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Medical Forum / Diseases and Disorders / Sinusitis / April 2007Less treatment is more?
I realize that there are factors in my own health history that make it different than most, but the similarity is chronic, increasingly refractory sinus infection of my right ethmoid. For several weeks now, it's been a non issue due to modifications in the medications I use for it and other conditions. The take home lesson for everyone may be that the less medication we attack it with, the better our sinuses may be. In my case, the use of a topical immunosuppressive vitamn D analog cream for a skin condition is clearly at the root of my intractable sinusitis. If I keep the use of the med to a fraction of what I used to use, I have little problem and I've been off of antibiotics for the first time in months as a result of this change. I've kept irrigating daily out of habit. When I increase the frequency of the vit. D cream, I get some immediate return of minor symptoms, but Bactroban up my nose with a Qtip and daily irrigation gets rid of it completely. In addition, someone on this group mentioned the benzalkonium chloride in the Astelin spray I was still using. I quit that, too, and my congestion is gone, my nose drains much better, despite tree pollen being high and my once again severe allergy to it. Yup, since discontinuing high doses of immunosuppressive therapy, my allergies have returned to the levels of two years ago, I'm still using strong allergy shots to desensitize to them all over again. For those who are chronically administering steroids in an effort to control sinusitis, I'd really urge you to consider the cycle of immune compromise you set up by not taking breaks from the steroids. They will, even if only locally, make your cells less able to fight infection. You can get the benefits from them that you may need by cycling off them every 2-3 weeks for as long as possible, by using them only in the a.m. and never at night (suppresses the HPA axis longer) and by keeping doses as minimal as possible. Just based upon my experience, an N of one. Doing less is helping more, and I'm no longer a slave to sinusitis. Susan On 4/1/07 9:17 AM, in article 57a48jF2cbpfsU1@mid.individual.net, "Susan" <nevermind@nomail.com> wrote: > topical immunosuppressive vitamn D analog cream > for a skin condition Immunosuppressive cream? What's that? Are you saying ordinary cortisone cream effects your system????? > On 4/1/07 9:17 AM, in article 57a48jF2cbpfsU1@mid.individual.net, "Susan" > <nevermind@nomail.com> wrote: [quoted text clipped - 4 lines] > Immunosuppressive cream? What's that? Are you saying ordinary cortisone > cream effects your system????? Yes, as do inhaled steroids. But the cream is used over a wider area. I was using a lot for many years and had severe bone marrow edema in my mid foot and heel, too, which has also remitted since cutting way back, and is consistent with my Lyme history. Susan > x-no-archive: yes > [quoted text clipped - 10 lines] > In my case, the use of a topical immunosuppressive vitamn D analog cream > for a skin condition is clearly at the root of my intractable sinusitis. Yes, Susan, you've only mentioned that about 50,000 times already. I don't think there is any hard-and-fast rule about "less is more" or "more is more." What I do believe, and it ought to be common practice but unfortunately isn't, is: If you're being treated for multiple chronic conditions, you need to find a physician who is board-certified in internal medicine and who is competent enough to keep track of all your various chronic conditions and *balance* the various medications you take. The usual dose of a medication for one condition may end up worsening another condition, and may need to be reduced or given on a different schedule. To this end, your primary care physician has to speak with your various specialists and thrash it all out. It should *NOT* be the patient's responsibility to be his own medical coordinator. All too often, the way it works is that your primary care physician only writes referrals to various specialists. Each specialist prescribes separate meds on a separate schedule. There is no follow-up with the primary care physician so he never finds out what you've been prescribed by specialists. And no one physician has responsibility for all the meds you take on one schedule for all the conditions you have. Perhaps the limitations of managed care have reduced your primary-care physician from the *coordinator* of your care to a mere "gatekeeper," as he is called, writing referrals to specialists and then washing his hands of you. If so, that's an ominous trend. I remember the first time an ENT recommended surgery. I was already being treated for other conditions. The conversation went like this: ENT: So I think you need septoplasty, ethmoidectomy, blah-blah-blah.... Steven: OK, I would like to discuss your recommendations with my primary care physician. ENT: Does your insurance require you to? Steven: No. ENT: Then why are you even going to bother? :-)  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > Yes, Susan, > you've only mentioned that about 50,000 times already. It bears repeating. I've avoided surgery, other procedures and now no longer need chronic antibiotics or constant care of my sinuses. > I don't think there is any hard-and-fast rule about "less is more" or > "more is more." That's why I began by emphasizing how my case differs. > If you're being treated for multiple chronic conditions, you need to > find a physician who is board-certified in internal medicine and who is > competent enough to keep track of all your various chronic conditions > and *balance* the various medications you take. Yeah, if you ever find one, just shout. I've just paid to enter a concierge practice because my internist, also bd. certified inf. diseases has no time to do what you unrealistically believe doctors capable of. Docs who do anything that's not reflexive or out of a cookbook are rare as hen's teeth. My now former PCP was the only internist I ever had to act like a case manager, til I became too much trouble and not enough reward. Not one of the many board certified doctors who rx'ed immunosuppressive, hormonally active meds for me, including academic dept. heads, nor others I saw about related problems ever considered the impact of the meds I was on. Nor did any of my primaries. The usual dose of a > medication for one condition may end up worsening another condition, and > may need to be reduced or given on a different schedule. To this end, > your primary care physician has to speak with your various specialists > and thrash it all out. It should *NOT* be the patient's responsibility > to be his own medical coordinator. No sh.t. But it *is*, after decades of seeing alleged top docs at alleged finest academic and community care practices for decades. Any patient who fails to take the lead case management role in today's medical practice environment is a sitting duck. > All too often, the way it works is that your primary care physician only > writes referrals to various specialists. Each specialist prescribes > separate meds on a separate schedule. There is no follow-up with the > primary care physician so he never finds out what you've been prescribed > by specialists. And no one physician has responsibility for all the > meds you take on one schedule for all the conditions you have. This is how it works. And none of them do careful monitoring for effects of the various meds and their interactions with other diseases and meds. > Perhaps the limitations of managed care have reduced your primary-care > physician from the *coordinator* of your care to a mere "gatekeeper," as > he is called, writing referrals to specialists and then washing his > hands of you. If so, that's an ominous trend. It's the way medicine is practiced now, generally speaking. There are nothing but financial disincentives for docs to spend time thinking about and coordinating care. Doctors get paid for procedures and rewarded for diagnosing and rx'ing for what pharma and insurers want them to. > I remember the first time an ENT recommended surgery. I was already > being treated for other conditions. The conversation went like this: [quoted text clipped - 11 lines] > > :-) SIGH. Susan On 4/1/07 1:21 PM, in article ZuUPh.20141$Jl.20079@newsread3.news.pas.earthlink.net, "Steven L." <sdlitvin@earthlinkNOSPAM.net> wrote: >> x-no-archive: yes >> [quoted text clipped - 57 lines] > > Along this line may I repeat myself; try to have a single pharmacist who knows you and fills all your prescriptions. This could save your life, what with so many interactions. You get one Rx from the podiatrist, another from the GP, another from the urologist and another from the cardiologist. As stated, a single doctor in charge is best. A pharmacist who knows you is also good. >>Along this line may I repeat myself; try to have a single pharmacist who knows > > you and fills all your prescriptions. This could save your life, what with so > many interactions. You get one Rx from the podiatrist, another from the GP, > another from the urologist and another from the cardiologist. As stated, a > single doctor in charge is best. A pharmacist who knows you is also good. I've typically had both those situations and it made no difference. In addition, I've always been scrupulous about offering a list of everything I take and what it's for and how it works to every doctor I consult. It's not the patients falling down on the job, it's the doctors and allied professionals. Susan > x-no-archive: yes > [quoted text clipped - 14 lines] > > Susan Yep, feels very lonely when those you would like to depend on not only don't really seem to care, I can deal with that, but they seem bent on treating an entirely different disease, or treating no disease at all. There have been several studies that used killed fungi, bacteria and viruses to see if they could ellicit a response by eosinophiles. The fact that they were usually unable to do so has not shaken the conviction of some that sinusitis inflammation is due to collateral damage caused when the immune system attacks benign fungi or bacteria in the lining of the sinuses. Something similar to that happens when the immune systems attacks organs in some cancer patients. On the other hand, if one tests positive for several pathogens, then immune system dysfunction is proposed because Docs have been conditioned by AIDS to think immune disfunction if they see multiple pathogens. Ignorance of the properties and ubigutious nature of biofilms hinders differential diagnosis.....a bunch. And when it hinders the doc into prescribing immunosuppressive drugs when you actually have an infection, it can be pretty bad. Susan, Unfortunately, it's the system. I spent several hours coordinating the care of a very ill patient. I did not see her in the office, because she needed a hospital level of care. It literally took my entire day, and interferred with the care I delivered to patients in the office--I was constantly getting called to the phone. What was I paid for several hours of work? Nothing. Insurance doesn't reimburse for coordination of care, except under very restricted conditions. If I was an attorney, I could have billed for 4 hours of intellectual work product. Instead, I just stayed hours late. I teach young medical students, and I watch their idealism face reality, and it's not a good thing. I've been in medicine since 1980, and it's only getting worse. And Murray Grossan's contention that a pharmacist can coordinate your meds: not in my experience. As small independent pharmacies disappear, I find the rotating pharmacist at my local pharmacy has NEVER counseled me: they hand me the form with the box alread checked that I don't want to speak to the pharmacist. The really sad thing is that concierge practices deliver, ideally, what should be the norm. When the pace of primary care is so unremitting, it's harder--if not impossible--to practice the kind of medicine we all want and deserve. (And the pace of specialty practice is no less demanding, IMO.) Judy > x-no-archive: yes > [quoted text clipped - 14 lines] > > Susan > Susan, > Unfortunately, it's the system. I spent several hours coordinating [quoted text clipped - 7 lines] > for 4 hours of intellectual work product. Instead, I just stayed hours > late. Judy, I completely agree, and I understood this reality completely when I decided to buy my way into the practice of a doc who has only 360 patients to date. She assured me that she's not put off by my extensive health hx, intense research and knowledge and that she has time to give me and to do research and coordination on my behalf. > I teach young medical students, and I watch their idealism face > reality, and it's not a good thing. I've been in medicine since 1980, > and it's only getting worse. You're not kidding. Frankly, with insurers and pharmas deciding what the consensus guidelines are, I don't see why anyone needs a medical education to think so little and to just follow the recipe in an abridged cookbook. > And Murray Grossan's contention that a pharmacist can coordinate > your meds: not in my experience. As small independent pharmacies > disappear, I find the rotating pharmacist at my local pharmacy has > NEVER counseled me: they hand me the form with the box alread checked > that I don't want to speak to the pharmacist. Yes, this is what happens at my chain pharmacy, too. I use mail order, mostly, too. I will say that in the past, independent pharmacists were often better resources than my doctors. > The really sad thing is that concierge practices deliver, ideally, > what should be the norm. Yes, and what once was the norm. I'm old enough to remember. > When the pace of primary care is so unremitting, it's harder--if not > impossible--to practice the kind of medicine we all want and deserve. > (And the pace of specialty practice is no less demanding, IMO.) As someone with complex medical issues that require unpaid thinking and coordinating time, I realize how much all our lives are endangered by the way modern day medicine is practiced in this country. Doctors get paid for procedures and rx'ing, not for thinking and helping. It's sad for the well intentioned doc and unbelievably frightening for the patient. The fact that I have to fly across the country to find that kind of endocrinologist is just ridiculous and sickening, but that's how it is. Susan Susan, Don't you also find that generations make a difference? I'm finding that as I age, and my doctors age, the doctors I really trust--like my allergist--are starting to retire. I sit on committees at the medical school and all the members are around my age or a little older and they decry the ethics of the younger generation, who won't stay late for meetings or interfere with their family time. Some of this is reasonable, because the old selfless doctor concept is dying as we have become slaves to third party payors, and as you said, controlled by guidelines (which are created by expert committees with so many conflicts of interest that their guidelines need to be viewed with extreme caution--they are not objective, unfortunately, and they often don't realize their bias), but as a patient it's scary to be cared for by physicians who don't have the work ethic or the desire or the ability to truly care for me. I recently took a writing class from an infectious disease doctor who has left clinical practice to write. She said to write about what scares you, and her personal fear was to be on the receiving end of the healthcare system. I concur. Judy > x-no-archive: yes > [quoted text clipped - 55 lines] > > Susan > Susan, > Don't you also find that generations make a difference? I'm finding > that as I age, and my doctors age, the doctors I really trust--like my > allergist--are starting to retire. I don't have any young doctors, so I can't really compare. I can say that I've seen lots of crappy older doctors, though. If my allergist ever dies or retires, I'm going with him; he's a true disciple of Osler, as his father was. I sit on committees at the medical > school and all the members are around my age or a little older and > they decry the ethics of the younger generation, who won't stay late [quoted text clipped - 7 lines] > by physicians who don't have the work ethic or the desire or the > ability to truly care for me. Yes, very scary. Even if you're not ill, if your doctor uses something as simple as fasting blood glucose to screen you for DM, you're not going to be diagnosed until your DM is very well advanced thanks to the consensus guidelines, for example. This is typical of modern medicine, not an exception, just one example of how bad it is out there. FBG misses 70% of female diabetics, and 48% of males. Frex. > I recently took a writing class from an infectious disease doctor > who has left clinical practice to write. She said to write about what > scares you, and her personal fear was to be on the receiving end of > the healthcare system. I concur. Me, too. There's nothing wrong with me that hasn't been made worse by or directly been caused by the doctoring I've received over the last four decades, except for my allergies. Susan I am sorry to hear of your experiences. So manhy in my family have had heart surgery with great results. My family has had hip replacement surgery with miraculous results. When patient comes to my group we can do a 2 minute digital Ct and give a diagnosis and Rx plan in less than an huor's visit instead of try this and try that. WE can get quick cultures and we can Rx without systemic medicaitons. T think these are real advancements and worth while. 25 years ago, no stents, hip replacement, digital CT, etc . Not that we depend on the CT. Quite the contrarty but it can save needless triats. > x-no-archive: yes > [quoted text clipped - 38 lines] > > Susan > I am sorry to hear of your experiences. So manhy in my family have had heart > surgery with great results. My family has had hip replacement surgery with [quoted text clipped - 50 lines] > > - Show quoted text - Murray: I fully appreciate orthoscopic surgery and digital CT scans, and confocal microscopes and computer controled cap el sequencers. And I think that it is very commendable that your practice gives speedy diagnosis and an Rx plan which uses antibiotics buy avoids systemic meds. And you have GOT to know that this is not the norm. But I do not know what the norm is. In my experience it takes a couple of years and $3500.00 in tests to get a prescription for effective antibotics and antifungals. while workman I know go to the emergency room (which have very young doctors) or an old family GP or the health dept and get the right drug combos prescribed right away. > I am sorry to hear of your experiences. So manhy in my family have had heart > surgery with great results. My family has had hip replacement surgery with [quoted text clipped - 50 lines] > > - Show quoted text - Murray: I fully appreciate orthoscopic surgery and digital CT scans, and confocal microscopes and computer controled cap el sequencers. And I think that it is very commendable that your practice gives speedy diagnosis and an Rx plan which uses antimicrobials but avoids systemic meds. And you have GOT to know that this is not the norm. But I do not know what the norm is. In my experience it takes a couple of years and $3500.00 in tests to get a prescription for effective antibotics and antifungals. while workman I know go to the emergency room (which have very young doctors) or an old family GP or the health dept and get the right drug combos prescribed right away. > I am sorry to hear of your experiences. So manhy in my family have had heart > surgery with great results. My family has had hip replacement surgery with > miraculous results. Murray, my point is that there is medical advice being given as the guideline that makes such illness and prodedures more necessary. Low fat diets, for one, increase CVD, joint and bone destruction by increasing inflammation in the body and epithelium. You make my point; folks think they're getting good medical care, but the need for such procedures argues against good preventive health care as the routine. When patient comes to my group we can do a 2 minute > digital Ct and give a diagnosis and Rx plan in less than an huor's visit > instead of try this and try that. WE can get quick cultures and we can Rx > without systemic medicaitons. T think these are real advancements and worth > while. 25 years ago, no stents, hip replacement, digital CT, etc . > Not that we depend on the CT. Quite the contrarty but it can save > needless triats. That's highly abnormal, and is hardly an argument against my experiences in many presigious academic medical centers or large metro area clinical offices for decades of intensive health care. The community standard is malpractice. Susan The price for digitial CT scans is astronomical--so of course every patient gets one.(The reimbursement for the imaging is lucrative, and it offsets the price of the machine.) It's the absolute certainty that concerns me: every patient gets a state of the art CT which will perfectly diagnose the problem (just don't irrigate with Dr. Grossan's device for 2 days prior or it will look as though you have fluid in the sinuses), then in less than an hour every patient is diagnosed and a perfect treatment plan is created. There is no perfect clinic, nor any perfect physician. I'm sure that Dr. Grossan's clinic is very high tech, and offers excellent care, but I am leery of absolutes. If sinusitis was so simply cured, then why does this group exist? Acknowledge that you have excellent radiography, talented specialists and a wealth of clinical experience, but even all of that doesn't guarantee an excellent outcome to all patients. I trust physicians who acknowledge that they do the best they can, but that risks exist, there are limitations to their therapeutic options and despite the uncertainty, they will stick with you. Judy > x-no-archive: yes > [quoted text clipped - 25 lines] > > Susan On 4/9/07 2:11 PM, in article 1176153073.428250.124990@e65g2000hsc.googlegroups.com, "judy.n" > The price for digitial CT scans is astronomical--so of course every > patient gets one.(The reimbursement for the imaging is lucrative, and [quoted text clipped - 43 lines] >>> needless triats. >> Judy you are correct, not every patient gets cured and there are multiple reasons for this. Our group gets referred the ones that don't get well. The average patient I see has already had 3 antibiotics or has symptoms due to the irritation of the saline preservatives. By the way, there is a list of medical conditions in the new edition of The Sinus Cure for not using the Hydro Pulse. > > The price for digitial CT scans is astronomical--so of course every > > patient gets one.(The reimbursement for the imaging is lucrative, and > > it offsets the price of the machine.) It's the absolute certainty > > that concerns me: every patient gets a state of the art CT which will > > perfectly diagnose the problem Judy n.; Murray: Where is the data on the diagnostic value of CT scans published? The best references that I can find give the false negatives as 38% not the 7 to 10% that Steve L. keeps quoteing from somewhere. and the false positives, people showing abnormal CTs when scaned for something else unrelated, was over 40%. I am not saying that CTs are not a helpful tool, but a negative CT does not rule out sinusitis by a long shot. > Where is the data on the diagnostic value of CT scans published? > > The best references that I can find give the false negatives as 38% > not the 7 to 10% that Steve L. keeps quoteing from somewhere. > and the false positives, people showing abnormal CTs when scaned for > something else unrelated, was over 40%. Can you please share those references re: false negatives? > I am not saying that CTs are not a helpful tool, but a negative CT > does not rule out sinusitis by a long shot. That's for sure, especially when it's ethmoid. Susan Susan, Here are some out dated references from an article I wrote over 6 years ago http://www.aafp.org/afp/20010901/cochrane.html I would need to do a literature search to give you data. There was an excellent article in JAMA in 2000 or so by Kennedy that cited sensitivity/specificity, but it's outdated as well. There have been posts on this group about surgical findings compared to pre-op CT's--which would be the gold standard. Definitely almost every patient who gets an MRI has the findings of mucosal thickening--they are overly sensitive, and clearly patients with chronic infections can have "normal" CT's. My ENT demands to see all films as he does not feel the radioloigists' readings give him the information he needs. The other issue here is the different types of CT's: Murray Grossan's is a digital CT which is almost 3-D in its images. It provides different images from conventional CTs. I don't know if anyone has looked at the sensitivity and specificity of those images compared to clinical criteria. CT's are helpful, but as with any medical test, there are false negatives and positives. I think there are too many variables here for us to know the true numbers: different machines, and we need to define how we determine a false result--we can't take everyone who gets a CT to surgery. I've seen the digital CT images, and they are impressive, but they may be overly sensitive, like MRI's. It would be nice to have data. Judy > x-no-archive: yes > [quoted text clipped - 13 lines] > > Susan > Susan, > Here are some out dated references from an article I wrote over 6 [quoted text clipped - 12 lines] > all films as he does not feel the radioloigists' readings give him the > information he needs. Judy, I wasn't doubting the claim at all, I was just hoping for actual data on those high false negative figures to help me get better care from my ID doc. Thanks for the article and references. Susan Susan, I was away, I hope you got the answers you need, we should compile some references re: sensitivity and specifity and predictive value of sinus imaging. Judy ( I wrote the article when I was full time faculty: my chief asked what topic interested me: go figure it would be sinusitis. I was never sicker than when I was full time in the hospital--combination of working amongst germ central, working with sick residents, and the hospital plant itself was mold infested. It's what led me to push for the diastrous surgery in 2000: I didn't recognize how much of my illness was environmental. Since I left the hospital, which coincided with the low dose macrolides, I've been so much healthier. I still work with med students: but in an actual classroom, and I see patients in an office that is it's own biohazard, but not as bad.) > x-no-archive: yes > [quoted text clipped - 22 lines] > > Susan > Susan, > I was away, I hope you got the answers you need, we should compile [quoted text clipped - 38 lines] > > > Susan Judy I have been wondering for some time how to get more funds focused on sinusitis research. I have been also wondering what an epidimological study into the association between sinuisitis and altzheimer's would show. I remember in 1981 I was bathing my 4 month old son in the sink listening to a piece on National Public Radio about a guy named Couch who worked by the CDC had done research into the interdependance between staph a. and one of the flu viruses and toxic shock. He showed that chronic respiratory infection could be established by exposure to the flu in the presence of staph, (in a mouse model and that the staph had some sort of relationship to the virus. (I believe the staph could actually harbor the virus and use it to gain a foothold.) Anyway, I remember his work but I can't get to it, all that comes up with an internet search is the title of the artical not the no abstract, no full text. Then in 1982 AIDS was proven to be a contagious virus with a long latency and all the research grant applications became about AIDS and the immune system. Anyone who had three bacteria at a time was suspected of having an "underlying immune system dysfunction.", rather than a dead common bacterial super infection supsequent to a dead common viral event. Once we get it sorted out that sinusitis and altzheimers and heart disease and "acid reflux" have always been caused by our old buggy buddies, there are all sorts of things we can do about it. I've only been on Federal teaching grants, so I'm no expert, but the last conference I went to about getting grants talked about how the current rate of federal funding for research grants is %5 of all of those submitted. It's the primary reason why most research is done with industry money. Even at the federal level, they've discovered that most of the FDA employees receive drug industry funding, including the majority who sit on expert panels to create guidelines. So, I completely agree that for something that is so common and causes so much disability and lost productivity and in this age of antibiotic resistance, it deserves tons of funding, I think the reality is the studies will be done by the drug companies--which is not necessarily a bad thing, but it will be a narrow focus. I started to look for primary immunodeficiencies when I received a mailing from the NIH which was sponsored by the family of a child who had died of it: it's a simple workup: a CBC and quantitative immunoglobulins with IgG subsets. And, I find it exists--even in myself (IgG subset deficiency) and in my family (IgA deficiency). But, the money for the mailing came from the family foundation. So, I agree with you . I just wonder where the money for the research will come from. Judy > > Susan, > > I was away, I hope you got the answers you need, we should compile [quoted text clipped - 69 lines] > disease and "acid reflux" have always been caused by our old buggy > buddies, there are all sorts of things we can do about it. > I've only been on Federal teaching grants, so I'm no expert, but the > last conference I went to about getting grants talked about how the [quoted text clipped - 97 lines] > > - Show quoted text - I think the stakes are higher than we know. We can't culture 99% of bacteria, we don't know what they do or what now idopathic chronic disease they cause and as of 2005, NO ONE HAD EVEN PUT IN AN APPLICATION FOR A GRANT TO CHARACTERIZE THE BACTERIAL COMMUNITY GENOME IN HEALTHY SINUSES AND COMPARE IT TO THAT IN PEOPLE WITH CHRONIC SINUSITIS. The sinuses are the high ground and when they become infected it establishes a beachhead for to infect other organs and structures in the vacanity and below. Like the brain, heart, spine and lungs. We need a National Sinus Foundation so the work on does not get put off for another 25 years. By the way, they have just come out and said that the "thrifty gene" complex that was suppose to predispose people to type II diabetes was a mirage of comfirmatory bias and bad stastics. Since type II diabetes also responds to macrolides, I believe it too will be found to be and infectious disease. > By the way, they have just come out and said that the "thrifty gene" > complex that was suppose to predispose people to type II diabetes > was a mirage of comfirmatory bias and bad stastics. Since type II > diabetes also responds to macrolides, I believe it too will be found > to be > and infectious disease. I think you may be overstepping a tad here. Not that infectious diseases don't raise bg, but there certainly is a genetic tendency toward insulin resistance (which can be overcome with low glycemic eating), Cushing's syndrome and disease, subclinical and full blown which causes a very significant percentage of DM type 2 and also inherited glucocorticoid resistance syndrome, thought rare but actually quite common when one considers how varied the presentation is even within the same families. There's also steroid drug induced IR and DM, endocrine disruptors in our food and water supply, I could go on... Susan > x-no-archive: yes > [quoted text clipped - 16 lines] > > Susan Considering that Cystic Fibrosis actually refers to the scaring of the pancreas that accompanies that disease and that only 50% of the people with clinical CF have the mutation in the CF trans-membrane conductance factor, AND that dental procedures can cause remission of diabetes, AND that bacteria outnumber the cells in a human 10 to 1. And that gut bacteria produce all kinds of hormones and immunogularatroy factors, It is in the genes alright, but those genes may be in bacteria that your whole family has carried through the generations. First it was proved that worms did not arrive in the body by spontanous generation. Then they found that ulcers are not genetic. And when the tests are done with killed viruses and bacteria they do not elicit the inflammation that would suggest that the body is reacting to their mere presense, rather than to toxins that they produce. I think it likely that we are looking at some very complex predator/prey dynamics. > Considering that Cystic Fibrosis actually refers to the scaring of the > pancreas that accompanies that disease [quoted text clipped - 7 lines] > It is in the genes alright, but those genes may be in bacteria that > your whole family has carried through the generations. Listen, it's not that I haven't considered it. I'm often quoted for saying that once we can detect pathogens better, the DSM for psychiatric illness will shrink from 4" thick to pamphlet size. I know that chronic infections, like gum disease, raise serum glucose. Brief, acute infections do, too. That doesn't explain why so many folks harboring the same bugs don't become DM while others do. The epidemic of what used to be called "adult onset" DM in children perfectly matches the implementation of the starch laden, fat and protein deprivation of the food pyramid. Snackwells Syndrome is the biggest cause of DM in our culture. We have a kidney disease epidemic to go along with the glycemic load/starch driven obesity/type 2 DM epidemic wrought by government guidelines. Susan > x-no-archive: yes > [quoted text clipped - 28 lines] > > Susan Lets be clear about what I am not saying. I am not saying that diet has no effect. Remember when you could buy foliate or frolic acid because it interfered with some test for something? I can't guess how many cases of spina bifita that that probably contributed to. So yeah, a starchy diet sucks. But I have seen cases where DM has literally a struck guys I know over night who did not previously show any signs of diabetes. If you are a bug, it could be handy to be able to secrete an enzyme that would raise the amount of sugar available to you. There are also bugs do not produce the lipids that they need to build their cell walls. They produce hormones that elevate the amount of cholesterol produced by the liver and circulated in the bloodstream. It may not mean anything, on the other hand, it may mean that a lot of so-called genetic diseases can be cured with a vaccine. > Lets be clear about what I am not saying. > I am not saying that diet has no effect. [quoted text clipped - 5 lines] > But I have seen cases where DM has literally a struck guys I know over > night who did not previously show any signs of diabetes. So what? It didn't suddenly strike him, he, like almost all diabetics, didn't show DM range fasting blood glucose, which is what's used as a screen. Unfortunately, post prandial glucose is rising into DM ranges for many years before most diabetics start to have high fasting numbers. I've been DM for many years, and my fbg has never hit the diagnostic range. People don't "show signs of diabetes" until they're in an extremely advanced state. > If you are a bug, it could be handy to be able to secrete an enzyme > that would raise the amount of sugar available to you. [quoted text clipped - 4 lines] > It may not mean anything, on the other hand, it may mean that a lot of > so-called genetic diseases can be cured with a vaccine. As a chronic tick borne disease patient, I understand the point you make about alleged genetics in what may be an inherited infection, and I agree with the notion. OTOH, you don't seem to know enough about how DM develops to make a claim that folks are suddenly diabetic due to infections. I don't agree with your assertions about this at all. Susan > x-no-archive: yes > [quoted text clipped - 34 lines] > > Susan Half of my posts vanish into thin air. > > x-no-archive: yes > [quoted text clipped - 34 lines] > > - Show quoted text - One thing for certain,, if the cause of most DM is infectious, then it will never be found with the present culture driven methods. So lets just characterize the bacterial community genome of people with DM and compare it to healthy controls and see if anybuggy pops out. By the way You said >I know that chronic infections, like gum disease, raise serum glucose. >Brief, acute infections do, too. > > OTOH, you don't seem to know enough about how DM develops to make a > > claim that folks are suddenly diabetic due to infections. I don't agree > > with your assertions about this at all. Don't look now, but you already did. Prevention of the metabolic syndrome insulin resistance and the atherosclerotic diseases in Africans infected by Helicobacter pylori infection and treated by antibiotics. * Longo-Mbenza B, * Nkondi Nsenga J, * Vangu Ngoma D. Department of Internal Medicine, University of Kinshasa, and Lomo Medical/ Limete, Kinshasa, DR Congo. AIMS: To report on the association between certain components of the metabolic syndrome/Insulin resistance, gender, cardiovascular diseases and Helicobacter (H.) pylori seropositivity/Infection and the response of these cardiovascular risk factors to Helicobacter pylori titers after an antibiotic course. METHODS: In 205 consecutive Africans referred to the cardiovascular Center of LOMO MEDICAL in Kinshasa for management of their cardiovascular diseases, the proportions of seropositives for H. pylori and H. pylori infection (H. pylori seropositivety and histologically proven H. pylori gastritis) were investigated. The association between traditional cardiovascular risk factors, certain components of the metabolic syndrome and each H. pylori disease group (seropositivity or infection) was evaluated. The response of the cardio-metabolic level to H. pylori antibody titers after an antibiotic course was also evaluated for patients with H. pylori infection. Baseline levels of H. pylori antibody titer and cardio-metabolic parameters were compared with those after the antibiotic treatment. RESULTS: A total of 62.4% of participants were tested positive for the H. pylori antibody. Out of all participants, 25% had H. pylori infection and chronic gastritis without H. pylori. Men were more (p<0.01) H. pylori seropositive than women. Older age, higher triglycerides, higher weight, wider waist girth, higher fibrinogenemia, greater intima-mediathighness and higher rate of hypertension were significantly associated with H. pylori seropositivity. Lower HDL-cholesterol, higher levels of systolic blood pressure, triglycerides, uric acid, fibrinogen, hematocrit, glycemia, arterial hypertension hypercholesterolemia, diabetes mellitus hypo-HDL- cholesterolemia, hyperuricemia (Total), Overweight, overall obesity, abdominal obesity were significantly associated with H. pylori infection. Within the total population, there was a significant dose- response relationship between the rates of arterial hypertension, rate of overweight/overall obesity, and H. pylori antibody titers, respectively. After adjusting for age, and compared with H. pylori- seropositive women, H. pylori-seropositive men showed higher mean values for body weight, waist girth, waist-to-hip ration blood pressure, hematocrit, uric acid, triglycerides and total cholesterol. The levels of uric acid (p<0.05), plasma glucose (p<0.01), total cholesterol (p<0.01), fibrinogen (p<0.01), blood pressure (p<0.05), after 3 weeks antibiotics duration were lower than their baseline levels; weight, waist girth and triglyceride levels did not change (p<0.05) with the antibiotics course. The total population was characterized by lower levels of triglycerides, absence of cases with triglycerides >50 mg/dL. CONCLUSION: This study adds evidence for supporting the association of seropositivity to H. pylori with cardiovascular diseases and elevated number of components of metabolic syndrome. In these Africans with low triglyceride levels, H. pylori infection per se might generate atherosclerosis or metabolic syndrome, particularly in men with H. pylori-seropositive. H. pylori infection might be one of the risk factors of atherosclerosis thorough inflammation (fibrinogen) and modulation of glucose and lipid profiles, which may be prevented by low antibiotics in developing countries. Here is another study that has some intreging data. Dogs Lived 1.8 Years Longer On Low Calorie Diet: Gut Flora May Explain It Science Daily - Changes caused to bugs in the gut by restricting calorie intake may partly explain why dietary restriction can extend lifespan, according to new analysis from a life-long project looking at the effects of dietary restriction on Labrador Retriever dogs. Study found that dogs on a diet lived on average 1.8 years longer than those with a greater calorie intake. (Credit: Michele Hogan)Ads by Google Advertise on this site -------------------------------------------------------------------------------- Do You Look Old ? It's Not Your Fault. You Just Need To Boost Your HGH Levels. It's Easy www.HGH-Facts.com Buy 500 mg Resveratrol Bioforte trans reveratrol Sirt1 activator. 2 Months supply @ $39.95 www.Bioflu.com Healthy Weight Loss A Healthy Diet that's Right for You Achieve Your Ideal Weight! www.energyhealthlife.com Oprah's Official Diet The Best Life Diet. Get Your Free Diet Profile. Go Now! TheBestLife.com 1 Month Low Calorie Diet Need Help with a Weight Loss Diet? Healthy Diet with Easy Meals ak7.co.uk/Diets -------------------------------------------------------------------------------- Bugs in the gut are known as gut microbes and they live symbiotically in human and animal bodies, playing an important role in metabolism. Abnormalities in some types of gut microbes have recently been linked to diseases such as diabetes and obesity. Today's research, published in the Journal of Proteome Research, was based on a study in which 24 dogs were paired, with one dog in each pair given 25% less food than the other. Those with a restricted intake of calories lived, on average, about 1.8 years longer than those with a greater intake and they had fewer problems with diseases such as diabetes and osteoarthritis, plus an older median age for onset of late-life diseases. The researchers, from Imperial College London, Nestlé Research Center (NRC) and Nestlé-Purina, found long-term differences in the metabolism of the dietary-restricted and non-dietary-restricted dogs. Metabolic profile plays a key role in determining animals' response to illness and their susceptibility to disease. The scientists believe that differences in the makeup of gut microbes between the two sets of dogs could partly explain their metabolic differences. The dogs that were not on a restricted diet had increased levels of potentially unhealthy aliphatic amines in their urine. These reflect reduced levels of a nutrient that is essential for metabolising fat, known as choline, indicating the presence of a certain makeup of gut microbe in the dogs. This makeup of gut microbes has been associated in recent studies with the development of insulin resistance and obesity. Professor Jeremy Nicholson from Imperial College London said: "This fascinating study was primarily focused on trying to find optimised nutritional regimes to keep pet animals such as dogs healthy and as long-lived as possible. However these types of life-long studies can help us understand human diseases and ageing as well, and that is the added bonus of being able to do long-term non-invasive metabolic monitoring." The researchers suggest that part of the healthier metabolic profiles of dogs on a restricted diet is related to their changed gut microbial activity, which in turn contributes to their generally improved health and longer lifespan. However, they also found that the overall effects of ageing on restricted and non-restricted animals exerted a greater effect on the metabolic profile than dietary restriction. This in itself is interesting as the lifelong metabolic trajectories of large animals had never been studied in this detail before and such information might be of relevance to ageing humans and their diseases. The team believes that one important outcome of this work will be the ability to improve the design of products' nutritional properties that mimic the health benefits of dietary restriction in pet dogs. Note: This story has been adapted from a news release issued by Imperial College London. On 4/10/07 5:56 AM, in article 1176209764.447011.312790@e65g2000hsc.googlegroups.com, "judy.n" > Susan, > Here are some out dated references from an article I wrote over 6 [quoted text clipped - 47 lines] >> >> Susan Its not that the CT is wrong, this is a tool that is part of the evaluation by the doctor. There are reasons why a person can have a negative CT report and still have sinus symptoms and a positive culture - all this is part of the evaluation. > On 4/10/07 5:56 AM, in article > 1176209764.447011.312...@e65g2000hsc.googlegroups.com, "judy.n" [quoted text clipped - 57 lines] > > - Show quoted text - Murray: Yeah I know, Susan the reference is here. http://www.aafp.org/afp/20041101/1685.html Acute Bacterial Rhinosinusitis in Adults: Part I. Evaluation However according to the posters here, some ENTs don't seem to accord any of the other symptoms who's predictive value is described in the article below, any weight at all. http://www.aafp.org/afp/20041101/1685.html Acute Bacterial Rhinosinusitis in Adults: Part I. Evaluation Judy: The article that you wrote might be out of date as far as the diagnostic power of state of the art imaging and contrast agents, but it looks from trying to find sources that not a lot has changed since you wrote. To that I would add is that you won't detect patches of biofilm that may be at the rear of in the upper sinus vault with present techniques, and one only has to light up clear goo with Styro 13 to see that life is finding a way to be a pest without necessarily showing up on culture. Hopefully one day we will have diagnostic probes that detect bacterial toxins that cause swelling and inflammation, stun cilia and digest epithelium, since the bacteria play musical plasmid, swapping DNA rings all the time and those toxins might be pesent in any one or many of a cast of bacteria characters who may or may not be culturable. But the presence of those toxins in sinus aspriate above a certain concentration should be definative for weather bacterial sinusitis exists. > x-no-archive: yes > [quoted text clipped - 13 lines] > > Susan Susan: The reference I refer to in the November 1 2004 issue of American Family Physician in an artical entitled "Acute Bacterial Rhinosinusitis in Adults: Part I. Evaluation". http://www.aafp.org/afp/20041101/1685.html All worth reading because it talks about the predictive value of different symptoms in diagnosing bacterial sinusitus. Big Snip -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- CT scanning provides better visualization of the sinuses and ostiomeatal complex than plain radiographs and ultrasonography. CT signs of rhinosinusitis are air-fluid levels, total opacification, or mucosal thickening greater than 5 mm. Limited-sinus CT is a series of four noncontiguous, 5-mm slices in the coronal plane through the frontal sinus, the anterior ethmoid and maxillary sinuses, the posterior ethmoid and maxillary sinuses, and the sphenoid sinus. Limited-sinus CT is less expensive and results in less radiation exposure than full-sinus CT. The sensitivity of CT is unknown because it has never been compared with sinus aspiration. Only 62 percent of patients with sinus symptoms have CT abnormalities.11 In addition, the CT scan lacks specificity. Forty-two percent of patients undergoing head CT for other reasons have sinus mucosal abnormalities,32,33 and up to 87 percent of patients with common colds have abnormalities of at least one maxillary sinus.34 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- > The reference I refer to in the November 1 2004 issue of American > Family Physician in an artical entitled [quoted text clipped - 7 lines] > > Big Snip Many thanks. Susan Dr. Grossan, The Sinus Cure is your book, right? I thought you said it was out of print. I don't understand the last statement about the list of conditions for not using the hydropulse, but maybe I need to see the book. Judy > On 4/9/07 2:11 PM, in article > 1176153073.428250.124...@e65g2000hsc.googlegroups.com, "judy.n" [quoted text clipped - 53 lines] > By the way, there is a list of medical conditions in the new edition of The > Sinus Cure for not using the Hydro Pulse. On 4/10/07 5:45 AM, in article 1176209102.224571.171790@y80g2000hsf.googlegroups.com, "judy.n" > Dr. Grossan, > The Sinus Cure is your book, right? I thought you said it was out of > print. I don't understand the last statement about the list of > conditions for not using the hydropulse, but maybe I need to see the > book. > Judy The Sinus Cure is out in a revised edition on April 10, 2007 and includes Balloon Sinuplasty, ENS, Guided Imagry, etc etc. Also a list of conditions where Hydro Pulse should not be used. These are If nose is completely blocked. Hydro Pulse is designed not to work if the nose is fully blocked. Immediately after nasal surgery - follow instructions of your doctor Child under 4 years of age. Actually The Sinus Cure was never out of print and remained on Amazon upper list from 2001 to today. The new edition still features my miracle cure - breakfast in bed. > > Doing less is helping more, and I'm no longer a slave to sinusitis. > > Susan In general you are right. But I am having a difficult time to get a doctor to believe that I have a problem. After 3.5 years with a constant low level infection , that won't go away , still no doctor has tried to do a culture. I think that they see that I can still breathe through my nose a little , so they don't think it's serious. They only prescribe more steroids and send me home. Jamffer
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