Why Colon Cancer Won’t Be 100% Cured By A Mouse Study.

As someone who’s had colon cancer, I was excited by the Newsmax headline that trumpeted. “3-Step Treatment Cures Colorectal Cancer in Mice” (yes, I use a variety of news sources, NPR to Newsmax). But when they said that this new treatment was 100% cure, I got suspicious. 

When I get suspicious, I go digging. The Newsmax story didn’t give me enough specifics to find the original medical article, but I found it eventually. The original title is a mind-numbing, “Curative Multicycle Radioimmunotherapy Monitored by Quantitative SPECT/CT-Based Theranostics, Using Bispecific Antibody Pretargeting Strategy in Colorectal Cancer.” It makes me wonder if I missed the class in medical school on how to write the most boring headlines imaginable. 

The most exciting word of the headline is “curative.” These mice were cured. But these mice didn’t get colon cancer the normal way (bad lifestyle choices and poor genetics). They had human colon cancer cells xenografted onto them. If that sounds Dr. Frankensteinish, it is. You get a specifically bred mouse that won’t reject the human cells, then you graft on separately grown cancer cells. The result may or not be relevant to even cancer growth in regular mice. A lot of cancer research has moved away from these mice because regular mice give us a better sense of regular cancer growth. But the xenograft can use human cells, that may or may not give us a better sense of how human cancers would respond to a treatment.  

So maybe this is a cure for colon cancer? Well…maybe. How many mice were treated? Ten. How many got better? Ten, but they only assessed nine of the mice under a microscope. The abstract didn’t mention what happened to the tenth mouse. 

Before I sign up for this particular treatment, I think I’ll at least wait for the bigger mouse trial. Call me a skeptic, but I like at least a hundred xenografted Frankenstein mice in my studies before I think about it. Not to mention a primate trial, small experimental human trials on metastatic patients, and finally a large-scale trial of human patients. In other words, we’re years from having this news really be news you can use. 

Dr. Sarno, All THE RAGE, and Chronic Back Pain.

Today, for those of us in the chronic back pain field, Dr. Sarno is a bit of a legend. He has a perpetually best-selling book, multiple celebrity endorsements, and an established place in the NY medical community. When I wrote my own book on chronic back pain, I looked at him as a leader in the field. 

But the movie All The Rage brings that idea into a sharp contrast with the reality of Dr. Sarno’s ideas being largely ignored by his colleagues. Not just ignored, disregarded as foolish. In a world where we cut, inject, and numb with our strongest painkillers, Dr. Sarno’s solution of the mind has no place. His results were disregarded as placebo, and his colleagues did not refer their patients to him because they did not believe what he was doing could work.

In the past year we have had the medical realization that our strongest painkillers are not more effective than lesser, over-the-counter medication. They are also addictive, creating a crisis that kills patients and robs others of their health. Our surgeries are not as effective as advertised, leaving half of those going under the knife still in agony. We have no better solutions, and Dr. Sarno seems all the wiser for seeing the obvious well before the rest of his colleagues.

Is Dr. Sarno’s mind-over-pain the answer? No. But it is half the answer. The half that has been silenced, ignored, and ridiculed. Today we know that a patient’s emotional state before a surgery has as much effect on the pain after the surgery as the best surgical team. We know that chronic pain can appear and continue with or without any visible mechanical problem. And we know that the mind, when used properly, can be more effective at pain management than our most powerful drugs.

All The Rage captures the profoundly personal journey of chronic pain, detailing one family’s issues with chronic pain and their encounters with the enigmatic Dr. Sarno. Through them, we see his own journey, his progression from traditionalist to staunch pioneer in the pain field. All The Rage captures the beginning, the middle, and the end of Dr. Sarno’s career seen through the lens of a filmmaker forced to cross the fourth wall from objective observer to unwilling participant. In so doing, the film becomes as much autobiographical as biographical, giving us an intimate portrait of the true effect of chronic pain on a family. We see the origin, the arc, and the possible resolution of a lifelong dance with pain. By the end, the viewer wants to see more of the family’s journey, but hopes for their sake that no sequel is ever necessary.

If you have experienced chronic pain and wondered if perhaps there was an emotional aspect, Dr. Sarno is here on the screen to squinch up his bushy eyebrows and tell you, “Of course there is a direct relationship.” All the more helpful, now that he has left his practice and gone to that medical classroom in the sky. He passed away in June, 2017, leaving his books, his legacy, and this movie to catalogue his passing. While they did not appreciate him in his life, the medical community may yet learn to use what he left us to help solve the puzzle of intractable pain.

 

All The Rage (Saved by Sarno) from rumur on Vimeo.

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. 

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. 

 

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. 

Three Things I Wish My Doctors Had Told Me About Recovering From Colon Cancer Surgery

Three Things I Wish Someone Had Told Me After Surgery 2015_12_22_15_55_46

  1. One: Your first bowel movements will be blood. That’s expected, don’t freak out.
  2. Two: Gas will hurt for a long time after your surgery. You will expect to hurt every time you laugh or sneeze or poop.
  3. Three: Your nerves that were cut will gradually heal back. When they do, you will hurt like something bad is happening in various parts of your body you previously didn’t know could hurt.

This painful reunion of your nerves will go on for months after your surgery.

Do call your surgeons about any pain, and realize there’s not much they can do.