Daily Archives: February 9, 2016

Multiple Sclerosis, Jamie-Lynn Sigler’s Autoimmune Disease, Explained

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What is multiple sclerosis?

MS is a degenerative nervous system disease, in which the immune system attacks it’s own nerve cells, slowing down messages between the brain and the rest of the body. No one knows what causes MS, but symptoms — which differ from person to person, but typically include muscle weakness, coordination and memory problems and a tingling or electric-shock sensation — usually start between the ages of 20 and 40, according to the National Institute of Neurological Disorders and Stroke.

There are currently 400,000 people in the United States living with MS. Women are twice as likely to develop the disease as men are, and individuals from Northern European decent, especially those who live in temperate climates, including Canada, the northern United States, New Zealand, Europe and southeastern Australia are at an increased risk, according to the Mayo Clinic.

While there’s no cure for MS, medication and physical and occupational therapy can help manage symptoms and slow down the progression of the disease.

Over the past decade, Sigler said her symptoms flared up, making walking long distances difficult and running impossible. “When I walk, I have to think about every single step, which is annoying and frustrating,” she told People.

Hashimoto’s Thyroiditis: We Can Win This Battle!

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Thyroid disease is an epidemic affecting up to 20 percent of American women. The most common cause of low thyroid today is an autoimmune condition called Hashimoto’s Thyroiditis. Like all autoimmune disease, the main feature is the production of antibodies that attack the healthy tissue of the body. In this case, thyroid peroxidase antibodies (TPOAb) and or thyroglobulin antibodies (TgAb) are created against the thyroid.

The roller coaster called Hashimoto’s — it’s not a fun ride.

Antibodies wage war against the thyroid, damaging follicles and spilling large amounts of hormone into the bloodstream. Patients experience symptoms of hyperthyroidism or too much thyroid hormone like sudden weight loss, rapid heartbeat, anxiety, high blood pressure and hot flashes. As levels of hormone clear from the blood and drop, patients experience low thyroid symptoms like fatigue, depression, weight gain, constipation and mood swings! This pattern repeats until thyroid hormone becomes depleted. Patients are often diagnosed in a low thyroid state.

How does it develop?

1) It’s in the genes. Certain genes in the body increase the chances of becoming autoimmune.

2) Triggers like poor diet, stress, toxins and illness can create negative changes in the microbiome. Friendly bacteria that normally support health become suppressed while opportunistic and pathogenic bacteria take center stage. This can lead to a whole host of health conditions including autoimmunity.

Chemicals and toxins can bind to body cells triggering the creation of antibodies. The immune system will attack the toxin and the cell it’s attached to.

Mistaken identity — The bacteria Yersinia Enterocolitica has been shown to provoke autoimmune attacks through a case of mistaken identity. This bacterium has surface peptides that look like receptors on the thyroid. They are similar enough that when the immune system goes after the Yersinia, it attacks thyroid tissue as well. (1)

Viruses like HTLV-1, enterovirus, rubella, mumps virus, HSV, EBV and parvovirus are all found to be linked with Hashimoto’s thyroiditis. These pathogens promote inflammation, provoke overstimulation of the immune system and may create the same type of molecular mimicry seen with Yersinia. Research is still working on finding the exact mechanisms that trigger the self-immune attack in the presence of these viruses. (2)

Hydrogen peroxide is created in the thyroid to help convert iodine to it’s usable form. This can be inflammatory without adequate selenium levels to protect tissue by neutralizing free radicals. Selenium deficiency will increase cellular damage and set off autoimmunity. This is one of the reasons the thyroid is so susceptible to the development of Hashimoto’s.

Excessive iodine intake can fuel autoimmunity by causing even more hydrogen peroxide to be made. While deficiency can lead to goiter and low thyroid function, too much can make autoimmunity worse.

3) Leaky gut — the last straw! Tight junctions are like gates between intestine cells forming a protective barrier. Vital nutrients pass through while toxins and pathogens are kept out. Zonulin is a regulatory protein that triggers the temporary opening of these “gates” allowing certain molecules to pass. Gluten is a major trigger for Zonulin over-activity. So are conditions like parasites, candida and SIBO. Similarly, infections, toxins, stress and even a lack of vitamin D can all cause these tight junctions to become weakened and break apart. When the gates are left open large food molecules, pathogens and foreign particles pass into the body setting off a full-scale immune attack. Food intolerances are born, allergies, more inflammation and if you are predisposed-autoimmunity can ensue. (3)

Gluten and antibodies.
There is a clear link between gluten consumption and Hashimoto’s Thyroiditis. According to research, the structure of gliadin, a component of gluten, is very similar to thyroid cells. As leaky gut persists and the immune system tags gluten molecules for destruction, thyroid cells get destroyed too. The more gluten you eat, the more antibodies you will make and the more the thyroid will be attacked!

Patients arriving at my office often fall into one of these categories.
1) The patient has been told they have thyroid antibodies but wasn’t treated. Instead doctors advised to “watch” it allowing antibodies to run rampant.
2) The patient has symptoms suggesting Hashimoto’s but was never tested for antibodies.
3) The patient knows she has Hashimoto’s and was treated with thyroid hormone, but the antibodies and underlying condition was never addressed.

All of these scenarios fail the patient.

Antibodies are a sign of some over-activity or misfiring of the immune system that needs to be quieted. Allowing it to persist will only lead to more autoimmunity and more tissue destruction.

Physicians generally order a very limited thyroid blood panel excluding antibodies-mainly because they believe they are untreatable. This is false-we see them normalize all the time.

The standard of care suggests treating patients with replacement thyroid hormone only if the TSH or T4 level is low. I see patients with antibodies and normal hormone levels respond quite well with some form of thyroid medication. Often there is a reduction of symptoms as systems begin to regulate. This is only part of the equation however. Hashimoto’s is not a thyroid disease. It is an autoimmune disease that affects the thyroid. This is a very important distinction and one that must be made to fully understand the mechanisms at work and the underlying causes to successfully treat and reverse the condition.

Treatment strategies to tame the autoimmune response.

It’s essential to work with a doctor who understands the underlying causes.
Starting with a comprehensive blood panel is the first key element. Levels of TSH, free T3 and T4, total T3 and T4, RT3 and TPO and Tg antibodies must be measured. I also run a specialized test called the TRH stimulation test which allows me to cast a wider net. Even if the regular thyroid panel comes up normal, the TRH will often pick up on missed cases of hypothyroidism (4).

In treating Hashimoto’s I begin with healing the gut through the 4R approach. First remove anything that is negatively affecting intestinal health like gluten and other inflammatory foods, toxins, medications, infections, parasites, virus and bacterial overgrowth. Next replace hydrochloric acid and digestive enzymes to aid digestion. Reinocculating the gut with healthy organisms can help regulate the immune system, and fortify the gut wall. Finally glutamine, DGL, aloe and zinc are key ingredients to repair, heal and energize the cells of the intestine.

Vitamin D is very tied to immunity and has been shown to fortify the intestine wall by strengthening tight junctions (5). Further studies find adequate D levels increase cathelicidin antimicrobial peptide or CAMP which is an antimicrobial and antibiotic we make internally (6)! Currently a blood level between 30-100 is considered to be in a healthy range. I find the higher end of the lab range is needed to support proper health. Many patients with antibodies come in with grossly low levels.

Selenium deficiency often plays a roll in autoimmunity. Supplementing with 200-400mcg per day has been shown to reduce thyroid antibodies.

Glutathione is the major antioxidant in the body and can help to further neutralize inflammation and free radicals.

Specialized treatments like UV blood irradiation can oxygenate blood, reset the immune system and kill off harmful bacteria, fungus and viruses that could have been part of the initial immune reaction. Transfer factors are another way to modulate the immune system by boosting the part that is deficient and quieting the part that may be over stimulated.

An Alternative Approach to Treating Fibromyalgia

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Many of my patients with fibromyalgia carry with them the daily burden of fatigue, “all over body pain,” sleep problems, mood symptoms, and sometimes even irritable bowel symptoms and palpitations. These are just some of the examples of symptoms associated with fibromyalgia. So, for patients dealing with this disease on a daily basis, it can have a significant negative impact on their quality of life and functionality.

Treatment for fibromyalgia requires a comprehensive approach where we target all of the symptoms that occur on a persistent daily basis for any given patient. That would include addressing issues such as, but are not limited to, sleep, mood, chronic pain, fatigue, thyroid dysfunction, adrenal dysfunction, gastroenterological symptoms, and chronic headaches.

So, because fibromyalgia treatment varies depending on the constellation of symptoms found in any given patient, there is no cookie-cutter way to effectively treating fibromyalgia in regards to a more natural non-pharmaceutical approach. There are, of course, some fundamental treatment concepts that recur in fibromyalgia therapy, but it is important to keep in mind that treatment should be fluid with these patients and not based on a pre-conceived treatment protocol.

The fundamental treatment modalities I use consistently with fibromyalgia patients include acupuncture, soft tissue therapy, sleep hygiene counseling, nutritional counseling, mind-body therapy types that resonate with a patient, and supplements that target foundational deficiencies found in a patient on lab testing and based on clinical history. These treatment modalities target the basis of a person’s physiology, which in my experience, achieve the greatest therapeutic results. Since fibromyalgia is pervasive in its ability to affect numerous aspects of a person’s physiology, I prefer to treat from a “bottom-up” perspective rather than from superficial symptoms downward perspective.

What I mean by this is to first evaluate the person’s physiology and try to adjust any organ system or nutritional deficiency first, instead of purely treating the fibromyalgia patient’s outward symptoms only. Don’t get me wrong, it’s very important to bridge the patient with medications or supplements as well as hands-on treatment options like acupuncture or soft tissue therapy, but those are meant to keep the patient comfortable while we get to the root of the problem.

While treating the symptoms are essential for fibromyalgia patients, I’ve had greater success with fibromyalgia therapy by focusing on deficiencies of the body as well as removing any and all triggers that are causing inflammation in the body. I tend to use medications and symptom-targeting therapies as a bridge until we can get the patient feeling better on his or her own, then typically, my patients have been able to use fewer medications and need less hands-on treatments once their underlying problems have been addressed.

In my experience, it is imperative to evaluate the hormonal status of a fibromyalgia patient, since disorders of thyroid, adrenal and sex hormone production can significantly impact the disease status in a negative way. So, if you have fibromyalgia, make sure to ask your doctor to check your thyroid not just with a TSH but also a free T3 and free T4 and a reverse T3 level as well as having them check your adrenal status using salivary cortisol testing. You should also ask for DHEA-s, pregnenolone, progesterone, estradiol and free and total testosterone testing. By checking these levels for a basic evaluation of your hormonal status, you should be able to see if any of these factors are at a sub-optimal status. If they are, they definitely need to be addressed and treated to help improve fibromyalgia symptoms.

Another aspect to look at is whether you have any food sensitivities or allergies. By doing the testing for this through either your allergist or integrative physician, you should be able to identify if there are foods you are eating that are worsening your fibromyalgia on a daily basis. I have had tremendous success with my patients in improving their symptoms simply by removing food triggers and adding in supplements or vitamins to target deficiencies in their nutritional status.

If you think about it, our bodies are machines first and foremost. We need minerals (like calcium, potassium, magnesium, just to name a few), amino acids, and various vitamins to keep our organs functioning and producing hormones and signals. If we are deficient in the fundamental building blocks of organ function, our nerves and muscles and cells aren’t going to be functioning at their best. Many of my patients have felt improvement in their fibromyalgia symptoms purely by increasing their vitamin, mineral and amino acid levels to a middle range number instead of low normal levels. You should be targeting for middle of the range normal and not just scraping the bottom of the barrel normal nutrient levels when you are monitoring labs for vitamin/mineral intake using supplements. Having said that, you shouldn’t be over-dosing on vitamins and minerals, either, so you should have your doctor help you monitor your supplement intake to make sure you are getting the right amount of nutrients.

Because our intestinal tract is one of the largest immune systems in our body, what you eat can affect your health tremendously. When you remove potential food triggers such as gluten, animal dairy or any other food sensitivities/allergies you may find on food testing, based on my experience in my clinic of integrative medicine in San Jose Calif., my patients typically report significant improvement in fibromyalgia symptoms.

So, the next time you see your doctor, ask for a comprehensive evaluation of your endocrine system as well as checking for deficiencies in vitamins and minerals. If you can tune up your body and then remove potential inflammatory triggers of various foods you might be ingesting, you could potentially see a significant improvement in your health and fibromyalgia symptoms as I frequently see in my patients who I treat in this similar fashion. Just remember, your body works at its best when it is fed premium fuel just like your car does… so make sure that you optimize your nutrient intake, remove foods that inflame your body, and make sure to get regular check-ups with your doctor so that your endocrine and other organ functions are working at its best. If you are able to do this, you’ll have a better chance of achieving the health status that you’ve always wanted.

Eczema: Studies for New Treatment

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We face a very exciting and very optimistic time in the treatment of eczema, or atopic dermatitis (AD). Initially we thought eczema — an inflammatory skin disease that affects four to seven percent of adults, and 15 to 25 percent of children worldwide (with the highest numbers in Asia) — was caused by defects in the epidermal skin barrier, or the outer layer of the skin. Now we know that eczema is an immune-driven disease that in turn causes secondary defects in the epidermal barrier. That’s a real paradigm shift.

A substantial proportion of the U.S. population, 31.6 million, has eczema; at least 17.8 million have moderate to severe cases. The prevalence of childhood eczema in the U.S. is 10.7 percent overall and as high as 18.1 percent in some states. For many years, eczema was considered mainly a disease of childhood; 85 percent of the time, it begins in early childhood. A recent study found that the prevalence of eczema in adults is 10.2 percent, which suggests that most children with eczema continue to be affected even in adulthood.

In eight out of 10 cases, eczema has a genetic background and a family history of eczema, seasonal allergies or asthma. I grew up in Romania and Israel and had eczema as a child. It was never so severe that I needed systemic treatments; it was mainly treated topically. Now I still get it in winter, as does my daughter, who’s 11; we treat hers with topical steroids. When she was younger, she really had it all over. (My son, who’s 15, has asthma.)

My daughter and I both get eczema more in winter. Eczema generally exacerbates in winter, when it’s dry, or in the summer, when there is increased sweating. An intractable itch, which affects sleep and daily activities, is associated with eczema. Increased accidents, due to lack of sleep, are often reported in both patients and parents.

There are still very large unmet needs for the treatment of patients with eczema.

Current treatments for eczema are still limited:

  • Oral prednisone has multiple side effects, and the moment you stop taking it, the eczema returns.
  • Cyclosporine suppresses the immune system, but its possible side effects include kidney damage after one to two years of treatment.
  • Phototherapy, or light therapy, is effective for most patients, but requires that patients come to the doctor’s office three times a week.

Latest Eczema Treatment Research

My research, which started at Rockefeller University and now continues at Mount Sinai, has provided the most comprehensive molecular maps available today of the mechanisms of eczema, mapping out the immune circuits characterizing this disease and the accompanying barrier defects. My laboratory is composed of postdocs, medical students, research associates, and clinical fellows working on the clinical front. I also have wide collaborations with other institutions, particularly with the Investigative Dermatology Laboratory at the Rockefeller University, and with national and international institutions and investigators.

Until a few years ago, eczema was believed to be driven by a type of white blood cell called Th2 lymphocyte. Lymphocytes produce inflammatory molecules, and normally these molecules are produced in low amounts required for maintaining a steady state. In eczema patients, the lymphocytes are activated and overproduce inflammatory molecules, ultimately leading to skin inflammation. In 2009, I was the principal investigator of a studythat found that a novel, previously unreported lymphocyte, T helper 22 or Th22, plays a key role in eczema. Th22 cells produce interleukin 22 (IL-22), an inflammatory product that has major effects on the epidermal barrier, such as thickening and abnormal differentiation, ultimately weakening the skin barrier. Thus, the effects of this cytokine might link the barrier and immune defects in eczema.

We are currently testing in clinical trials at Mount Sinai Dermatology several treatments that target not the whole immune system but specific molecules in the immune system. Some of our studies are part of larger clinical trials being done on a national or international level, but for some we are a single center or part of a few centers (together with Rockefeller University, for example) performing these trials. One of these ongoing trials, recently funded by the National Institutes of Health, is the first to explore the biological effects of blocking the IL-22 molecule on eczema disease activity and associated skin pathology. We have enrolled in these studies approximately 60 patients in the course of the last year, with new studies opening up this year that will offer many opportunities for patients to participate in these trials.

Using cyclosporine A, which suppresses the entire immune system, we were able to reverse the barrier pathology of the disease (skin thickness, and increased permeability of the skin barrier leading to penetration by irritants and allergens, and increased inflammation and itching). We are now testing treatments that specifically target the immune pathways involved in the immune activation in eczema, namely Th2, Th22 and others. Some of them, such as dupilumab, a biologic (meaning it is made from living cells), are showing great promise in terms of both safety and efficacy in early trials. These treatments are given either subcutaneously, intravenously or orally. There are also a few topical treatments for patients with milder forms of the disease.

Another study my laboratory is involved with, in collaboration with Dr. Amy Paller, a pediatric dermatologist and the chair of dermatology at Northwestern University Feinberg School of Medicine, aims to find out whether eczema in children and adults are comparable. This study is crucial in finding out whether we are dealing with a single disease in children and adults, and in developing drugs to target the pediatric population.

The new therapies will likely start becoming available in two to five years, pending the outcomes of clinical trials and then government approvals. In 10 years, I believe, we should have a wealth of new, safer and effective systemic and topical medications. Although emollients and barrier-targeting creams will still be important, we do need to target the immune system to be able to treat the disease effectively.

Scrambler Therapy: ‘Future of chronic pain’ relief

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WEST LINN, Ore. (KOIN) — Those suffering from chronic pain go to great lengths to find relief. But things like prescription drugs, physical therapy, acupuncture and massages don’t always work for everyone.

A local dentist who suffered severe head and neck pain for years says he’s finally pain-free thanks to something called Scrambler Therapy.

“I still remember thinking that day, ‘this is a little different, but we’ll give it a try,’” Dr. Kyle Valentine told KOIN 6 News. “I came in that day and I couldn’t move. In fact, my kids always made fun of me.”

Valentine says he tried nearly everything to help relieve his head and neck pain. When things were at their worst, he even had to close down his practice. Then, he heard about Scrambler Therapy at the Radiant Pain Relief Center in West Linn.

After his first treatment, Valentine says he was pain-free.

“This is definitely the future of chronic pain,” Radiant Pain Relief Center CEO Brendon Lundberg said. “We have no side effects, we don’t use drugs, we don’t use needles. There’s no risk to this technology.”

So, how does it work

Scrambler Therapy virtually re-trains the brain when it comes to the way it responds to pain. Electrodes are placed on the body in pairs, and a Scrambler Therapy machine directs electrical signals to simulate non-pain information in patients.

Scrambler Therapy virtually re-trains the brain when it comes to the way it responds to pain. (KOIN)

Scrambler Therapy virtually re-trains the brain when it comes to the way it responds to pain. (KOIN)

“[The] device acts like an artificial nerve and it generates a series of impulses which are obviously artificial… they mimic what exists in us naturally when we don’t have chronic pain,” Lundberg explained.

The technology was cleared by the FDA in 2009. In some cases, 10 treatments are enough to relieve symptoms of chronic pain.

In Valentine’s case, his treatments are becoming less frequent. His last one was about 9 months ago. In the meantime, he’s built a new life for himself, serving on the board of directors for the Jerome Kersey Foundation.

And, most importantly, his kids have their dad back.

“Now he can do stuff,” Valentine’s son Derek said. “He’s gotten a lot better.”

The cost for Scrambler Therapy varies, but it’s typically around $250 a treatment. It is currently not covered by insurance.

Radiant Pain Relief Center offers the first session for free and sells packages for treatments.

Five rules for beating dementia

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Research has found that sticking to four of the following five lifestyle changes will slash the risk of dementia and cognitive decline by at least 60%.

  • Exercise regularly – take the stairs instead of the lift.
  • Quit smoking – go to SmokeFree for more tips.
  • Adopt a healthy diet – try turning to a Mediterranean diet
  • Lower alcohol intake – drastically cut your alcohol intake.
  • Lose weight – maybe join a weight loss group like Weight Watchers

While getting healthier is beneficial for many reasons, by making these tiny tweaks it can also prevent up to 70% fewer instances of diabetes, heart disease and stroke compared to people who followed none of the tips.

The long-term study by Cardiff University began with 2,235 men in the Caerphilly area of South Wales in 1979, and found that the five factors above had an impact on preventing illnesses developing in older age.

“What the research shows is that following a healthy lifestyle confers surprisingly large benefits to health – healthy behaviours have a far more beneficial effect than any medical treatment or preventative procedure,” head researcher Professor Peter Elwood, of Cardiff University’s School of Medicine, told the Daily Mail.

“Taking up and following a healthy lifestyle is, however, the responsibility of the individual him or herself. Sadly, the evidence from this study shows that very few people follow a fully healthy lifestyle.”

Why Do We Keep Telling Cancer Patients How to Feel and What to Do?

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Do you remember when you were a small child and afraid of the dark? I do. Or maybe you were afraid of something lurking under your bed or in your closet. For years I thought something or someone was hiding under my bed just waiting to grab me if I as much as dangled my foot over the edge.

I also remember running into my parents’ bedroom (after garnering enough courage to leap out of my bed) in the middle of the night from time to time and being told the usual things. Go back to bed. There’s nothing to be afraid of. It’s only your imagination. There’s nothing under there.

Sound familiar?

Do you ever stop to think about how kids must feel when they are told such things?

Just because someone tells you there’s nothing to be afraid of, this doesn’t mean you stop being afraid, right?

Talk about no validation.

This same sort of thing often happens in Cancer Land. Too often cancer patients do not get validation for feeling afraid, angry, anxious or however they might be feeling.

In fact, instead it’s often subtly, or not so subtly, suggested there are certain ways cancer patients should feel and certain things they should do.

For example, when diagnosed, we’re often told things like:

Be strong. Be brave. Stay positive (this one really irks me). Fight hard. Kick ass. Be a warrior. And so on…

Then throughout treatment we hear things like:

You’re so tough. You can beat this. You’re only given what you can handle. You only have two rounds of chemo left. You don’t look sick. I hear chemo’s not that bad these days. You’re only having radiation, so you’re lucky. Everything happens for a reason. At least you’re getting a free boob job out of it. Attitude is everything, so just stay positive.

You get my drift…

Then… if you’re “lucky” enough to wrap up active treatment (metastatic patients are not; their treatments continue for life), again, the advice on how to feel and what to do starts rolling in.

Sometimes the advice is helpful, but often it’s not.

A few “gems” often tossed around, again, sometimes subtly and sometimes not so subtly, are:

Put it behind you. Move on. Find your new normal. Forget about it. It’s time to pick up where you left off. You’re a better person now, right? (If not, why not?) What did cancer teach you? Be grateful, you’re alive aren’t you? And the real stunner to me, what gift(s) did cancer give you?

Supposedly, it’s all about encouragement. I get that. This is the intended nature of most advice, to encourage.

But it might very well be more encouraging to allow for genuine-ness. There is no need to fix or make light of anyone’s feelings, cancer or no cancer.

It might not be helpful to tell a cancer patient how to feel or how to act unless, of course, they want you to. And some cancer patients do like hearing this sort of thing, which is fine. But many do not.

For many, cancer or no cancer (including that child who’s afraid of the dark), listening, validating and allowing genuine feelings to be felt and shared might be a more helpful and loving option.

And isn’t this what truly meaningful support is all about?

Why do you think people keep telling cancer patients how to feel and what to do?

Do you think doing so is helpful?

Nancy Stordahl is a breast cancer survivor who blogs candidly about her experience at Nancy’s Point. She is the author of Cancer Was Not a Gift & It Didn’t Make Me a Better Person: A memoir about cancer as I know it and is also the author of Getting Past the Fear: A Guide to Help You Mentally Prepare for Chemotherapy.

CAUSES AND SYMPTOMS OF PULMONARY FIBROSIS

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It can be challenging to figure out what caused your pulmonary fibrosis. Sometimes doctors are able to identify one or more causes of your disease, but it is also common to end up without an answer, despite completing a large number of medical tests. Diseases where a specific cause is not identified are often called “idiopathic” – meaning the cause is not identified or the disease occurs spontaneously.

There are many forms of pulmonary fibrosis that are idiopathic. The one that many people have heard of is “idiopathic pulmonary fibrosis” or IPF, but there are many others. A few examples are:

  • Idiopathic nonspecific interstitial pneumonia (NSIP)
  • Cryptogenic organizing pneumonia (COP)
  • Sarcoidosis

When the cause of PF is known, if often falls into one of these categories:

Autoimmune diseases

Autoimmune diseases are also called connective tissue diseases, collagen vascular diseases, or rheumatologic diseases. “Auto” means “self” and “immune” refers to your immune system. With autoimmune diseases, your own immune system is attacking your lung. If you have an autoimmune disease, your immune system can cause inflammation and scarring in the lungs. Examples of autoimmune diseases that can cause PF include:

  • Rheumatoid arthritis
  • Scleroderma (now called “systemic sclerosis”)
  • Certain muscle diseases (polymyositis, dermatomyositis, and the anti-synthetase syndrome)

Occupational exposures

Pulmonary fibrosis can develop after significant exposure to a wide variety of inorganic dusts, including asbestos, silica, coal dust, beryllium, hard metal dusts.

Environmental exposures

Organic dusts, including animal proteins, bacteria, and molds, can also contribute to the development of some types of PF. Diseases caused by inhaled organic dusts are often called “hypersensitivity pneumonitis”. Exposure to radiation can also contribute to the risk of PF.

Drug Induced or Medication exposures

Some medications have been linked to the development of PF, including drugs used to treat:

  • Infections (nitrofurantoin, sulfasalazine)
  • Heart disease (amiodarone, propranolol)
  • Seizures (phenytoin)
  • Cancer (methotrexate, bleomycin, oxaliplatin, radiation therapy)

Genetic/Inherited diseases

Approximately 10-15% of those with an “idiopathic” form of PF have another family member afflicted by the disease. This is called familial pulmonary fibrosis (FPF) or familial interstitial pneumonia (FIP). A number of genes and genetic variants have been identified that are associated with the development pulmonary fibrosis, but frequently genetic tests are not performed when PF is diagnosed, as we are only just beginning to understand the significance of these genetic abnormalities. It is important to discuss the potential risks and benefits of genetic testing with a qualified genetic counselor and your medical provider. To speak with a Certified Genetic Counselor free of charge, contact Janet Talbert, MS, CGC at 800.423.8891, extension 1097.

Symptoms

The most common symptoms of PF are cough and shortness of breath. Symptoms may be mild or even absent early in the disease process. As the lungs develop more scar tissue, symptoms worsen. Shortness of breath initially occurs with exercise, but as the disease progresses patients may become breathless while taking part in everyday activities, such as showering, getting dressed, speaking on the phone, or even eating.

Due to a lack of oxygen in the blood, some people with idiopathic pulmonary fibrosis may also have “clubbing” of the fingertips. Clubbing is a thickening of the flesh under the fingernails, causing the nails to curve downward. It is not specific to IPF and occurs in other diseases of the lungs, heart, and liver, and can also be present at birth.

Other common symptoms of pulmonary fibrosis include:

  • Chronic dry, hacking cough
  • Fatigue and weakness
  • Discomfort in the chest
  • Loss of appetite
  • Unexplained weight loss

People Who Suffer Depression And Anxiety After A Traumatic Brain Injury May Have Damaged White Matter

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Over the past few years, it’s become widely known among the scientific community that traumatic brain injuries, or concussions as they’re more often called, can result in lasting physical and mental damage for the sufferer — a reality that only entered the public consciousness with the emergence of lawsuits filed against the NFL, alleging that they had ignored the evidence showing this when it came to their own players.

But while we know that a concussion can leave you with more than dizziness and a temporary headache, it’s been harder to understand exactly why. Now, new research published in the Radiological Society of North America claims to have possibly figured out part of the mystery. The study authors say they were able to detect unique brain patterns among people suffering from depression or anxiety as a result of their concussion when compared to the brains of those concussion sufferers with no reported mental problems — in some cases, these patterns resembled the brains of those whose mental illness wasn’t caused by head trauma.

Noting that conventional screening techniques have failed to find substantial differences in the brains of concussion sufferers compared to a healthy population, the researchers instead utilized diffusion tensor imaging, a MRI method that can detect abnormalities in the structure of white matter, namely the fibers that allow signals to be transmitted throughout the rest of the brain (multiple sclerosis, a degenerative neurological disorder that gradually disturbs physical and mental functioning, is known to occur in white matter).

They tested two groups of post-concussion patients: 45 reporting psychological issues like irritability, depression, and anxiety, and 29 with no reported mental ailments. “Using other concussion patients as our controls was a big advantage of our study,” said lead author Dr. Lea M. Alhilali, assistant professor of radiology at the University of Pittsburgh Medical Center (UPMC). “When you are able to study a similar population with similar risk factors, you get much more reliable results.”

The authors were able to find noticeable differences in the brain structure of the two groups. Depressed post-concussion sufferers had decreased functionality of the white matter surrounding an area near the deep gray matter of the brain that is strongly associated with the brain’s reward circuit, according to an accompanying statement by UPMC. Similarly, concussion-related anxiety was linked to the impaired functioning of white matter in an area of the brain called the vermis that is believed to be involved in the regulation of our fear responses. Unfortunately, no smoking gun was found for those with irritability.

The patterns they discovered were especially revealing for their differences and similarities to other types of mental illnesses. “The regions injured in concussion patients with depression were very similar to those of people with non-traumatic major depression disorder,” Dr. Alhilali said. “This suggests there may be similar mechanisms to non-trauma and trauma-dependent depression that may help guide treatment.”

Meanwhile, because the vermis hasn’t been linked to anxiety disorders in those without head trauma, it may point to a need to handle these cases differently from conventional anxiety patients.

Overall, the authors feel their findings may pave the way to advances in understanding what can happen to people after a traumatic brain injury, and how to better treat those who suffer lingering side effects in the wake of it. “There are two major implications for this study,” Dr. Alhilali said. “First, it gives us insight into how abnormalities in the brain occur after trauma, and second, it shows that treatments for non-trauma patients with neuropsychological symptoms may be applicable to some concussion patients.”