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A 200% Increase In Powassan Virus In Maine?

Is your inner anxiety not yet up to “impending catastrophe?” Are you not watching enough political media to make your blood boil? Here’s a new threat, possibly lurking in your backyard, Powassan virus!

The earliest mention of Powassan Virus in online medical journals is from 1959,  when it was first named after a town in Ontario where it was found. That 1959 medical article mentions that Powassan had probably been around for decades. So why are we hearing so much about it now?

Well, we’ve just had two cases of Powassan in Maine. By just, I mean that we just had two more cases. Two earlier cases this year were reported in a Bangor Daily article back in April. Those were from around Portland, and these two new ones are from the midcoast region. Bringing our total for the year to four cases.

At the same time, we’re counting hundreds of Lyme cases, so why do we care so much about Powassan? Well, according to the CDC, Maine only had two Powassan cases IN THE PAST TEN YEARS. So the four this year brings our total up to a headline causing,

“Two hundred percent increase in Powassan in Maine!”

Is Powassan a true terror? Yes and no. It’s not new to Maine, and previous surveys have found it widely spread (but not very common) among Maine’s tick populations. We had another notable outbreak at the turn of the Millenium, four cases that included both Maine and Vermont. Checking residents, between 1% and 4% of Mainers likely have antibodies to Powassan.

But Powassan is scary because it’s viral and we don’t have a good treatment. Arguably, we don’t have great treatments for Lyme either, but that’s a whole different issue (a bit more on that later). 

If you get Powassan, you very likely won’t get symptoms. If you do get symptoms, they feel like the flu and you’ll likely recover. But if you get symptoms and your body doesn’t kick it, there’s very little modern medicine can do for you besides support you. Just like any number of other viruses. 

If it starts to feel vaguely familiar, it should. Powassan is a flavivirus. Yes, like Zika virus. Different subspecies, same family. Powassan’s flaviviral branch includes Russian spring-summer encephalitis, Central European encephalitis, Omsk hemorrhagic fever, Kyasanur Forest disease, and Powassan. Just reading through its close family members, you should get the sense that Powassan is likely coming from a more northern branch of the flavivirus family than Zika.  

Also notice that every one of these viruses has a pretty scary sounding name. Omsk hemorrhagic fever sounds like a reason to never, ever visit Omsk, which Dostoevsky immortalized as “a hateful hellhole” but which likely influenced all his writing since he was imprisoned there. (They now have a museum for him.) 

A large part of the problem of the flaviviruses is that we’re still assigning every member of the flavivirus family a new name. Think about the flu viruses. We had swine flu, avian flu, etc. and they sound much scarier than H1N1, which is another variation of the same family of viruses. All of the flaviviruses should be assigned a number so that we understand that this isn’t a total unknown, this is another member of a well known and widespread set of viruses that has been with humanity for centuries. Public health officials have started the process by labeling the four different strains of Dengue fever (another flavivirus) one through four rather than giving them all different names like the four horsemen of the Apocolypse. 

According to the CDC, “Powassan (POW) virus is transmitted to humans by infected ticks. Approximately 75 cases of POW virus disease were reported in the United States over the past 10 years.” So our four cases of POW will really make the news. Maine, home of the Whoopie pie, the lobster roll, and the obscure tickborne illness. Is this really what we want to be known for? 

So, should we just watch out for ticks to protect ourselves from Powassan? Maybe. I would argue that the flaviviruses are largely misunderstood as only vector-borne diseases. I’ve mapped this out in Zika Virus When You’re Expecting and I talk about focusing on just ticks in Why Chronic Lyme Doesn’t (And Does) Exist. Blood born diseases need to be seen as more widespread and contagious than we’d like to think. 

But, because they are much more widespread, they also may be much less deadly than they would appear from the very few serious cases that get reported. Powassan reports of serious side effects may indicate a spread of the disease in Maine. But the number of symptom-free cases of Powassan will continue to dwarf the number of serious reported cases. 

Should you worry about Powassan? No more than you would about getting a serious flu and not recovering. While this year in Maine we had four hospitalizations from Powassan, we also had 586 hospitalizations for the flu.

For the few of you heedless folk who ignore the Lyme warnings, who’ve still been frolicking in the buff in tick-infested fields, I doubt if the added threat of Powassan will convince you to change your behavior. For those of us who are already avoiding the fields and doing tick checks, don’t let the fear of more rapid transmission of Powassan panic you. Continue doing what you’ve been doing, and take care of yourself if you get sick. As a virus, all of the things you would do to help yourself get better from the flu would apply to Powassan too.   

NYT Article On Salt: A Rhythm And Weight Loss

Salt may not make you thirsty, and it may help with weight loss. 

Yep, those on the conclusions of a NYT article on Russian Cosmonaut studies. Researchers rarely get to put people in isolation and measure all their excretions (what a great job!) so they can be forgiven for missing this particular discovery. 

It turns out that the cosmonauts had twenty-eight-day cycle of salt retention, even if they were on a low salt diet. Because these were men, it’s a new discovery. If they’d been women, everyone would have said, “I knew that.” 

The men also lost weight when they ate lots of salt, and weren’t thirstier overall. Again, this seems miraculous until you remember that iodine reacts with the thyroid to stimulate thyroid function. Lots of salt, lots of thyroid function. But the reason we don’t do tons of salt is because you can’t really control thyroid function well with salt. Sometimes it becomes active (weight loss) sometimes it gets very active (panic attack) and sometimes it desensitizes the body to thyroid (weight gain despite all your best efforts). 

So, while researchers scratch their heads, here’s the take home. Turns out men have a twenty-eight-day cycle too. If he’s cranky and looks bloated, it may really be his time of the month. 

New Norwegian Study Supports The Colon Cancer Diet’s Recommendations.

A recent Norwegian study on aspirin and colon cancer patients was published in May. Unlike many other, smaller studies, they were able to survey the entire population and had automatically recorded their aspirin use from over ten years ago. Bad for personal privacy, good for medical research. 

The study combined all cancer groups, but found a significant (15%) reduction in cancer deaths directly associated with aspirin use. Stage II patients benefitted slightly more. 

 Aspirin is recommended in my book, The Colon Cancer Diet, though my personal experience with it has been that it likely increased my CEA. It’s nice to see it being supported so broadly.

A study of this size is wonderful because it doesn’t just make the alternative medical journals. Not only did the study get written up by N.D.s (article here), it appears on a conservative Texas Colon Cancer Research Center’s site.

2015_12_22_15_55_46

Hopefully, the broad interest will translate into a changing of recommendations for colon cancer patients. The problem is that adding aspirin after surgery might make surgeons concerned about bleeding. So the proper time to recommend aspirin would be at the six week follow-up appointment.

Should Colon Cancer Patients Take Avemar or Fermented Wheat Germ Extract?

So many products have no medical research, it’s hard to say no to one that does. Avemar is sold widely and used by many practitioners, so why would I not recommend it? I don’t, and here’s why. 

 

Patented back in 1998, fermented wheat germ extract (Avemar) was supposedly Dr.Hidvégi’s life work. He based it on Dr. Gyorgi’s idea that compounds like it might balance blood sugars. So how did we get from balancing blood sugars to curing cancer?

The company isn’t saying, but I suspect that this particular extract tastes terrible. The initial studies talked about basically a paste you had to eat. They’ve added more water and an orange flavor, but that usually is a sign of something fairly unpalatable. 

But there are studies. We’ve got test tube studies, rat studies, and an open label human trial for colon cancer patients. Overall, the results are all very positive. An article by another enthusiastic practitioner pushing the product for all cancers brought it to my attention. 

Let’s skip the other studies and move right into the human trial. The open-label trial showed that the product lowers recurrence and metastasis. So sign me up, right?

Not necessarily. The open label trial started with this selection process: “Patients were asked if they prefer to take MSC (Avemar), and thus enrolled in the MSC cohort. Those patients who refused to take the preparation formed the control cohort.” In other words, those who wanted to try anything to get better took the product, while those who couldn’t be bothered didn’t. The researchers note that there were more advanced cancers in the study group, as well as that the control group was older. Both groups got other treatments, including radiation and chemotherapy, and there wasn’t any difference in outcomes between the two groups due to those treatments. Those taking the product took nine mg of it, once a day in water, for months. The effect was startling: “MSC decreased the risk of death among colorectal cancer patients by nearly 70%.”

A 70% reduction is astounding, especially if we’re talking about metastatic patients who made up almost a quarter of those taking the product.

So…where are our follow-up studies? The initial open-label study was published in 2003, and we’ve seen many other test-tube studies since. But these are in other areas, things like Lupus or Rheumatoid Arthritis. Avemar is still being discussed as an addition to chemotherapy because it may help with side effects, but there hasn’t been another study published on a human colon cancer trial since. The initial study was funded by a grant from the Hungarian government, so maybe that grant wasn’t renewed? My suspicion is that a second study did not show as significant a benefit, and they never published it. Instead, they did what every drug manufacturer does. Look for other possible uses for your drug rather than trying to find a new one. 

So, since Dr. Hidvégi is listed as a co-author for several of the Avemar studies, I thought I would look more closely at his life’s work. Interestingly, he seems to have spent much of his career working in the grain industry, switching over to working in the supplement field in 1990. His first patented product was called Esterin (an alfalfa based extract), which supposedly lowered cholesterol. 

Now, there’s a lot of research on alfalfa saponins and lowered cholesterol. It stretches farther back than Dr. Hidvégi. But even in 2014 we’re still looking at rat studies. That didn’t stop Dr. Hidvégi from patenting his compound, exclusively marketing it through a single U.S. company as Cholestaid or on Amazon as Cholestsorb. It’s not available anymore, and a lawsuit in 2004 details how GNC repackaged it for years

Here’s the updated history, then, of Dr. Dr. Hidvégi. He started his own company to sell a patented product, Avemar, after failing to sell another patented product Esterin. With Esterin he made the mistake of reselling it to many supplement companies, but now he’s figured out that exclusivity is the key. 

All of this is interesting, but is it relevant? Yes. Because now we come to cost. A thirty day supply of Avemar will cost around $200. That’s an absurd price, unless you’re a drug manufacturer, which is where Avemar is going with the current research. Rather than focus on the retail crowd, Dr. Hidvégi is angling his product to be included in with chemotherapy. Given that chemo tends to run $1500 a treatment, a $200 add-on makes a lot of sense. 

But in terms of cancer patients, a $200 price tag means trading food for Avemar. And that price tag does not meet the minimum requirements for matching the one human trial. The trial subjects took nine mg of Avemar a day, while the daily dose given for $200 is 5.5 mg. So to match the only human trial, patients would need to double their dosage at $400 a month. 

Even that dosage might not be enough. Japanese researchers found a benefit from Avemar, but at a dose in rates of one mg for every two pounds of body weight. To afford that, a 100 pound patient would need ten standard packets a day at a cost of $2000 (maybe less. They sell it cheaper in bulk). 

If Avemar were priced affordably, I would consider it. The side-effect picture is very mild, and -especially for metastatic patients- the open label results were very hopeful. But given the cost, and the lack of any further studies despite drug-level prices, I’d have to pass on Avemar.  

 

Notes and research for Marijuana and Cancer Pain Talk.

I spoke at the Alfond Cancer Center at 6 pm on Tuesday, October 25, 2016 on pain and marijuana use. These are my extended notes including studies I cited. 

Casket joke: What would you want them to say? Doctor, Teacher, realist.

Discussing Pain

 Who I am.

  1. Naturopathic Doctor
  2. Colon Cancer Survivor? (I prefer the term “careful person”)
  • Researcher Does marijuana help with cancer pain?
  1. No. -side note on politics and medicine.
  2. Maybe. -nausea research.
  • What is pain?
  1. A definition of pain. Unpleasant sensation. physical suffering or discomfort caused by illness or injury”
  2. a) Dental work b) broken arm c) vagovasal response to needles d) “gas pains” post-surgery.
  • Tolerance is based on predictability, expectation, and duration.
  1. Uncontrolled, random, unending pain
  2. Torture is “the action or practice of inflicting severe pain on someone as a punishment or to force them to do or say something” it’s horrible but at least you know when and why.
  • What causes the pain in cancer?
  1. The mass vs. the mind.

In the subgroup of 22 patients who underwent the full cycle of 4 treatments, the mean VAS anxiety score decreased from 6.77 to 2.28 (P <.000001) and the mean VAS pain score from 4.4 to 2.32 (P = .091). Overall, the sessions were felt helpful in improving well-being, relaxation, pain relief, sleep quality and reducing anxiety.”

  1. Not limited to cancer. Knee surgery outcomes depend on a) expection b) anxiety, c) depression, d) the skill of the surgeon.
  2. Not a learned behavior. Touch and sugar on neonatals.
  • Standard treatments for cancer
  1. How well studied are the opiods?
  2. How well done is end of life care?
  3. Prior to hospice, are we taking care of patients?
  • Tracking, meeting and treating pain

Other natural Treatments for Cancer Pain:

A. Ice Locally Proximally

B. Heat Locally Full body Distant

C. Capsaicin Local depletion of substance P. Along entire nerve root

D. Massage

  1. Proximal to the area (upstream and down)
  2. On the opposite side
  3. On the spinal column
  4. On the feet
  5. On the ear

E. Prayer/Reiki

  1. Any area
  2. Hands on/Hands off
  3. Distant, specifically (give time and frequency)
  • Cortisone shots
  1. Proximal
  2. Into nerve roots
  3. Much simpler that nerve cutting
  4. Saline injections may be as effective (nerve pressure)
  • TENS units
  1. Muscle fatigue and natural opiod release
  2. At nerve root to fatigue nerve pathway
  • Anti-anxiety medication
  1. Anticipatory pain relief
  2. Many natural options: valerian, hops,passion flower, etc.
  • Muscle relaxants
  1. Muscle clenching due to pain builds lactic acid=more pain
  2. Natural option Kava releases muscles and lowers anxiety
  • Meditation
  1. Jon Kabat Zinn
  2. Women (colon and gynecologic cancers) experienced significant improvements in mood
  3. Meditation outperforms groups.
  4. Ipads during chemo for meditation-average distress dropped 46% (p < 0.0001).
  5. Telomere length is maintained.
  • Where does marijuana fit in?
  1. Do you mind the side effects?
  2. Do you want the side effects?
  3. Are you cachexic?
  4. Are you nauseous?
  5. Have you experienced relief before?

Pain

How much is objective?

Patients experiencing high levels of pain before surgery should be informed of the chances of improvement by having a TKA (total knee arthroplasty). A validated psychological screening tool that separates depression and anxiety is recommended as part of the pre-operative assessment stage. Patients presenting with symptoms of depression and anxiety should be identified and consulted before a TKA.

How much is subjective?

Based on cut-off scores for the Neonatal Infant Pain Scale, infants receiving skin-to-skin contact during IM injection were more likely to display low pain after injection; and during recovery

Sucrose is effective for reducing procedural pain from single events such as heel lance, venipuncture and intramuscular injection in both preterm and term infants.

How well have we studied the opiods?

Data gathered in this review showed that hydromorphone had a similar effect on participant-reported pain intensity as reported for oxycodone and morphine. Participants generally achieved no worse than mild pain after taking hydromorphone, which is comparable with the other drugs. It produced a consistent analgesic effect through the night and could be considered for use in people with cancer pain experiencing sleep disturbance. However, the overall quality of evidence was very low mainly due to risk of bias, imprecision of effect estimates and publication bias.

How well have we studied end of life care?

often was not implemented properly, and had instead become a barrier to good care; it made over 40 recommendations, including education and training, research and development, access to specialist palliative care services, and the need to ensure care and compassion for all dying patients. In July 2013, the Department of Health released a statement that stated the use of the LCP should be “phased out over the next 6-12 months and replaced with an individual approach to end of life care for each patient”.The impact of opioids was a particular concern because of their potential influence on consciousness, appetite and thirst in people near the end of life. There was concern that impaired patient consciousness may lead to an earlier death, and that effects of opioids on appetite and thirst may result in unnecessary suffering

Meditation

  1. Jon Kabat Zinn http://umassmed.edu/cfm/stress-reduction/mbsr-8-week-online-live/
  2. Women (colon and gynecologic cancers) experienced significant improvements in sex-related distress (p < .001), sexual function (p < .001 and p < .01), and mood (p < .001)”
  3. women in MBCR reported greater reduction in mood disturbance (primarily fatigue, anxiety and confusion) and stress symptoms including tension, sympathetic arousal and cognitive symptoms than those in SET. They also reported increased emotional and functional quality of life, emotional, affective and positive social support, spirituality (feelings of peace and meaning in life) and post-traumatic growth (appreciation for life and ability to see new possibilities) relative to those in SET,
  4. meditation iPads during the chemotherapy session. Among those who accepted the iPads, average distress dropped 46% by the end of the session (p < 0.0001).
  5. TL in the intervention group was maintained whereas it was found to decrease for control participants. There were no associations noted between changes in TL and changes in mood or stress scores over time.
  6. For those already trained in the practice of meditation, a retreat appears to provide additional benefits to cellular health beyond the vacation effect.

Marijuana cancer 752

+cochrane 7

THC cancer 565

  • Cochrane 5

Marijuana cancer pain 150

Cannabinoids bind not only to classical receptors (CB1 and CB2) but also to certain orphan receptors (GPR55 and GPR119), ion channels (transient receptor potential vanilloid), and peroxisome proliferator-activated receptors. Cannabinoids are known to modulate a multitude of monoamine receptors. Structurally, there are 3 groups of cannabinoids. Multiple studies, most of which are of moderate to low quality, demonstrate that tetrahydrocannabinol (THC) and oromucosal cannabinoid combinations of THC and cannabidiol (CBD) modestly reduce cancerpain. Dronabinol and nabilone are better antiemetics for chemotherapy-induced nausea and vomiting (CINV) than certain neuroleptics, but are not better than serotonin receptor antagonists in reducing delayed emesis, and cannabinoids have largely been superseded by neurokinin-1 receptor antagonists and olanzapine; both cannabinoids have been recommended for breakthrough nausea and vomiting among other antiemetics. Dronabinol is ineffective in ameliorating cancer anorexia but does improve associated cancer-related dysgeusia. Multiple cancers express cannabinoid receptors directly related to the degree of anaplasia and grade of tumor. Preclinical in vitro and in vivo studies suggest that cannabinoids may have anticancer activity. Paradoxically, cannabinoid receptor antagonists also have antitumor activity. There are few randomized smoked or vaporized cannabis trials in cancer on which to judge the benefits of these forms of cannabinoids on symptoms and the clinical course of cancer. Smoked cannabis has been found to contain Aspergillosis. Immunosuppressed patients should be advised of the risks of using “medical marijuana” in this regard.

Schmerz, Cochrane Review, this year:

Out of initially 108 studies 9, with a total of 1561 participants suffering from advanced or end stage diseases, were included…The outcome results for cannabis/cannabinoids vs. placebo in patients with cancer were not significant for the 30 % decrease in pain (RD: 0.07; 95 % confidence interval (CI): – 0.01 to 0.16; p = 0.07), caloric intake (SMD: 0.2; 95 % CI: – 0.66 to 1.06; p = 0.65) or sleep problems (SMD: – 0.09; 95 % CI: – 0.62 to 0.43; p = 0.72).Change in appetite was significant for the treatment of HIV (SMD: 0.57; 95 % CI: 0.11-1.03; p = 0.02), but not for treatment of cancer (SMD: 0.81; 95 % CI: – 1.14 to 2.75; p = 0.42). Nausea/vomiting (SMD: 0.20; 95 % CI: – 0.03 to 0.44; p = 0.09) and health-related quality of life (HRQoL; SMD: 0.00; 95 % CI: – 0.19 to 0.18; p = 0.98) did not show significant differences in the therapy of the two diseases. For the outcomes of tolerability the results were not significant for occurrence of dizziness (RD: 0.03; 95 % CI: – 0.02 to 0.08; p = 0.23) or psychiatric diseases, such as hallucinations or psychosis (RD: – 0.01; 95 % CI: – 0.04 to 0.03; p = 0.69) in the therapy of cancer.  Dronabinol vs. megestrol acetate showed a superiority of megestrol in the therapy of cancer-associated anorexia for the endpoints change of appetite (49 vs. 75 %; p = 0.0001), weight gain (3 vs. 11 %; p = 0.02), HRQoL (p = 0.003) and tolerability (p = 0.03). There was no difference in the safety of the therapies (p = 0.12). In the treatment of HIV-associated wasting syndrome megestrol acetate was better than dronabinol for the endpoint of weight gain (p = 0.0001), whereas tolerability and safety did not differ. In the therapy of Alzheimer’s dronabinol was better than placebo in the endpoint of weight gain according to one study (n = 15). A difference between herbal cannabis and synthetic cannabinoids, analysed by one study (n = 62) could not be found.

Also Schmerz, this year:

cannabinoids were superior to placebo in the reduction of mean pain intensity with SMD – 0.10 (95 % CI – 0.20- – 0.00, p = 0.05, 13 studies with 1565 participants), in the frequency of at least a 30 % reduction in pain with an RD of 0.10 [95 % CI 0.03-0.16, p = 0.004, 9 studies with 1346 participants, number needed to treat for additional benefit (NNTB) 14, 95 % CI 8-45] and in the frequency of a large or very large global improvement with an RD of 0.09 (95 % CI 0.01-0.17, p = 0.009, 7 studies with 1092 participants). There were no statistically significant differences between cannabinoids and placebo in the frequency of at least a 50 % reduction in pain, in improvement of health-related quality of life and in the frequency of serious adverse events. Patients treated with cannabinoids dropped out more frequently due to adverse events with an RD of 0.04 [95 % CI 0.01-0.07, p = 0.009, 11 studies with 1572 participants, number needed to treat for additional harm (NNTH) 19, 95 % CI 13-37], reported central nervous system side effects more frequently with an RD of 0.38 (95 % CI 0.18-0.58, p = 0.0003, 9 studies with 1304 participants, NNTH 3, 95 % CI 2-4) and psychiatric side effects with an RD of 0.11 (95 % CI 0.06-0.16, p < 0.0001, 9 studies with 1304 participants, NNTH 8, 95 % CI 7-12).

CONCLUSION:

Cannabinoids were marginally superior to placebo in terms of efficacy and inferior in terms of tolerability.

Another Cochrane Review, this year, Nausea and vomiting only:

We included 23 RCTs. Most were of cross-over design, on adults undergoing a variety of chemotherapeutic regimens ranging from moderate to high emetic potential for a variety of cancers. The majority of the studies were at risk of bias due to either lack of allocation concealment or attrition. Trials were conducted between 1975 and 1991. No trials involved comparison with newer anti-emetic drugs such as ondansetron. Comparison with placebo People had more chance of reporting complete absence of vomiting (3 trials; 168 participants; RR 5.7; 95% CI 2.6 to 12.6; low quality evidence) and complete absence of nausea and vomiting (3 trials; 288 participants; RR 2.9; 95% CI 1.8 to 4.7; moderate quality evidence)

People reported a preference for cannabinoids rather than prochlorperazine (7 trials; 695 participants; RR 3.3; 95% CI 2.2 to 4.8; I(2) = 51%; low quality evidence)

Nurses Cochrane Review:Cannabinoids are effective in controlling CINV, and oral THC and smoked marijuana have similar efficacy. However, smoked marijuana may not be accessible or safe for all patients with cancer. Also, these drugs have a unique side-effect profile that may include alterations in motor control, dizziness, dysphoria, and decreased concentration.Conclusions: This synthesis shows that cannabinoids are more effective than placebo and comparable to antiemetics such as prochlorperazine and ondansetron for CINV

European Review from 2008:

From 12 749 initially identified papers, 30 fulfilled the inclusion criteria for this review, with demonstration of superiority of the anti-emetic efficacy of cannabinoids compared with conventional drugs and placebo. The adverse effects were more intense and occurred more often among patients who used cannabinoids. Five meta-analyses were carried out: (1) dronabinol versus placebo [n=185; relative risk (RR)=0.47; confidence interval (CI)=0.19-1.16]; (2) Dronabinol versus neuroleptics [n=325; RR=0.67; CI=0.47-0.96; number needed to treat (NNT)=3.4]; (3) nabilone versus neuroleptics (n=277; RR=0.88; CI=0.72-1.08); (4) levonantradol versus neuroleptics (n=194; RR=0.94; CI=0.75-1.18); and (5) patients’ preference for cannabis or other drugs (n=1138; RR=0.33; CI=0.24-0.44; NNT=1.8). The superiority of the anti-emetic efficacy of cannabinoids was demonstrated through meta-analysis.

Here’s the Problem:

Based on available evidence, we could find that psychoeducational interventions, music interventions, acupuncture plus drug therapy, Chinese herbal medicine plus cancer therapy, compound kushen injection, reflexology, lycopene, TENS, qigong, cupping, cannabis, Reiki, homeopathy (Traumeel), and creative arts therapies might have beneficial effects on adult cancer pain. No benefits were found for acupuncture (versus drug therapy or shame acupuncture), and the results were inconsistent for massage therapy, transcutaneous electric nerve stimulation (TENS), and Viscum album L plus cancer treatment. However, the evidence levels for these interventions were low or moderate due to high risk of bias and/or small sample size of primary studies. Conclusion. CAM may be beneficial for alleviating cancer pain, but the evidence levels were found to be low or moderate. Future large and rigor randomized controlled studies are needed to confirm the benefits of CAM on adult cancer pain.

Cancer Pain, from 2001:

20 randomised controlled trials were identified, 11 of which were excluded. Of the 9 included trials (222 patients), 5 trials related to cancer pain, 2 to chronic non-malignant pain, and 2 to acute postoperative pain. No randomised controlled trials evaluated cannabis; all tested active substances were cannabinoids. Oral delta-9-tetrahydrocannabinol (THC) 5-20 mg, an oral synthetic nitrogen analogue of THC 1 mg, and intramuscular levonantradol 1.5-3 mg were about as effective as codeine 50-120 mg, and oral benzopyranoperidine 2-4 mg was less effective than codeine 60-120 mg and no better than placebo. Adverse effects, most often psychotropic, were common.

CONCLUSION:

Cannabinoids are no more effective than codeine in controlling pain and have depressant effects on the central nervous system that limit their use. Their widespread introduction into clinical practice for pain management is therefore undesirable.

Free article:

No large trials examined cannabinoids in cancer pain and chronic non-malignant pain

What is already known on this topic

Three quarters of British doctors surveyed in 1994 wanted cannabis available on prescription

Humans have cannabinoid receptors in the central and peripheral nervous system

In animal testing cannabinoids are analgesic and reduce signs of neuropathic pain

Some evidence exists that cannabinoids may be analgesic in humans

What this study adds

No studies have been conducted on smoked cannabis

Cannabinoids give about the same level of pain relief as codeine in acute postoperative pain

They depress the central nervous system

The effect of marijuana and placebo on pain tolerance was compared in cannabis-experienced and naive subjects. A statistically significant increase in tolerance was observed after smoking marijuana. Although there was no statistically significant interaction between the drug effect and having had previous cannabis experience, there was a definite trend towards a greater increase for the experienced (16%) compared to the naive group(8%).

Pain detection thresholds were altered unpredictably with high THC doses, but analgesia as indicated by pain tolerance was less than that after diazepam and placebo. In three subjects low-dose THC (0.022 mg/kg) was a better analgesic than placebo but not diazepam. Six subjects preferred placebo to low-dose THC as an analgesic; this group experienced increases in subjective surgical pain and were submissive, rigid, and less introspective with high State Anxiety

Can You “Catch” Alzheimer’s From Transplanted Material?

Some years ago I did some research on prions as part of my interest in mad cow disease. What I found was very disturbing, as well as the possible overlap between diseases like mad cow and Alzheimers. 

Now, other doctors are considering the possibility that we could be passing material from one person to another and infecting them with early Alzheimers. It’s very preliminary, but it’s based on the idea that patients with Creutzfeldt-Jakob disease (the human version of mad cow) who received spinal column material had early onset Alzheimers develop while other patients who didn’t receive the material did not. 

The biggest issue is that prions, the material that may have been passed, are resistant to normal sterilization procedures. Until we have larger studies on early onset Alzheimers, we won’t know if the issue is widespread or limited to people who already have a prion disease. 

 

Need Stress Relief? Do Art. Even If You “Can’t Draw.”

Doing art lowers the stress levels of most people, regardless of their level of talent. A few people continue to stress, about 25%, but most had lower cortisol (the stress hormone) levels after doing creative art. The Drexel University study expected that experience would matter, but finger painting works as well as making a Monet.  

So do something nice for yourself. Doodle, sculpt, and be messy!

Are Your Teeth Grinding All Night? What To Do?

Most of us only want to “bite the bullet” occasionally, but a disturbing number of people bite the bullet, or their own teeth, all night long. 

The common medical opinion is that grinding your teeth is all in your mind. It’s called bruxism, and the Mayo Clinic defines it as ” when you grind, gnash or clench your teeth.” I love it when we give something a Latin name and pretend that means we know anything about it. 

In the same breath that the Mayo clinic says bruxism is due to stress,they also say it can be associated with a whole host of medical conditions. So don’t worry, or really worry, and grind your teeth some more. At any rate, there isn’t much to be done for it besides seeing a shrink, getting a dental guard (a plastic bullet to bite instead), or trying out botox injections. So much for conventional treatments. 

We need another plan for treating teeth grinding. Let’s start by asking if bruxism, grinding, is the same as chewing or sucking. This is a behavior we develop in childhood, called rhythmic masticatory muscle activity (RMMA). Isn’t it great when you can make thumb sucking sound clinical? According to researchers,”No relationships were found between RMMA (presence/absence) and clinically assessed tooth wear or reports of tooth clenching or grinding or craniofacial complaints.” Except that by the time we get to be adults with bruxism, more RMMA is associated with more tooth wear. Keep in mind that most adults have RMMA, 60%, and only 8% have bruxism. So suck away, or gurgle and coo to your heart’s content. Just don’t bite down.

If mouth movements don’t necessarily cause grinding, what does? Maybe micro-arousals? Someone jostling you in your sleep, a noise that partially wakes you, these are micro-arousals. “Although post-arousal RMMA occurred in all SB (sleep bruxism) patients, it was seen in only one normal subject. Moreover, tooth-grinding occurred during 71% of the evoked RMMA in SB patients.” Other researchers playing around in brains found that during sleep RMMA does not occur, so the process is associated with waking

Since bruxism has nothing to do with sleep, but with waking, my thoughts for possible treatments would include some obvious things like melatonin. In uncontrolled epileptic children, adding melatonin reduced bruxism. Another herb, Lemon balm, didn’t help with muscle movements, and the researchers didn’t measure if the bruxism was worse or better. 

There are various drugs that have been tried for bruxism, and most decrease it while sedating the person. But most have side effects from that sedation. One “drug” listed was L-tryptophan, which again was measured against motion rather than grinding.

Massage combined with splinting was more effective than splinting alone. In patients who received counseling and massage, “After 6 weeks, a mean of 60% pain decrease was reported.”

So, in the end, the alternative approach to bruxism would be, get better sleep, get counseling and massage, and use a mouth guard if you can.

 

Itchy Eyes? A Few Thoughts On Eye Drops.

As pollen season hits with a bludgeon, many people turn to antihistamines to keep their eyes from looking like something out of the Walking Dead.

Those seeking out a doctor’s prescription for itchy eyes are most often prescribed antihistamines, and most doctors do not change the prescription despite continued complaints from patients (43% found the treatment unsatisfactory in one study). 

But what about eye drops? Patients have a choice between simple saline, any number of drug preparations, homeopathic remedies, and even Ayurvedic options. For a start,”The simple washing of nasal cavities using isotonic saline provides a significant improvement and is useful, particularly in children.”

None of the eye drop options are risk-free. Of the studies available, the drug sodium cromoglicate was far less risky than anything in the steroid classes (usually words ending in -one). But patients are typically prescribed both. Of the alternative treatments, homeopathics would generally be considered less likely to cause possible side effects. But anything made in a non-sterile environment should be avoided, as washing the eyes with bacteria or viruses is always a bad idea. Commercially prepared homeopathics have shown some benefit, and usually mix in commonly prescribed remedies like euphrasia, allium, and apis. 

In preparation for the next year, you could get hold of some local honey. The honey contains the local pollens, and a small amount of the honey daily might act in the same way as Sublingual Immunotherapy (SLIT). In SLIT, patients place a small amount of an allergen under their tongues, which can reduce symptoms over time

If you really want to avoid itchy eyes, better get in a time machine and head back to your own birth. “Based on current systematic review evidence, the most promising intervention for the prevention of AE is the use of probiotics (and possibly prebiotics) during the late stages of pregnancy and early life.”

Is Colon Cancer Catching?

I received an email from a married couple that both came down with colon cancer at nearly the same time. The husband has an extensive history of surgeries for other reasons, and the wife has a resistant case of c. difficile. I would love to hear from any other couples out there who have both been diagnosed with colon cancer near each other. As far as I know, no one is researching this particular aspect of colon cancer.