Tuesday, August 30, 2011

Diabetes and DPN

Okay, at some point I'll stop blogging about these medical webinars . . . but not tonight! I actually found the latest one that I attended fairly fascinating. Seriously.

At the church where Jonathan used to be pastor, we joked among ourselves that there must be "something in the water": Out of a congregation of about 60 people, there were two who were missing limbs. One was a man who'd lost his arm in a farming accident (and he was an amazing woodworker, especially considering his injury!) and a "senior saint" who'd lost her leg due to complications of Diabetes. About a month after we left, we heard that she had realized one of her worst fears: She'd lost her other leg.

I have to admit that I had no idea exactly why the amputation of limbs has anything to do with Diabetes, which is pretty pathetic, considering the fact that it runs in my family, and my dad has had it for a few years, now.

In a nutshell, the following is what I learned about diabetic peripheral neuropathy, or DPN (they also called it "Silence of the Limbs"--bahaha!).
  • Peripheral nuropathy--relating to the limbs--is the most common complication of Diabetes, occurring in 50-90% of patients (depending o the criteria used for diagnosis)
  • Up to 70% of diabetics will lose sensation in their feet.
  • Approximately 25% develop foot ulcers, which often become infected, requiring hospitalization, with a 20% chance of amputation.
  • Of those who have major amputations, almost half will have the other limb amputated within 3 years, and a startling 50% of them will die within 5 years of having their first limb amputated.
Okay, suddenly the idea of tingling, numbness, or burning foot pain seemed pretty serious. I had no clue! Basically, the sensory loss and atrophy of nerve fibers is the problem, and it leads to infections simply because the patient can't feel pain from cuts or burns or whatever.

(As a side note, one huge way to decrease amputation rates is for Diabetes patients to undergo regular foot examinations at home as well as during doctor visits. I learned that the latter often takes insistence on the part of patients, which is so, so sad! In the mean time, the primary treatment option for Diabetes slows the disease's progression, the secondary option is simply pain management. Often toleration of side effects or maxing out the efficacy of pain meds leads to issues as attempts are made to mask pain, while the disease continues progressing.)

The good news is that peripheral nerve fibers have the ability to repair and regenerate with adequate blood flow. The bad news is that blood flow is often lessened in patients who have DPN. But there's more good news (or so it seems): Nutritional support in the form of a newly available medical food can aid in Nitric Oxide Synthesis, improving blood flow. Treatment over 6 months has seen to result in 97% increase in nerve fiber density, potentially decreasing amputation rates by 50%! (This "medical food" is considered "gras," or "generally recommended as safe," with risk factors similar to taking a placebo--i.e., not very high at all!)

Until there's a medical discipline that takes ownership for DPN, patients will need to be proactive in examining their feet, asking about various treatments, and insisting that their doctors examine their feet at regular visits.

Tuesday, August 16, 2011

Now, That's Depressing!

Okay, so I attended another medical webinar I heard about through one of my clients, this one about depression. Since again, I have a family history of clinical depression and similar "mental illness" issues, I found the topic interresting. I also have a friend who recently blogged about her battle with depression and anxiety and the increasing (decreasing?) failure of her Prozak and other meds to help her, anymore.

By the way, did I mention that my dad's a pharmacist? (When I student taught in a ghetto area of South Carolina, I told my students he was a "drug dealer in Chicago," which earned me their undying respect! lol) He and I have very different perspectives regarding the treatment of depression, and I was intersted in another--and less pointed--medical view.

The information presented was largely regarding the (eh-hem!) failure of antidepressants to actually work. Well, you probably already know the warning that
the FDA requires of virtually all "antidepressant" medications: a warning of "increased risks of suicidal thinking and behavior, known as suicidality, in young adults ages 18 to 24 during initial treatment." Terribly ironic, huh? (Emphasis on the terribly.)

Add to that, the fact that success rates for initial, or level 1, antidepressant therapy are only 27.5%, and a remission rate is only at 1/3, and it's pretty clear that if you're on Prozac, Sarafem, Paxil, or any number of other such drugs, and it's not working for you . . . you are far from alone.

What's worse is that as low as successful treatment is at level 1, by the time a patient has been re-evaluated 3 times and had therapy altered accordingly, at level 4, success occurs only 7% of the time. And we won't even go into all the side effects that accompany these largely ineffective drugs!

Okay, so if you weren't depressed before you started reading this, you probably are now, right? Well, don't be.

Basically, depression is connected to an imbalance of three neurotransmitters associated with mood: serotonin, norepinephrine, and dopamine. Most antidepressants address one or 2 of them. L-methylfolate (the only form of folate that can cross the blood-brain barrier) is needed within the patient's body in order to regulate theose neurotransmitters, but many people's bodies fail to metabolize the L-methylfolate they need.

Factors in lessening the amount of L-methylfolate available in a person's body can be caused by a wide range of factors, from lifestyle choices to genetics and age. In fact, 7 out of 10 depressed people's genetic makeup predisposes their bodies to an inability to use dietary folate to become L-methylfolate, which can be used by the brain in order to regulate their moods.

An illustration given was that SSRIs (or Antidepressants) basically "plug the drain," rather than making more of the monoamines, which would be like turning on the shower. Until 2000, manufacturing T-Methylfolate was not possible. Now, the makers of
Deplin are pretty excited that their drug has led to the ultimate in breakthrough technology--the coinage of a new word! The synthesis of monoamines is known as a trimonoamine modulator (TMM).

Deplin is currently recommended for use as a complement to other antidepressants and is in trials to be able to be prescribed on its own.

During the webinar, I asked if there were updated percentages available to counter those I mentioned earlier in this post, but the improved success rates have not yet been surveyed in a comparable manner.
If anything, this webinar has made the following facts clearer to me than ever:

  • Psychiatry and the pharmaceutical world do not have this issue down to a science.
  • The drugs often prescribed for depression have negligible
  • The so-called "chemical imbalances" are still difficult for the medical community to delineate, and that's at least in part because measuring them is something that simply cannot be done.
As far as my personal opinion on all of this, I tend to agree withthis blogger, who gives a lot of facts and figures before coming to this conclusion: "The pharmaceutical industry and psychiatry would have us believe that an antidepressant is a pill for all seasons. Conversely, critics of psychiatry contend we would be better off on a sugar pill (at least there's no side effects). But there is a time and a place, even for an antidepressant. The catch is we're tripping over furniture in the dark with no watch."

Even more so, I also agree with Jay Adams, a champion of the biblically based Nouthetic Counseling movement. I've read his book Competent to Counsel and just recently stumbled on his blog. One post seems especially apropos regarding the untrue allegations that those who subscribe to a nouthetic counseling model reject any use of medication. However, if "depression" clearly comes as a result of circumstancial--rather than physical--prompting, is it really a medical issue? Or is it an issue of the heart? Certainly, our beliefs are betrayed by our internal reactions (or, as Scripture puts it, "the meditations of our hearts") which, in turn, affect our moods. (Remember this post about bitterness? It's s definite mood-altering frame of mind!)

I think it's absolutely bizarre that people treat depression medically when they can point to the following issues as the genesis of their dives:
  • Relationship tension
  • Deaths of loved ones
  • Job loss or stress
  • Financial troubles
I am not trying to be unsympathetic, here. Those things can be immensely hard. For the Christian, though, that's when real hope and faith matter, when it really steps up to the plate.

I love
these words that describe my new favorite music album, or at least the one with my fave song, which you can listen to via this YouTube video: "Scripture assures us that God is sovereignly using our difficulties as tools to make us more like his Son . . . (Ro 5:3–5) . . . While we know these things are true, in the midst of our hardships we can lose perspective. Problems can loom large, and our hopes can grow dim."

I know the numbness that comes with some antidepressants; I was on one of them for a while, years ago. I didn't feel the "lows," but then, I barely felt anything at all. I wasn't in control, and I knew it. I also knew that the Holy Spirit could help me deal with the thoughts and feelings I was having. Yes, they did escalate during times of lost sleep, hormonal tides, and other physical prompts. However, it's the internal struggle where I start to lose control, and for that, I pray, with David in Psalm 19:14, "Let the words of my mouth and the meditation of my heart Be acceptable in Your sight, O LORD, my rock and my Redeemer."

Another related thought comes from 1 Peter 3:15, which encourages believers to be able to answer "everyone who asks you to give an account for the hope that is in you, yet with gentleness and reverence," and if we have no more hope than they do, will they even ask?
When hard times and negative thoughts come, I can choose not to listen to them and instead to counsel myself with Scripture, with Truth. Maybe there aren't documented "success rates" with that, either, but it's definitely better than a placebo!