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Early Signs and Symptoms Of SPD In Infants And Toddlers Missed by Mostly Parents-Term life

The purpose of this “SPD Symptom Checklist For Infants and Toddlers” is to help parents and professionals who interact with children become educated about particular signs of sensory processing disorder in the youngest children and babies.

It is not to be used as the absolute diagnostic criteria for labeling children with sensory processing disorder. But rather, as an educational tool and checklist for your own knowledge. Professionals who can diagnose this disorder have their own tools in addition to checklists to observe and test for SPD (formerly called SID or Sensory Integration Dysfunction).

 As you go through this list, you may say,“Wow, my child has so many of these characteristics/behaviors, he must have a sensory processing disorder!!”

 

 

 

That MAY be true, and I want you to take it very seriously if you find a host of these to be characteristic of your child. But, then use this as a guide to speak with your doctor and an Occupational Therapist so you can clearly explain why you think your child may need help.

Or, you may go through the list and say,

“No big deal, so my child has some of these behaviors/characteristics, doesn’t every child?”

Well, this may be true too and your child’s behavior may fluctuate from day to day.

What we need to be concerned with is WHICH symptoms your child shows, how much these symptoms interfere with their or other’s lives, and what kind ofimpact it is having on their level of functioning. This will help target diagnosis and treatment.

Early identification and understanding of this disorder is HUGE!

Please understand the “Five Caveats” that Carol Stock Kranowitz points out in her book, The Out-of-Sync Child about using a checklist such as this. She writes:

1. “The child with sensory dysfunction does not necessarily exhibit every characteristic. Thus, the child with vestibular dysfunction may have poor balance but good muscle tone.”

2. “Sometimes the child will show characteristics of a dysfunction one day but not the next. For instance, the child with proprioceptive problems may trip over every bump in the pavement on Friday yet score every soccer goal on Saturday.“Inconsistency is A hallmark of every neurological dysfunction.”

3. “The child may exhibit characteristics of a particular dysfunction yet not have that dysfunction. For example, the child who typically withdraws from being touched may seem to be hypersensitive to tactile stimulation but may, instead, have an emotional problem.”

4. “The child may be both hypersensitive and hyposensitive. For instance, the child may be extremely sensitive to light touch, jerking away from a soft pat on the shoulder, while being rather indifferent to the deep pain of an inoculation.”

5. “Everyone has some sensory integration problems now and then, because no one is well regulated all the time. All kinds of stimuli can temporarily disrupt normal functioning of the brain, either by overloading it with, or by depriving it of, sensory stimulation.”

IF, you in fact check off many of these symptoms, an OT evaluation should be considered. IF, in your gut, you know something just isn’t right… listen to it!

Take this checklist with you and go get an evaluation. We NEED to catch SPD in the earliest years of life for the treatment to be the MOST effective; while their nervous systems are still developing. The time is NOW… for you, your child, and your family!

Again, this is NOT to be used to OFFICIALLY diagnose SPD, just to indicate if further evaluation is needed.

 

 SPD Symptom Checklist For Infants &Toddlers

 

__ Resists being held or cuddled

__ Cries and/or arches back when people try to hold him/her

__ Distressed by diaper changes

__ Distressed by baths and/or water splashing on him/her

__ Doesn’t fall into a predictable sleep/wake pattern or cycle

__ Cries excessively throughout the day (more than a half hour or hour at a time)

__ Doesn’t smile often, appears “sad” or “uncomfortable” much of the time

__ Has distinct preferences for adults of certain energy levels or voices (i.e., intonation, loudness, high pitched, low pitched, etc.)

__ Avoids eye contact, has difficulty focusing on objects or following them with eyes

__ Distressed when moved suddenly or whole body and/or head is tipped

__ Distressed by rocking motions

__ Distressed when moving in space (i.e., swinging around, bouncing up and down, or being “thrown” up in the air)

__ Doesn’t appear to respond to name or familiar voice

__ Can’t seem to calm baby down no matter what you try (or there is only ONE thing that does, i.e., a car ride)

__ Difficulty breastfeeding

__ Difficulty with sucking, chewing, or swallowing

__ Doesn’t tolerate new foods well

__ Gags or vomits from textured foods or on variety of different foods (very limited diet for age)

__ Does not seem to sense when diaper is wet or dirty

__ Cries inconsolably until a wet or dirty diaper is changed

__ Prefers to be without clothing

__ Severe separation anxiety

__ Tantrums many times a day

__ Distressed by sunlight or bright lights

__ Distressed in public places, especially if crowded or noisy

__ Doesn’t enjoy regular interactive movement games, i.e., peek-a-boo, pat-a-cake, etc.

__ Doesn’t notice new toys/novel toys and/or resists playing with them

__ Only uses one hand to manipulate and explore toys and/or can’t switch from hand to hand

__ Unable to bang toys together or clap hands (at appropriate age)

__ Keeps hands fisted and closed most of the time

__ Distressed by dirty hands or face

__ Cries inconsolably when left with strangers or less familiar people

__ Significantly late to talk, walk, gesture, smile, hold bottle, sleep through the night, manipulate/play with toys, etc.

__ Major difficulties transitioning to solid foods and/or rice cereal after bottle or breast fed

__ Can not hold onto or use objects or utensils well for age

__ Regularly avoids certain foods, food categories, consistencies, temperatures of food, eliminates whole food groups, etc.

__ Difficulties with excessive reflux or allergies to foods and/or formulas

__ Doesn’t seem to notice sounds others do

__ Frequent ear infections

__ Sensitive to sounds others don’t seem to be bothered by

__ Difficult to engage; is an observer, doesn’t interact with peers or adults

__ Apprehensive and/or distressed by playground equipment

__ Distressed by baby swings, jolly jumpers, wagon/stroller rides, car rides, etc.

__ Avoids putting toys in mouth, exploring them with her mouth

__ Baby gags or vomits when objects are placed in his mouth

__ Beyond teething stage, always has something in his/her mouth, or chewing on clothes, hands, fingers

__ Avoids categories of toys, i.e., vibrating, stuffed animals, rough textured toys, slippery/slimy toys, brightly colored objects, etc.

__ Appears overwhelmed, cries, or falls asleep when over stimulated

__ Refuses/distressed by certain positions, i.e., being on tummy, on back, sitting, etc.

__ Stays in one position and becomes uncomfortable when moving to another; if moving on own has significant difficulty transitioning to another position (hard to do, awkward)

__ You find you are always trying to be one step ahead of baby; trying to control his environment and “warning” people what to do/not to do so baby is comfortable

__ Difficulty staying asleep for more than 30 minutes at a time, or wakes up frequently throughout the night, unable to soothe himself back to sleep

__ Seems to get too much sleep, very short time when he is alert, playing, responding, and interacting

__ Has significant difficulty waking up

__ Needs a particular sound to stay asleep, i.e., fan, nature tape, white noise, music, etc.

__ Will not sleep if there is any noise

__ Wakes with the sun

__ Can not fall asleep anywhere but home, in familiar environment

__ Needs excessive help to fall asleep…rocking, bouncing, singing, rubbing back, etc. for long periods of time

__ Uncomfortable if not swaddled tightly; or, if older, needs heavy blankets, stuffed animals, or tighter pajamas for weight and pressure on them to fall asleep well

__ Able to switch moods effectively and relatively quickly… easily distracted if upset, “gets over it” within a reasonable amount of time, a favorite toy/face/sound will soothe him/her

__ Excessively attached to a pacifier

__ Never attached to any comfort object, i.e., blanket, stuffed animal, rubbing something, pacifier, thumb, etc.

__ Doesn’t reach for or hold toys (especially textured toys) at appropriate age

__ Closes hand if toy coming near it, or drops it immediately if placed in hand

__ When begins to walk, walks on tip toes only, will not put bare feet on ground/floor

__ Distressed by textured materials under themselves

__ Appears distressed by movement; i.e., a startled response, arches back, frightened look in eyes, etc.

__ Does not crawl before walks (or limited/different type of crawl)

__ Craves movement, distressed if not moving, being swung, rocking, bouncing, rocks self constantly

__ Does not play reciprocally with caregivers or familiar people

__ Frequently engages in repetitive, non-purposeful play with one or two objects

__ Can not switch activities or participate in daily routines without distress when transitioning from one to another

__ Baby is not understood using language, cues, gestures, etc. and becomes frustrated frequently

__ Frequent head banging, hitting, biting, pinching, or hurting self or others

__ Breaks toys frequently

__ Unable to be gentle with animals

__ Appears uncoordinated, frequently bumps into things

__ Can not focus attention on play, caregiver, or toy long enough to interact (for age level)

__ Wanders around aimlessly or engages in non-purposeful activities in excess, i.e., spinning, rocking, staring at certain objects, etc… not interested in play or doesn’t use objects for purposeful play.

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Early Symptoms&Treatment of Addison’s Disease in Dogs Missed By Mostly People- Drug rehab center

Hypoadrenocorticism in Dogs

Mineralocorticoids and glucocorticoids are hormones normally produced by the adrenal glands, which are located near the kidneys. Both of these hormones are critical to the healthy functioning of the body, and an abnormal increase or decrease of either of these hormones can lead to serious health problems if not addressed in time. Hypoadrenocorticism is characterized by a deficient production of glucocorticoids and/or mineralocorticoids. Deficient production of both these hormones can cause a number of symptoms like weakness, dehydration, low blood pressure, depression, heart toxicity, vomiting, blood in feces, and weight loss.

 

This disease is relatively rare in dogs, but when it does occur it tends to be seen most often in young to middle-aged dogs, female dogs, and may be familial in Bearded Collies, Standard Poodles, Portuguese water dogs, West Highland white terriers, rottweilers, and wheaten terriers.

Symptoms and Types

Symptoms will vary depending on the duration of the problem. Life-threatening symptoms are usually observed in acute episodes of this disease. The following symptoms are commonly observed in dogs:

  • Lethargy
  • Lack of appetite (anorexia)
  • Vomiting
  • Weight loss
  • Diarrhea
  • Shaking
  • Increased frequency of urination (polyuria)
  • Increased thirst (polydipsia)
  • Depression
  • Dehydration
  • Weak pulse
  • Collapse
  • Low temperature
  • Blood in feces
  • Hair loss (alopecia)
  • Painful abdomen

Causes

  • Adrenocorticotropic hormone (ACTH) deficiency
  • Metastatic tumors
  • Long term glucocorticoid withdrawal

Diagnosis

You will need to give your veterinarian a thorough history of your dog’s health and onset of symptoms. Your veterinarian will perform a thorough physical exam on your dog, including routine laboratory tests, a complete blood count, biochemistry profile, and urinalysis. The complete blood count may reveal anemia, an abnormally high number of eosinophils (a type of white blood cells that readily stains with eosin dye), and an increased number of lymphocytes (also a type of white blood cell) called (lymphocytosis).

Serum biochemistry testing may reveal an abnormally higher level of potassium, and an accumulation in the blood of urea – nitrogenous waste products that are usually excreted out of the body through the urine (azotemia). Other findings include lower levels of sodium (hyponatremia) and chloride (hypochloremia), increased levels of calcium (hypercalcemia), increased liver enzymes, including ALT and AST, and low blood sugar (hypoglycemia). The urinalysis may reveal a low concentration of urine. The definitive test for diagnosing this condition is by detecting the levels of cortisol in the body. Normally the adrenocorticotropic hormone (ACTH) is produced by thepituitary gland, which then stimulates the adrenal glands to release their hormones. ACTH can be injected into the body to test the normal response functions of the adrenal glands. If your dog’s adrenal glands do not show an increase in the release of hormones after being given ACTH, then the diagnosis of hypoadrenocorticism will be confirmed. Visual diagnostic procedures, like X-ray and ultrasound, may reveal smaller than normal adrenal glands.

Treatment

A sudden and severe (acute) episode of hypoadrenocorticism is a medical emergency requiring immediate hospitalization and intensive therapy. The treatment for this disease depends on the type and severity of symptoms. Patients with low bodily fluids are given intravenous fluids to replace the deficient fluid levels, but the cornerstone of therapy is to supplementally replace the deficient hormones. Dogs that have been diagnosed with this condition need to be treated with hormone injections for the rest of their lives.

Living and Management

In case of an acute episode of hypoadrenocorticism, your dog will need immediate treatment due to life-threatening symptoms. After the initial recovery, your veterinarian will calculate the dose that will balance your dog’s hormone deficiency. The dose of these hormones may need to be increased occasionally, especially during periods of stress like travel, hospitalization, and surgery. Do not alter the brand or dose of hormone that has been prescribed without first consulting your veterinarian.

After the initial hormone replacement, you will need to visit your veterinarian at weekly intervals for at least the first four weeks. Your veterinarian will measure your dog’s hormones during therapy and will modify the doses accordingly. Hormone injections are usually required at monthly intervals, and in some patients they are required every three weeks. Electrolyte levels will also be checked regularly due to the significant alternations in electrolytes that are typically seen with this disease. Good owner compliance is required for the life of the patient in order to benefit from treatment. However, with regular treatment, most patients do well and have a good prognosis.

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Slow Carbs, Not Low Carbs, Are the Secret to Dropping Pounds and Unlocking Stored Fat-Best weight loss program

The low-carb frenzy hit its zenith in the early 2000’s and has since ebbed and flowed in popularity. I’ve seen patients get impressive results doing very low-carb diets, but eventually many become burned out and regain the weight as the novelty of eating bacon and other formerly forbidden foods becomes monotonous.

Traditional thinking suggests carbohydrates are bad for you. I have something surprising to say that might go against everything you’ve heard: Carbs are the single most important thing you can eat for health and weight loss. In fact, I often say my plan is a high-carb diet.



But wait, you say, don’t carbs contribute to insulin resistance, heart disease, and other health concerns?

Some do, but the truth is more complicated. You see, “carbohydrates” encompasses a huge category. A hot fudge sundae and cauliflower both fall into the “carbs” category, yet they are entirely different foods.

In fact, almost all plant foods fall into the carbs category. These are what I refer to as slow carbs, which are low-glycemic and don’t spike your blood sugar or insulin. These slow carbs come loaded with nutrients, fiber, and amazing molecules called phytochemicals.



When you eat a cornucopia of fresh fruits and vegetables teeming with phytonutrients — carotenoids, flavonoids, and polyphenols – they help improve nearly all health problems, including dementia, diabesity, and aging.

Ideally, about 75% of your carb intake should come from non-starchy veggies plus low-glycemic fruits. By volume, most of your plate should be carbs. Note I said volume, not calories. Many plant-based carbs actually have very few calories.



Why All Carbs Are Not Created Equally

Carbs are necessary for long-term health and brain function. But not the doughnuts, breads, bagels, and sweets we typically think of as carbs. These are highly processed foods, stripped of their nutrients and fiber. When I say carbs, I mean real, whole plant foods containing all the vitamins, minerals, fiber, and phytonutrients that create health.

Unfortunately, most people are not eating these plant foods. They are eating quickly absorbed carbs from sugar, high fructose corn syrup, and white flour, which are very efficiently turned into belly fat in the body.  After you eat a high-carb meal, your insulin spikes and your blood sugar plummets — leaving you very hungry. That is why you crave more carbs and sugar, and eat more.

The important difference is in how carbs affect your blood sugar. Calorie for calorie, sugar is different from other calories that come from protein, fat, or non-starchy carbs such as greens. Sugar scrambles all your normal appetite controls, so you consume more and more, driving your metabolism to convert it into lethal belly fat.

To drive home the point that not all calories – or carbs – are created equally, refer to my past blog in which I illustrate  that, while both soda and broccoli fall into the carbs category, 750 calories of soda and 750 calories of broccoli behave entirely differently once they enter your body.

Here’s a quick refresher.  Your gut quickly absorbs the fiber-free sugars in the soda. The glucose spikes your blood sugar, starting a domino effect of high insulin and a cascade of hormonal responses that kicks bad biochemistry into gear. The high insulin increases storage of belly fat, increases inflammation, raises triglycerides and lowers HDL, raises blood pressure, lowers testosterone in men, and contributes to infertility in women.

High-fiber, low-sugar carbs, such as broccoli, are slowly digested and don’t lead to blood sugar and insulin spikes. These slow carbs reduce cancer riskand increase your body’s ability to detoxify.

Therein lies the key difference. Slow carbs like broccoli heal rather than harm.

Choosing the Right Carbs

You may not realize this, but there are no essential carbs. There are essential fats (omega-3s) and essential proteins (amino acids), but if you never had any carbs again, you would survive.

That being said, good-quality carbs that come from plant foods provide unique benefits, including high levels of vitamins and minerals, fiber, and special plant compounds with healing properties called phytonutrients or phytochemicals. Phytochemicals are medicinal molecules such as curcumin in turmeric, glucosinolates in broccoli, anthocyanidins in berries and black rice, and so on.

Many of these foods are high in fiber, which helps buffer out their sugar content. That is one reason why eating a cup of blueberries has a dramatically different impact than put-ting four teaspoons of sugar in your coffee. Both have about 16 grams of sugar, but the nutrients, phytonutrients, and fiber in blueberries help buffer out that load, whereas the sugar-filled coffee simply raises your insulin levels and plummets your blood sugar, leaving you running for a muffin or other quick sugar fixes.

Besides stabilizing blood sugar by slowing the absorption of carbs, fiber feeds the friendly flora in your gut and scrubs your intestines, thus supporting a healthy digestive tract. Try to gradually increase your fiber intake to 30 to 50 grams a day. That becomes easy when you focus on viscous fiber from legumes, nuts, seeds, whole grains, vegetables, and low-glycemic-load fruits.

When you focus on these low-glycemic-load plant foods, your weight normalizes. You feel better without the sugar crashes. You reduce your risk for numerous diseases.

To simplify things and help you make optimal choices when it comes to carbs, I have divided them into four categories – green, yellow, red, and forbidden.

Green Carbs: Eat Freely

Slow-burning, low-glycemic vegetables should be the basis of your diet. Fill your plate with broccoli, asparagus, spinach, chard, kale, cabbage, bok choy, and more. These are truly an unlimited food!

Seaweed is another smart choice. Some weeds are good for you, and the weeds of the sea are among my favorite. If you’ve never tried them, be adventurous. Kombu, nori, hijiki, and wakame are all extraordinarily high in minerals, protein, and healing compounds.

Yellow Carbs: Eat in Moderation

  1. Whole grains. Brown, black, and red rice; quinoa; amaranth; buckwheat; and teff are delicious gluten-free grains. Black rice has as many anthocyanidins as blueberries and a low-glycemic load. Called forbidden rice, it was once eaten only by Chinese emperors.
  1. Fiber-rich, phytonutrient-rich legumes are underutilized in our culture. They slow the release of sugars into the bloodstream and help prevent the excess insulin release that leads to insulin resistance. Try red, French or regular lentils; chickpeas; green and yellow split peas; soybeans (edamame is a great snack); pinto, adzuki, black, navy, and other beans.
  1. Dark berries. Blueberries, cherries, blackberries, and raspberries are filled with phytonutrients. The richer the color, the more “medicine” you get. Eat as much as one-half cup a day. Organic frozen berries can be used in your protein shakes.
  1. Enjoy up to two pieces of the following fruits each day:

Stone fruit. Plums, peaches, nectarines, and their variants are known as “stone fruit.” They are healthy and full of fiber and healing chemicals.

Red Carbs: Eat Limited Amounts

You should limit your intake of the following:

  1. Starchy, high-glycemic cooked vegetables. These include winter squashes, peas, potatoes, corn, and root vegetables such as beets. Starchy vegetables raise blood sugar more quickly, so they should be consumed in smaller quantities (up to one-half cup a day) and ideally in the context of other foods that reduce the overall glycemic load of the meal.
  1. High-sugar fruits. Melons, grapes, and pineapple contain more sugar than the fruits listed above, so they should be limited to a half-cup treat once a week, and avoided altogether if you are on a low/no sugar protocol.

Forbidden Carbs: Avoid Processed Carbs Completely.

  1. Gluten-containing whole grains. Stay away from wheat, barley, rye, oats, spelt, kamut, and triticale.
  1. Processed foods (including “low carb” foods). Avoid highly processed, factory-manufactured Frankenfoods. Many of these processed foods will have health claims such as “low carb,” “no sugar added,” or “high fiber.” Always stick with real, whole, unprocessed foods. Remember, if it has a health claim on the label, it is probably bad for you.
  1. Dried fruit. They have a high-glycemic load.

Can a Low-Carb Diet Benefit You?

While I think nearly everyone does well incorporating nutrient-dense slow carbs, there are many cases in which a very low-carb diet can be beneficial. For people with type 2 diabetes, high blood sugar, and/ or obesity, you may need to restrict or cut out even starchy veggies and fruit for a period of time before re-introducing them back into your diet.

The trick involves gradually introducing slow carbs. As insulin sensitivity improves, you can increase your consumption of slow carbs like lentils, yams, fruit, and whole grains from time to time.

Once you’ve balanced your insulin levels and dealt with any deeper issues, you can move on to a slow-carb diet (about 30 grams per meal and 15 grams per snack).

No matter what, you want to keep your glycemic load low. Always avoid refined sugars, refined carbs, and processed foods. If you do decide to eat grains, keep them to a mini-mum. Any grains can increase your blood sugar. Consider sticking with quinoa or black rice.  And minimize starchy, high-glycemic cooked vegetables, such as potatoes, corn, and root vegetables, such as rutabagas, parsnips, and turnips.

Another trick is to always eat a carb with some protein, fiber, or anti-inflammatory fat to help buffer the carbs sugar load.

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The woman who can smell Parkinson’s disease- Term life

Meet the woman from Perth whose super sense of smell could change the way Parkinson’s disease is diagnosed.

Joy Milne’s husband, Les, died in June, aged 65.

He worked as a consultant anaesthetist before being diagnosed with Parkinson’s at the age of 45.

Joy Milne's husband
Image captionJoy first detected the odour on her husband Les, who was diagnosed with Parkinson’s at the age of 45

One in 500 people in the UK has Parkinson’s – that is 127,000 across Britain.

It can leave people struggling to walk, speak and sleep. There is no cure and no definitive diagnostic test.

Joy noticed something had changed with her husband long before he was diagnosed – six years before.

She says: “His smell changed and it seemed difficult to describe. It wasn’t all of a sudden. It was very subtle – a musky smell.

“I got an occasional smell.”

Joy only linked this odour to Parkinson’s after joining the charity Parkinson’s UK and meeting people with the same distinct odour.

By complete chance she mentioned this to scientists at a talk. They were intrigued.

Edinburgh University decided to test her – and she was very accurate.

Doctors
Image captionDoctors tested Joy’s sense of smell by using t-shirts which had been worn by six people with Parkinson’s and six without

Dr Tilo Kunath, a Parkinson’s UK fellow at the school of biological sciences at Edinburgh University, was one of the first scientists Joy spoke to.

He says: “The first time we tested Joy we recruited six people with Parkinson’s and six without.

“We had them wear a t-shirt for a day then retrieved the t-shirts, bagged them and coded them.

“Her job was to tell us who had Parkinson’s and who didn’t.

“Her accuracy was 11 out of 12. We were quite impressed.”

Dr Kunath adds: “She got the six Parkinson’s but then she was adamant one of the ‘control’ subjects had Parkinson’s.

Dr Tilo Kunath
Image captionDr Tilo Kunath was impressed with Joy’s results and is undertaking further research into the phenomenon

“But he was in our control group so he didn’t have Parkinson’s.

“According to him and according to us as well he didn’t have Parkinson’s.

“But eight months later he informed me that he had been diagnosed with Parkinson’s.

“So Joy wasn’t correct for 11 out of 12, she was actually 12 out of 12 correct at that time.

“That really impressed us and we had to dig further into this phenomenon.”

And that is exactly what they are doing.

Scientists believe that changes in the skin of people with early Parkinson’s produces a particular odour linked to the condition.

They hope to find the molecular signature responsible for the odour and then develop a simple test such as wiping a person’s forehead with a swab.

The charity Parkinson’s UK is now funding researchers at Manchester, Edinburgh and London to study about 200 people with and without Parkinson’s.

Katherine Crawford, the Scotland director of Parkinson's UK
Image captionKatherine Crawford, of Parkinson’s UK, said it was an incredibly difficult disease to diagnose

A simple test for Parkinson’s could be life-changing, according to Katherine Crawford, the Scotland director of Parkinson’s UK.

“This study is potentially transformational for the lives of people living with Parkinson’s,” she says.

“Parkinson’s is an incredibly difficult disease to diagnose.

“We still effectively diagnose it today the way that Dr James Parkinson diagnosed it in 1817, which is by observing people and their symptoms.

“A diagnostic test like this could cut through so much of that, enable people to go in and see a consultant, have a simple swab test and come out with a clear diagnosis of Parkinson’s.

“It would be absolutely incredible and life-changing for them immediately.”

Ms Crawford adds: “They and their professional colleagues would be able to discuss and arrange a treatment programme, be able to monitor the progression of the disease and treat it appropriately as it went on and it would potentially offer more opportunities for people living with Parkinson’s to get involved in research.”

It might have been an accidental discovery but Joy hopes it will make a real difference to people starting out on their own journey with Parkinson’s.

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Avril Lavigne: ‘I’m Doing a Lot Better’ After Lyme Disease Treatment- Term life

Singer Avril Lavigne said she’s seeing progress in her treatment for Lyme disease, which struck her last year while she was on tour.

Her treatment regimen has included multiple antibiotics and ample rest.

“I’m about halfway through my treatment,” the Canadian singer said in an interview with ABC News’ Jesse Palmer. “I’m doing a lot better. Seeing a lot of progress. … I’m just really grateful to know that, like, I will make [a] 100 percent recovery.”

Lavigne, 30, said trying to get a diagnosis was the worst time of her life.

Avril Lavigne ‘Doing Well’ Amidst Lyme Disease Fight
“I literally became bedridden last October,” the “Complicated” singer said, adding that she saw multiple specialists who failed to get to the root of the problem. “They would pull up their computer and be like, ‘Chronic fatigue syndrome.’ Or, ‘Why don’t you try to get out of bed, Avril, and just go play the piano?’ It’s like, ‘Are you depressed?’”

Lavigne said she would wake up with night sweats and felt as though she had the flu.

“This went on and off for a month,” she said. “And I saw my doctor right away, got blood tests, got swabbed, and they didn’t really know what was wrong with me.”

It wasn’t until two months into the symptoms that she said she suspected Lyme disease.

“I started going to other doctors and, like, specifically telling them and asking, like, ‘I have Lyme disease. I know I do. Can you check me?’” she said. “Then I finally figured out, ‘Find a Lyme specialist.'”

“And the thing is, when you’re a specialist, you also really know the disease inside and out and you can diagnose their symptoms,” Lavigne said.

After getting the diagnosis of Lyme disease, which Lavigne believes she got from a tick bite last spring, the singer was bedridden for five months in her Ontario home.

Lavigne, who is married to Nickelback frontman Chad Kroeger, said her family and fans have helped her through her ordeal.

Many fans, she said, made videos and sent her letters and posters and other items to show their support.

“I sat there in my bed and I watched the videos and, like, did exactly what I’m doing now. I cried through the whole thing,” she said, laughing. “Honestly, I felt very, very loved. And it sounds silly saying it, but I really truly did feel my fans through the process.”

She took the opportunity to share encouragement to others with Lyme disease.

“There is hope. Lyme disease does exist. And you can get better,” she said.

She called this period her “second shot at life,” adding: “I really just want to go out there and truly do what I love. So I’m so excited for life after this.”

Lavigne is set to perform her song, “Fly,” on July 25 at the opening ceremonies of the 2015 Special Olympics World Games next month in Los Angeles.

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Early Warning Signs and Treatment of Meniere’s Missed By Mostly People- Drug rehab center

HOW DID MÉNIÈRE’S DISEASE GET ITS NAME?

In 1861 the French physician Prosper Ménière theorized that attacks of vertigo, ringing in the ear (tinnitus) and hearing loss came from the inner ear rather than from the brain, as was generally believed at the time. Once this idea was accepted, the name of Dr. Prosper Ménière began its long association with this inner ear disease and with inner ear balance disorders in general.

WHAT IS MÉNIÈRE’S DISEASE?

Ménière’s disease is a chronic, incurable vestibular (inner ear) disorder defined in 1995 by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology—Head and Neck Surgery as “the idiopathic syndrome of endolymphatic hydrops.”1 In plain language, this means that Ménière’s disease, a form of endolymphatic hydrops, produces a recurring set of symptoms as a result of abnormally large amounts of a fluid called endolymph collecting in the inner ear.

Ménière’s disease can develop at any age, but it is more likely to happen to adults between 40 and 60 years of age. The exact number of people with Ménière’s disease is difficult to measure accurately because no official reporting system exists. Numbers used by researchers differ from one report to the next and from one country to the next. The National Institutes of Health estimates that about 615,000 people in the U.S. have Ménière’s disease and that 45,500 new cases re-diagnosed each year.2

CAUSES

The exact cause and reason why Ménière’s disease starts is not yet known. Many theories have been proposed over the years. They include: circulation problems, viral infection, allergies, an autoimmune reaction, migraine, and the possibility of a genetic connection.

Experts aren’t sure what generates the symptoms of an acute attack of Ménière’s disease. The leading theory is that they result from increased pressure of an abnormally large amount of endolymph in the inner ear and/or from the presence of potassium in an area of the inner ear where it doesn’t belong. These conditions may be due to breaks in the membrane separating endolymph from the other inner ear fluid, perilymph. Some people with Ménière’s disease find that certain events and situations, sometimes called triggers, can set off attacks. These triggers include stress, overwork, fatigue, emotional distress, additional illnesses, pressure changes, certain foods, and too much salt in the diet.

PROGRESSION OF SYMPTOMS

Common symptoms of a Ménière’s disease attack do not reflect the entire picture of the disorder, because symptoms vary before, during, between, and after attacks, and also during the late-stage of Ménière’s disease.

Ménière’s disease may start with fluctuating hearing loss, eventually progressing to attacks of vertigo and dizziness.

Oncoming attacks are often preceded by an “aura,” or the specific set of warning symptoms, listed below. Paying attention to these warning symptoms can allow a person to move to a safe or more comfortable situation before an attack.

  • balance disturbance
  • dizziness, lightheadedness
  • headache, increased ear pressure
  • hearing loss or tinnitus increase
  • sound sensitivity
  • vague feeling of uneasiness

During an attack of early-stage Ménière’s disease, symptoms include:

  • spontaneous, violent vertigo
  • fluctuating hearing loss
  • ear fullness (aural fullness) and/or tinnitus

In addition to the above main symptoms, attacks can also include:

  • anxiety, fear
  • diarrhea
  • blurry vision or eye jerking
  • nausea and vomiting
  • cold sweat, palpitations or rapid pulse
  • trembling

Following the attack, a period of extreme fatigue or exhaustion often occurs, prompting the need for hours of sleep.

The periods between attacks are symptom free for some people and symptomatic for others. Many symptoms have been reported after and between attacks:

  • anger, anxiety, fear, worry
  • appetite change
  • clumsiness
  • concentration difficulty, distractibility, tendency to grope for words
  • diarrhea
  • fatigue, malaise, sleepiness
  • headache, heavy head sensation
  • lightheadedness (faintness)
  • loss of self-confidence and self-reliance
  • nausea, queasiness, motion sickness
  • neck ache or stiff neck
  • palpitations or rapid pulse, cold sweat
  • sound distortion and sensitivity
  • unsteadiness (sudden falls, staggering or stumbling, difficulty turning or walking in poorly lit areas, tendency to look down or to grope for stable handholds)
  • vision difficulties (problems with blurring, bouncing, depth perception, glare intensification, focusing, watching movement; difficulty looking through lenses such as binoculars or cameras)
  • vomiting

Late-stage Ménière’s disease refers to a set of symptoms rather than a point in time. Hearing loss is more significant and is less likely to fluctuate. Tinnitus and/or aural fullness may be stronger and more constant. Attacks of vertigo may be replaced by more constant struggles with vision and balance, including difficulty walking in the dark and occasional sudden loss of balance. Sometimes, drop attacks of vestibular origin (Tumarkin’s otolithic crisis3) occur in this stage of Ménière’s disease and are characterized by sudden brief loss of posture without loss of consciousness. Some of these late-stage symptoms can become more problematic in conditions of low lighting, or with fatigue, or when a person is exposed to visually stimulating situations.

DURATION AND FREQUENCY OF ATTACKS

Attacks can last from 20 minutes to 24 hours. They can occur with the frequency of many attacks each week; or they can be separated by weeks, months, and even years. The unpredictable nature of this disease makes managing it challenging. It also complicates the ability of scientists and physicians to study it.

IS THERE A CURE?

To “cure” a disease means to eliminate the root cause of the disease and reverse the damage it has inflicted (on the inner ear, in this case). No treatment currently exists to cure Ménière’s disease. However, medical treatments exist that can help manage it.

TREATMENT

Existing treatments fall into two categories. Some treatments aim at reducing the severity of an attack while it is occurring; some treatments attempt to reduce the severity and number of attacks in the long term. Experts feel these medical treatments provide some degree of improvement in 60–80% of the treated people.Gentamicin is >80% effective at control of vertigo.

The most conservative long-term treatment for Ménière’s disease in the U.S. involves adhering to a reduced-sodium diet and using medication that helps control water retention (diuretics or “water pills”). The goal of this treatment is to reduce inner-ear fluid pressure. Some physicians, more commonly outside of the U.S., also weigh the potential efficacy of using betahistine HCl (Serc) as a vestibular suppressant for Ménière’s disease.5

Medications can be used during an attack to reduce the vertigo, nausea/vomiting or both. Some drugs used for this include diazepam (Valium), lorazepam (Ativan), promethazine (Phenergan), dimenhydrinate (Dramamine Original Formula), and meclizine hydrochloride (Antivert, Dramamine Less Drowsy Formula).

Vestibular rehabilitation therapy (VRT) is sometimes used to help with the imbalance that can plague people between attacks. Its goal is to help retrain the ability of the body and brain to process balance information. When successful, this can help a person regain confidence in the ability to move about.

When conservative treatments don’t work: For the 20–40% of people who do not respond to medication or diet, a physician may recommend a treatment that involves more physical risk. One such method, aintratympanic gentamicin, destroys vestibular tissue with injections into the ear of the aminoglycoside antibiotic (gentamicin). Recently, intratympanic steroid injections have been used with less risk of hearing loss and peristent imbalance.

Another less conservative treatment method involves surgery. Two categories of surgery are available. The goal of the first type is to relieve the pressure on the inner ear. Surgery to reduce pressure is not as widely used now as it was in the past due to questions about its long-term effectiveness.

The goal of the second type of surgery is to block the movement of information from the affected ear to the brain. The process involves either destroying the inner ear so that the ear does not generate balance information to send to the brain, or destroying the vestibular nerve so that balance information is not transmitted to the brain. In either instance, physical therapy is useful to help the brain compensate from the loss of inner ear function due to surgery.

PROGNOSIS

It is difficult to predict how Ménière’s disease will affect a person’s future. Symptoms can disappear one day and never return. Or they might become so severe that they are disabling.

COPING

Coping with Ménière’s disease is challenging because attacks are unpredictable, it is incurable, some of the symptoms are not obvious to others, and most people know virtually nothing about the disorder. Many people with Ménière’s disease are thrust into the role of educator—they must teach themselves, their family, friends, coworkers, and sometimes even health care professionals about the disorder and how it impacts them. Key features of communicating with family and friends include informing them about what might happen with the onset of an acute attack and how they can help. If a low-sodium diet is effective, family and friends should be informed about how important it is for them to support adherence to the diet regimen. Changes in lifelong eating patterns can be easier with the assistance of others.

Managing an acute attack involves preparation. This includes consulting with a physician about any appropriate drugs that can be taken when an acute attack occurs, and deciding ahead of time when it is appropriate to go to a hospital. During an attack, it is helpful to lie down in a safe place with a firm surface, and avoid any head movement. Sometimes keeping the eyes open and fixed on a stationary object about 18 inches away is helpful. In order to control dehydration, a doctor should be called if fluid intake is not possible over time due to persistent vomiting.

After an acute attack subsides, it is not uncommon to want to sleep for several hours. Resting in bed for a short time is appropriate, if the person is exhausted. But it is also important for the person to get up and move around as soon as possible so that the brain readjusts to the changed balance signals. Precautions need to be taken in this process to accommodate any new balance sensations.

Successfully coping with symptoms involves understanding the disease. Talking with health care providers, communicating with other people who are experiencing the same disease, and reading books and articles about the topic are all helpful methods of learning more about Ménière’s disease.

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06

How Eating These 5 Carbs Can Help You Lose 2 Dress Sizes in a Month-Best weight loss program

With no-carb and low-carb diets becoming increasingly popular, many people have come to think of carbs as the enemy. But not everyone is in agreement. 

Eating too few carbs can actually result in higher cortisol levels, which can make losing weight a lot more difficult. Eating the right carbs in the right amounts, on the other hand, can bring cortisol levels down and speed up weight loss. Here’s a study that backs up the theory, and some of the best carbs, proteins and fats to eat. 



You’ve probably been told that if you eat carbs, you should eat them in the morning. However, eating a controlled amount of healthy carbs at night can actually regulate your ever-important cortisol rhythm and encourage weight loss.

A recent study supports this idea that nighttime carbs can lead to weight loss, lower cholesterol levels, lower blood pressure, better blood sugar control, and less inflammation.

I tested this same idea in a clinical trial with a group of people who had a hard time losing weight. The 42 subjects had all struggled with unsuccessful diets – most looking to lose around 30 pounds. Over the course of the 30-day study, they consumed one serving (1/4 cups) of cooked carbohydrates with breakfast, 2 servings with lunch, and 3 with dinner. These carbs were paired with one serving of proteins and fats at each meal.



The results were uncanny. The participants saw their cortisol levels get healthier and reported fewer starch cravings, higher energy levels and better depth of sleep. They also had an average weight reduction of 2 dress sizes within the first month.

If you’re struggling with weight loss, carbs may not be the enemy.



Trying the 1-2-3 serving approach to carbohydrate cycling may be the ticket to finally getting down to the weight you want.

Here are the carbs, proteins and fats that I recommend for the best results.

Carbs

 

  • Buckwheat 1/4 cup cooked
  • Adzuki beans 1/4 cup cooked
  • Boiled potatoes 1/4 cup cooked
  • Kabocha squash 1/4 cup cooked
  • Brown rice 1/4 cup cooked

 

Proteins

 

  • Wild salmon 4-6 ounces
  • Shrimp 4-6 ounces
  • Organic white meat poultry 4-6 ounces
  • Vegetable-based protein powder 24-35 grams
  • Lean grass fed meat 4-6 ounces

 

Fats

 

  • Avocado 1/4 of a medium fruit
  • Almonds 1/2 ounce
  • Macadamia oil 2 tsp
  • Pumpkin seeds 1/2 ounce
  • Unsweetened coconut meat 1/2 ounceSource
Sleep-Disorder-Caused-by-Brain-Malformation

Sleep Disorder Caused by Brain Malformation- Term life

A disease on the rise. A congenital defect known as the Arnold-Chiari malformation, which often is not discovered until a person is in their late 20s, causes severe pain and insomnia. Simultaneous disorders are usually present in a person with this illness. These conditions are scoliosis, degenerative disk disease, syringomyelia, cervicalgia, arachnoiditis and connective tissue disorders. The Arnold-Chiari malformation is characterized by herniation of the cerebellar tonsils beyond the skull’s foramen magnum and into the spinal canal causing compromised cerebrospinal fluid and a “myriad of symptoms,” states the Mayfield Chiari Center. Sleep disorders can be caused by this brain malformation. Intracranial surgery is the only known treatment to correct the defect in part, but the neurological damage from this progressive illness is often said to be permanent.

The greatest problem facing chiari sufferers, debatably, is timely diagnosis. People often suffer for many years due to this brain malformation before a correct diagnosis is made. Misdiagnoses or “differential diagnoses” include, but are not limited to, fibromyalgia, multiple sclerosis, chronic fatigue syndrome, intracranial hypertension and a spinal cord tumor.

Sleep apnea has been repeatedly shown to cause sleep disturbances and respiratory complications. This is a potentially fatal condition that often requires a breathing machine to maintain oxygen levels. Because of increased MRI testing in recent years, the arnold chiari malformation is increasingly being diagnosed in people with chronic pain, sleep apnea, and spinal cord cysts called syringomyelia. The incidence rate of chiari type one is somewhere between one in 1,000 and one in 5,000 people; what used to be rare is now considered uncommon. Although awareness of this condition is spreading, children and adults can die unexpectedly if treatment is postponed.

There are four other defined forms of chiari, with varying degrees of herniation and displacement, including a controversial form, known as chiari zero, where there is no herniation but other abnormalities that cause the same symptoms. The chiari zero diagnosis was established in 1998 by Dr. Jerry Oakes and his research team, and is described in great detail on the CSF Foundation’s website (an unbiased website composed of the research findings from several teams, doctors, and surgeons across the globe). Though paralysis, muscle wasting, and chronic pain are symptoms of this condition, sleep disorders caused by this brain malformation are one of the signs that can be overlooked by both patient and doctor. The specialists at the Mayfield Chiari Center say anyone diagnosed with chiari should undergo sleep studies.

Emma Brotherhood of Coalville, England is a chiari sufferer who speaks about this congenital condition in Leicestermercury. She claims the pain can be so bad at times, she feels like smashing her skull into a wall or drilling a hole into the skull to relieve pressure. She describes her head symptoms as a “migraine on steroids.” Emma states how being connected with people in support groups is comforting, but what scares her are the many deaths that are reported in these groups.

Chiari itself can be fatal from the progressive trauma to the brain stem. This is described inNeurological Science titled under “Treatment of Chiari Malformation: Who when and how.” Suicides have also been reported from within these support groups due to the severe pain association and failed treatment plans. These are expected to diminish on part due to a growing number of physicians who fully understand chiari its associated illnesses.

Another fatal outcome of this condition and sleep disorders in general, is sleepiness. The National Sleep Foundation’s poll in 2005 indicates 37 percent and 103 million people report falling asleep at the wheel, while even more report driving while feeling drowsy. In 2009, Mike M. Ahlers with CNN reported a Boston trolley crash ended in the fatality of the driver who the National Safety Board ruled, “fell into a micro-sleep just prior to the crash.” Sleep disorders in general and sleep disorders caused by chiari brain malformation, should be taken very seriously as drowsiness has shown to be a threat to many lives.

The two types of sleep apnea conditions that can affect both chiari patients and the general public are obstructive apnea and central sleep apnea. “Central sleep apnea starts in the brain, causing a problem with signals going to the muscles controlling breathing,” states the Mayo Clinic Staff. In obstructive sleep apnea there is a physical blockage or hindrance of air through the passageway. Both types have the potential to cause damaging effects on the body and even death.

Other sleep conditions have also been reported in chiari and syringomyelia patients. Syringomyelia is commonly associated with chiari patients but can also be present on its own. Syringomyelia is when a progressive cavity in the spinal canal forms, causing a range of symptoms. Sources from the chiari support group list nocturia, sleep walking, chronic nightmares, trouble falling asleep, and trouble reaching deep sleep as part of their sleep disorder. Many sufferers report having high adrenal gland activity that causes them to lose sleep days on end.

In addition to sleep disorders, cardiovascular illnesses have been reported with chiari malformation. Postural orthostatic tachycardia syndrome (POTS) is on that list. Medical journals consider POTS an autonomic dysfunction. It can cause symptoms ranging from tremor to fainting spells, reports a study from AK Agarwal, R. Garg, and P. Sarkar, from the BMJ Postgraduate Medical Journal. This is a serious condition patients complain about with signs of a resting heart rate above 90 beats per minute and rapidly fluctuating blood pressure upon standing.

Initially being found only in autopsy, chiari poses a challenge for neurosurgeons worldwide. Though not all forms of insomnia are caused by a neurological disease, some sleep disorders are caused by the chiari brain malformation. Top research is currently being done at UCLA, the University of Miami, Duke University and the Chiari Institute in New York. Furthermore, an act called the Ehrick Garion’s Act is an awareness bill created to advocate for people with chiari malformation and their families. Named after two boys who died from chiari, the act is intended to bring about much needed awareness, education and research to avoid needless deaths.

By Lindsey Alexander

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How-To-Cope-With-Your-Childs-Sensory-Processing-Disorder_FT

Top 10 red flags for Sensory Processing Disorder- Term life

I wanted to put this list out there because one of the most common questions I get from parents and other professionals is “What should I look for if I think it’s a “sensory” issue?”.  This list is by no means inclusive of all of the difficulties a child can have as a result of processing delays but does hit on some of the most common symptoms we see with SPD.

1.      Difficulty with grooming tasks, specifically having teeth brushed, hair and nails cut, and washing hair and body. We are talking about SIGNIFICANT dislike…so much so that it might take multiple adults to hold the child down to cut nails, the family has stopped even attempting to give the child hair cuts, or the child is unsafe in the bath tub because they have such huge fits when getting washed/handled in the water.

2.      Picky eater. Refusing certain food textures (smooth, crunchy, lumpy) or resisting certain flavors / temperatures.  Unfortunately, this can be hard because lost of toddlers are picky eaters.  But, again, we are looking for  pretty significant difficulties with feeding, so much that the family routine and/or child’s nutrition are being disrupted.  We might see a child only wanting crunch foods (pretzels, chips, crackers) or not eating foods with multiple textures (peanut butter and jelly sandwhich). Sometimes children show a tendency to want only beige starch foods (french fries, bread, crackers).  Other children might resist certain temperatures (only want food at room temperature, NOTHING cold).

3.      Extreme difficulty with having face and hands get messy during feeding and play activities. I hear parents say “He will shake his hand and whine until I wipe his hand clean if he gets any food on it when we are eating”.  These children might also resist eating messy/puree foods altogether.

4.      Disliking playing in the sand, having lotion on skin, or wearing certain fabrics. Often times, children with tactile sensitivities or tactile defensiveness will shy away from play activities where the substance stays on their hands. These activities (finger painting, sand play, shaving cream) are all “light touch” activities and light touch is the kind of tactile input children most frequently have difficulty interpreting correctly.

5.      Showing fear when having head tilted backward (when changing diapers or playing at the park). Thse behaviors could be indicators that children are not understanding their relationship with gravity as a result of poor vestibular processing. Frequently, these children have a history of struggling with diaper changes or with having their hair rinsed in the bath tub.

6.      Showing fear with having feet off of the ground (swinging, rough house play, stepping off curbs). Again, these are behaviors that could indicate a child is not processing movement (vestibular) input correctly and struggles with having a good understanding of what it feels like to be on a curb 4 inches off of the ground versus a balance beam 4 feet off of the ground.

7.      Constant climbing / jumping/ crash such that the child has difficulty sitting still to complete a simple, sort, age appropriate play activity. This can be a very difficult area to assess as toddlers are expected to still be learning how to sit and engage in simple play activities. So what we look for is a child who craves movement so much that he/she struggles significantly with seated work that lasts for more than 1-2 minutes. We also look to see if the child struggles remaining at the dinner table, darts from family consistently when in public settings, and is observed to climb and jump on household objects excessively.

8.      Seeking spinning, swinging or other movement activities excessively. These types of behaviors could indicate that a child is not processing vestibular input efficiently and as a result needs extra movement to help their level of arousal get to a “just right” state. We might seek children spin in circles, run around a rug in the family room, or drive a ride-on-toy around the kitchen island for hours.

9.      Muscles that seem loose or floppy, such that the child slouches or struggles with sitting upright for long periods of time. Children with vestibular processing delays are frequently noted to have low muscle tone. We describe children with low muscle tone as looking loose or floppy and seem to have extra movement around their joints.

10.  Difficulty with transitions and sleep can be related to processing delays at times. Sometimes, children can struggle with filtering all the sensory information they get from the environment as well as from their own bodies. We call this ability to regulate our own level of arousal “modulation”. Children with modulation difficulties are frequently reported to have difficult self calming, have extreme tantrums, have difficult getting and staying asleep, and have difficult with transitioning between tasks and activities.

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shutterstock_114908254

A Potential New Treatment for Eosinophilic Esophagitis- advanced mold remediation

As part of the Pediatric Eosinophilic Esophagitis Research Study, researchers from Meritage Pharma and Indiana and Cincinnati Universities investigated the safety and efficacy of oral budesonide suspension (OBS) therapy of eosinophilic esophagitis (EoE). Children aged 2–18 years with at least 20 eosinophils per high-power field (HPF) on biopsy in multiple levels of the esophagus and symptoms consistent with EoE (based on an unvalidated symptom survey) were recruited from 16 centers, and were randomized to receive either placebo or OBS (at low, medium, or high dose). Participants were treated for 12 weeks, weaned from study medication over 3 weeks, and followed up for adverse events (AE) 4 weeks later. Cortisol levels, change in height and blood pressure, and occurrences of oropharyngeal and esophageal candidiasis were assessed to evaluate AE related to corticosteroid usage. The primary outcome was a positive response to therapy, defined as <6 eosinophils per HPF at all levels of the esophagus on post-therapy biopsy, and >50% reduction in symptom score compared to baseline. The percentage of responders in each of the OBS treatment groups was compared to that among placebo recipients using logistic regression.

Eighty-two patients were randomized (approximately 20 per each of the 4 groups), and 71 participants completed the study. Participants in both the medium- and high-dose OBS groups had significantly higher rates of responders compared to the placebo group (52.6%, 47.1%, and 5.6%, respectively; P = .009 for the comparison between the medium-dose OBS and placebo groups, and P = .017 for the comparison of the high-dose OBS and placebo groups). There was no significant difference in rate of responders between those in the low-dose OBS and placebo groups. However, histologic response rates appeared to be dose-dependent: approximately 6%, 24%, 53%, and 94% for placebo, low-, medium-, and high-dose OBS, respectively. There was a large symptomatic response to placebo (78%), which was comparable to the symptomatic response rates among those receiving the OBS.

There were no significant differences in mean cortisol levels among children in each of the groups, though 1 participant receiving the OBS had a transient low cortisol level at the end of the treatment period. No height differences were noted among groups. There was a slight increase in blood pressure among those in the OBS groups compared to placebo, and 2 OBS-treated patients developed oropharyngeal or esophageal candidiasis.

The authors conclude that medium- and high-dose OBS is safe and effective in the treatment of EoE.

Commentary

Drs Herzlinger and Ross have disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

  • eosinophilic esophagitis
  • oral budesonide suspension

EoE is a chronic, allergen-mediated, inflammatory condition affecting the esophagus.1 It typically presents with dysphagia in older children, and nonspecific gastrointestinal complaints in younger children. Diagnosis requires esophageal eosinophilia (>15 eosinophils per HPF) that cannot be explained by other gastrointestinal conditions, such as gastroesophageal reflux disease. Treatment options include dietary eliminations and topical steroids. Prior studies have shown that corticosteroids are effective in treating EoE.2,3 However, they are not approved by the FDA for use in EoE. Instead, typically-inhaled asthma medications are prescribed (off-label) to be swallowed, coating the esophagus to act locally.

The current study is a Meritage Pharma-sponsored Phase 2 clinical trial designed to evaluate the safety and efficacy of a novel, viscous, topically active swallowed formulation of budesonide specifically designed for the treatment of children with EoE. The results show the study medication (OBS) significantly improved histology if taken at sufficient dosing. Virtually all of the participants, including those receiving placebo, had symptomatic improvement over the study period. There was no correlation between reported symptoms and histology. Indeed, the placebo group had the least change in histology but the greatest symptomatic improvement; vice versa for the high-dose OBS group. Thus, patient symptom report is not a valid test for esophageal healing. This finding highlights the need for reliable, noninvasive methods for monitoring EoE patients.

At all doses, OBS appeared to be relatively safe, with only mildly or moderately severe AEs reported. Participants were administered the study medication for 12 weeks, yet patients with EoE require therapy for years. It is notable that only about 50% of patients treated with adequate doses of OBS achieved both a histologic and symptomatic response. Long-term data are still required in order to alleviate concerns about chronic steroid use, including candidiasis, adrenal insufficiency, growth retardation, bone density, and hypertension.

If eventually approved, OBS may be an important option in the treatment of EoE.

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