal disease such as gluten intolerance. Actually, it detects bacterial overgrowth in the small intestine. This is common in intestinal diseases in which the mucosa of the intestine is compromised like celiac, but also small intestinal diverticulosis, abnormal flora, parasites and previous surgery where the usual anatomy of the intestine has been changed. An example of this is bypass surgery for weight loss. Also if the intestine cannot make the enzymes to break down food stuff it also causes abnormal gases due to the fermentation from normal bacteria. Lactose intolerance is an illustration.
Normally there should be NO hydrogen in the breath since the bacteria and the enzymes and the anatomy is doing its job. But if something is awry then hydrogen which is normally produced in minute amounts goes up. Gastroenterologist picked the cut point of 10 parts per million or more to be abnormal. The test is done by holding one's breath for 30 seconds then exhaling through a carboard tube into a special handheld device. In 20 seconds, the results are apparent.