Psychology Today Blogs - Complementary Medicine

Vision Loss in One Eye

Jacob Teitelbaum, MD — Wed, 07 Jan 2009 07:13:24 -0800

Part 4 of a 6-Part Series

Though I prefer using natural therapies, if you have vision loss in one eye, call 911 and go to the emergency room immediately — even if it clears up on its own.

The information below is from our free new iPhone application called "Natural Cures" — already in the top 10 most popular free applications in the iPhone App store's "Health and Wellness" category!

Vision Loss in One Eye

BACKGROUND

Sudden loss of vision in one eye should be treated as a medical emergency, and the person should immediately be taken to the emergency room. This symptom can be a warning sign for a stroke, just like loss of function in an arm or leg on one side or sudden difficulty with speech can be a warning sign for an oncoming stroke. Caught early, the entire stroke may be prevented, where waiting could leave the person paralyzed.

TREATMENT

Call 911 or your local ambulance phone number and go to the emergency room — NOW!

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Eye Floaters

Jacob Teitelbaum, MD — Wed, 31 Dec 2008 07:47:14 -0800

Part 3 of a 6-Part Series

Tired of seeing spots when you don't own a dalmation? In rare cases where there is a new sudden shower of them in one eye, this can represent a medical emergency (called a "retinal tear") which should be seen in the ER or by your eye doctor immediately. For the rest of us, this common nuisance can be ignored, but can sometimes be treated as well.

Eye Floaters

BACKGROUND

Sometimes we get little bits of debris floating around in the liquid (called the "Vitreous Humor") that fills our eyes. This can include blood cells (round) or fungal filaments (which look like a thread with small lines along it). Oddly, the lens in our eye then acts like a microscope, allowing us to see them floating around in our eyes.

These are very common, and when they have come on gradually (over months to years) and there are just a few of them, they are normal and not dangerous. When there is a new sudden shower of them in one eye, this can represent a medical emergency (called a "retinal tear") which should be seen immediately. A simple laser technique can fix the tear if done early, where vision may not be recovered if the tear is allowed to progress.

PREVENTION & TREATMENT

As noted above, unless the "floaters" are suddenly occurring in one eye, and there are suddenly a lot of them, they can generally be ignored. Interestingly, we have found that the longer thread-like floaters (vs. the small round ones) sometimes reflect an overgrowth of yeast (candida ) in the body, and go away when the yeast is treated for six weeks with the prescription Diflucan 200 mg a day (see Candida/Yeast Overgrowth). If you have fatigue, pain, sinus congestion or spastic colon, this may reflect yeast overgrowth, and treating the yeast can help you feel better in general!

Treating Cataracts Naturally

Jacob Teitelbaum, MD — Mon, 22 Dec 2008 10:26:33 -0800

Part 2 of a 6-Part Series

Feeling like your vision has gotten cloudy as you've aged? Though cataract surgery can be helpful in some, cataracts can often be prevented and treated — naturally.

Cataracts

BACKGROUND

The lens of the eye, which is what allows us to focus, is filled with a clear protein containing liquid. If the proteins in the liquid start to denature, they become cloudy. This can cause vision to get cloudy.

Cataracts can be small and present at birth, occur (rarely) after eye injuries, and most often occur as people age — being hastened sometimes by diabetes or high blood pressure. The radiation/ultraviolet light increase seen at high altitudes can also increase risk.

Cataracts are not dangerous, but can impair vision. Let's look at prevention and treatment.

PREVENTION & TREATMENT

Optimizing antioxidant, zinc, and vitamin B2 intake (e.g., with the Energy Revitalization System vitamin powder) and avoiding excess sugar can help protect the lens in your eyes by preventing the denaturing of the proteins in them.

Once the cataracts begin, I would recommend (in addition to the above):

Vitamin A (25,000-50,000 units a day). Use actual vitamin A and not beta carotene for this. This is a high dose, and should not be used in children, people with severe liver disease, or women who might get pregnant (can cause birth defects) — folks who usually do not have cataracts anyway. One ophthalmologist jokingly complained that his cataract surgery income dropped by 2/3 when he started adding the vitamin A.
N- acetyl carnosine eyedrops (available as a product called "Can-C") used twice daily.
Bilberry (80 to 160 milligrams of a standardized 25% extract three times daily), and the
Chinese herbal mix Hachimijiogan (offered as "Clinical Nutrients for the Eyes," by Phytopharmica). Try three tablets daily.

If the cataracts are still problematic after 6-12 months of these treatments, surgery is very reasonable. Unlike most surgery, if the cataracts are bothering you to where you think that you eventually will need the surgery (after using the above treatments), I would do the surgery sooner rather than waiting. It is simple surgery and can markedly improve vision. So if you are going to do the surgery, why put up with poor vision while waiting?

Natural Treatments for Pink Eye

Jacob Teitelbaum, MD — Tue, 16 Dec 2008 10:23:35 -0800

Part 1 of a 6-Part Series

Dear Readers,

In the next 6 blog posts, I will discuss how to treat common eye conditions using the best of natural and allopathic medicine.

These are taken from our free, new iPhone application called "Natural Cures" (as of today, it was the 6th most popular free application in the iPhone App store's "Health and Wellness" category!).

Let’s start with a quick overview of how the eye works. The eye is like a fluid filled ball containing the following components:

Conjunctiva and sclera — the outer white part of the eyeball.
Cornea — the clear front opening which lets the light in.
Iris — the colored ring that determines the color of our eyes and how much light gets in.
Lens inside the eye (just behind the cornea and iris) which allows us to focus. A cataract is when the lens gets cloudy.
Retina — The nerve layer in the back of the eyeball which captures the images we see and sends them to the brain via the optic nerve.
Macula — A special area of the retina used for reading and fine detail.
Vitreous humor — clear, gelatinous substance filling the central cavity of the eye. This is like the eyes' circulatory system to bring in nutrients and wash out toxins.

This series will discuss the best of natural and standard therapies for common eye problems, including:

Conjunctivitis — Where the white’s of the eye(s) become red and uncomfortable.
Cataracts — Where the lens gets cloudy.
Eye floaters — Seeing spots.
Vision loss in 1 eye.
Macular degeneration.
Glaucoma — elevated eye pressure.

Treating Conjunctivitis Naturally

BACKGROUND

Often called "pink eye" or "red eye," conjunctivitis is a painful and/or itchy redness of the whites of one's eyes. It is most commonly due to an allergic reaction or an infection (usually bacterial, but sometimes viral). This is different from bleeding into the white part of one eye, called a "Subconjunctival Hemorrhage," which leaves part of 1 eye bright red, but causes no pain or vision change. Though it looks nasty, this goes away on its own and is not dangerous. It is more common in diabetes and high blood pressure (so check for these if it happens), but most often happens in healthy people.

Conjunctivitis is caused by:

Allergies — itching is the dominant symptom. It is more likely to affect both eyes, and the discharge/watering from the eyes is usually clear. It may hit suddenly, or be mild and ongoing.
Viral — Though there may be some itchiness, the pain, mild redness (more pink) and watering are more prominent. It may start in 1 eye, but easily can spread to the other (so be careful not to touch the unaffected eye). The discharge is usually clear and watery. It may take 3 weeks to resolve and may occur along with a respiratory infection or cold.
Bacterial — This is associated with a puss-looking yellow-green mucus discharge along with pain.
Toxic — From an acute chemical exposure (usually obvious and should be immediately treated).
Falling asleep with your contact lenses in or having inadequate tears to support the use of contact lenses.

Though the viral and allergic conjunctivitis tend to be benign and resolve on their own, it is best to see an eye doctor to rule out bacterial conjunctivitis or more dangerous viral infections of the cornea. Seeing an eye doctor is especially important if you have yellow discharge or severe pain or light sensitivity in the eye, or the pupil (black part of the eye) is irregularly shaped instead of round.

TREATMENT

Once the eye doctor has ruled out and treated more worrisome causes, treatment is for symptom relief. Cool compresses or rinses can help itching, and warm compresses help pain. If only 1 eye is involved, be sure to tilt your head to the side so the affected eye is lower than the healthy eye. Otherwise, if water flows from the infected eye to the other eye, it may also get infected. Antihistamines can also help with itching. Benadryl, which is sedating, is best at night so you can sleep. A non-sedating antihistamine is best during the day (e.g., Claritin or Zyrtec). For long term allergic conjunctivitis, treating allergies with the supplement MSM 3,000+ mg a day and/or a special acupressure technique called NAET can be helpful, but these take longer to work.

For contact lens and dry eye induced conjunctivitis, using special eye drops containing vitamin A (such as Vivia Eye drops) can be very helpful over time.

Sleep Your Way to Skinny?

Jacob Teitelbaum, MD — Mon, 08 Dec 2008 07:37:16 -0800

Obesity is epidemic, and has many causes. One of them is that the average nights' sleep has dropped from 9 hours a night to 6 3/4 hours a night over the last hundred years, and sleep is responsible for many weight and appetite controlling hormones, such as growth hormone, leptin, phrelin and ghrelin. So can you really sleep your way to skinny? Many studies suggest you can.

How Much Sleep is Optimal for Staying Thin?

How much sleep is optimal for staying skinny? Between 7 and 9 hours is best. Less than 7 hours increases the risk of obesity approximately 30% and adds an extra 5 pounds on average.

According to Jean-Philippe Chaput, MSc, from Laval University in Quebec City, Quebec, Canada, and colleagues, "Current treatments for obesity have been largely unsuccessful in maintaining long-term weight loss, suggesting the need for new insight into the mechanisms that result in altered metabolism and behavior and may lead to obesity."

The increase in body weight in the U.S. population has been paralleled by a reduction in sleep times. For the past 4 decades, daily sleep duration has decreased by 1.5 to 2 hours, and the proportion of young adults sleeping less than 7 hours per night has more than doubled, from 15.6% in 1960 to 37.1% from 2001 to 2002.

Studies in adults and children have repeatedly shown that reduced sleep is associated with increased weight.

To determine the relationship between sleep duration and weight, researchers followed up 276 adults aged 21 to 64 years who were enrolled in the Quebec Family Study, a 6-year longitudinal study in a community setting. The investigators compared weight gain relative to sleep duration: short (5-6 hours), average (7-8 hours), and long (9-10 hours).

Compared with average-duration sleepers, short-duration sleepers gained 4.4 pounds more in a 6-year period. At 6 years, short-duration and long-duration sleepers were 35% and 25% more likely to experience a 12 pound weight gain, respectively, compared to those who slept 7-8 hours a night.

Compared with average-duration sleepers, short-duration sleepers had a 27% increased risk for the development of obesity, and long-duration sleepers had a 21% increase in risk. Adjustment for caloric intake and physical activity did not affect these connections.

References

Sleep. 2008;31:517-523. Click here for article (free registration required).

Visit the End Fatigue website for other articles on weight loss.

Curing Restless Legs Syndrome

Jacob Teitelbaum, MD — Wed, 03 Dec 2008 08:01:39 -0800

Are you tired despite getting a good night’s sleep? Do you kick your blankets or bed partner around all night? If so, you may have restless legs syndrome (RLS), where your legs are running a marathon all night while you sleep. The good news is that in many this will go away by simply treating even mild iron deficiency (where the iron labs are normal). Let’s look at how to use Comprehensive Medicine, the best of natural and prescription therapies, to help your legs sleep all night and leave you feeling great!

People with restless legs syndrome continually move their legs while sleeping. Although some people may have a disagreeable leg sensation and sense of restlessness, it is not uncommon for only your bed partner to be aware that your legs are kicking much of the night or are constantly moving. Although the cause of RLS is not clear, it can be aggravated by iron and other nutritional deficiencies, hypothyroidism, and low blood sugars while sleeping. If you have daytime fatigue and your blankets are scattered around when you wake up or your bed partner notes that your legs move a lot during the night, restless legs syndrome may well be a problem for you. Although a sleep study can make the diagnosis, it usually runs approximately $2,000 and you may simply choose to videotape yourself for an hour or two while sleeping, instead, to see if this is a problem.

There are both natural and prescription approaches to treatment. Natural remedies focus on diet and nutritional supplementation.

Check a ferritin blood test and see the results yourself. Take iron till the ferritin level is at least 60 (even though the test is considered "normal" if it is over 9). In addition, the iron percent saturation should be over 22%.
Avoiding caffeine is important. Because RLS may be associated with hypoglycemia, eating a sugar-free, high-protein diet with a protein snack at night may be helpful.
In addition, vitamin C, tryptophan, and folic acid may also be helpful.

Medication can also help when needed. I recommend:

Ambien,
Neurontin, and
Klonopin (Klonopin, like valium, may be addictive)

These medications are highly effective in the treatment of RLS. I tell patients to adjust the dose to not only get adequate sleep, but to also keep the bedcovers in place and to avoid kicking their partners. I do not recommend Requip unless the above treatments have failed.

Restless Legs Syndrome and other sleep problems are discussed at length in my book From Fatigued to Fantastic! (Penguin/Avery 2007).

Eliminate Nerve Pain Naturally

Jacob Teitelbaum, MD — Fri, 07 Nov 2008 08:59:11 -0800

Nerve pain (called neuropathic pain), is one of the more difficult and uncomfortable types of pain. Whether the pain comes from diabetes, shingles, fibromyalgia, chemotherapy, or a host of other causes, this searing, burning, electric shock kind of pain can leave you miserable. Unfortunately, most physicians are still not trained in treating nerve pain, and give anti-inflammatory medications like Motrin (which are not effective and kill over 16,500 Americans unnecessarily each year) or narcotics, which are modestly effective.

The good news is that nerve pain is very treatable. Many studies have shown that using nutritional support with lipoic acid 300 mg 2x day, Acetyl-L-Carnitine 2,000 mg a day, Inositol (500-1,000 mg a day), and vitamins B6 (50-100 mg a day) and B12 (500-5,000 mcg a day—both B vitamins and Inositol are in the Energy Revitalization System vitamin powder) can actually help heal the nerves and decrease or eliminate the pain. Nerves take time to heal, so natural remedies need to be taken for 3-12 months. In the interim, holistic pharmacies can make powerful creams combining multiple medications effective against nerve pain (available by prescription from ITC Pharmacy at 303-663-4224; called the nerve pain gel). These are rubbed over the painful areas, and can be very effective after 1-2 weeks of use. Being rubbed on the skin though, the total dose to the rest of your body is very low, making it largely side effect free! Other medications can also be very effective.

Just because doctors are not trained in pain management does not mean you have to be in pain. Want to make your nerve pain go away? You can!

What is Nerve Pain?

The term "neuropathic pain," or nerve pain, refers to a wide range of problems that cause diseases of, or injury to, the nervous system. It is a category of pain syndromes and not a single problem. Neuropathic pain can come from malfunction of nerves or the brain associated with illness (e.g., diabetes, low thyroid, etc.), infections (e.g., shingles), pinched nerves, nutritional deficiencies (e.g., vitamin B6 and B12), injury (e.g., stroke, tumors, spinal cord injury, and multiple sclerosis), and medication/treatment side effects (e.g., radiation and chemotherapy, AIDS drugs, Flagyl®). It is estimated that 50-80% of diabetics will develop some nerve injury with 30-40% of these having painful diabetic neuropathy unless preventive measures are taken such as nutritional support. Neuropathic pain affects approximately 0.6-1.5% of the U.S. population and 25-40% of cancer patients. This represents over two million Americans.

Neuropathies are characterized by pain that is burning, shooting (often to distant areas), or stabbing. It also has an "electric" quality about it. Tingling or numbness (paresthesias) and increased sensitivity with normal touch being painful (allodynia) are also commonly seen. Ongoing pain is often continually present regardless of what the patient does or does not do. In some cases, pain comes in sudden attacks without any apparent trigger. Diagnosis is made predominantly by history and physical examination, as testing often offers little benefit clinically unless the testing is looking for a treatable cause.

As with other pain problems, neuropathies are both expensive and poorly treated.

In the presence of nerve pain, it is especially important to look for treatable causes. Lab testing should include:

A blood count (CBC) and an inflammation/sedimentation rate (ESR).
Thyroid testing with a Free T4 and TSH.
Vitamin B12 level.
Screening for diabetes with a morning fasting blood sugar and a glycosylated hemoglobin (HgBA1C).

The medical history should be assessed for excess alcohol use, vitamin deficiencies, hereditary factors, or treatment with medications that can cause nerve injury. A neurological examination may also give an indication of the cause.

Nerve pain is often associated with a process called "pain central sensitization." The nerves and brain are like wires that carry information. When they become over-stimulated with chronic pain, it may make the whole system over-excitable. In these situations normal touch and other usually comfortable contact can be painful. This is called allodynia. Medications that stimulate the "calming (GABA) receptors" in the brain, such as a number of anti-seizure medications (see below), can help settle the system and further decreases pain.

Let’s begin with the most common kinds of nerve pain, and how to treat them.

Postherpetic Neuralgia (PHN)

Postherpetic Neuralgia follows a rash called herpes zoster. Often called shingles, it is caused by the same virus that causes chickenpox. The first time you get chickenpox, the virus remains in your nerve endings even after the chickenpox is gone. This usually causes no problems. If the virus re-activates in one of the nerve endings, however, it causes a rash all along the distribution of the nerve. The rash of herpes zoster is characterized by being painful and being in a line totally on one side of the body. If it extends past the midline of your body, the rash is probably coming from something else. If the pain persists after the rash is gone, continuing for weeks to years (over one year in half of elderly patients), it is called "Postherpetic Neuralgia (PHN)." The pain tends to be burning, electric, or deep and aching. PHN affects between 500,000 and 1 million Americans—most of whom are elderly. It can severely disrupt one's life, but fortunately can now be effectively treated in most cases.

Painful Diabetic Neuropathy (PDN)

This is the most common cause of neuropathy in the U.S. Alterations in sensation are common, and the feet, which are most often affected, may feel both numb and painful at the same time. There are many factors contributing to nerve injury in diabetes, including decreased circulation, accumulation of toxic byproducts, damage from elevated sugars, and nutritional deficiencies. There are also changes in NMDA and opiate receptors.

Research has shown that many people who are labeled as having diabetic neuropathy actually experience neuropathic pain caused by vitamin B6 or B12 deficiency. In addition, the nutrients inositol has been shown to improve nerve function. The nutrients lipoic acid (see Lipoic Acid for Diabetic Neuropathy) and Acetyl-L-Carnitine (see Acetyl-L-Carnitine Helps Diabetic Neuropathy) have also been shown to be very helpful for diabetic and other nerve pains, but it can take 3-12 months to begin nerve healing. So give them time to work.

Nutritional Deficiencies

Neuropathic pain can also be caused by deficiencies of vitamins B12, B1, B6, D, E and zinc (all are present in the Energy Revitalization System). A number of studies have shown that different kinds of nerve pain can improve by supplementation with high dose B vitamins. Excess vitamin B6 (over 500 mg a day for years), however, can also cause neuropathy. Vitamin D 2,000 units a day was also shown to decrease diabetic neuropathy pain by 47% after 3 months.

In patients with long-standing shingles pain, one study showed that taking 1,600 units of vitamin E (use the natural form) daily before a meal for 6 months was markedly helpful in eliminating the pain. Another study showed that taking lower doses for less than 6 months was not effective.

Hormonal Deficiencies

Hormonal deficiencies, especially an under-active thyroid, can also cause neuropathic as well as muscular pain. A therapeutic trial of thyroid hormone is reasonable for anybody who has the symptoms of low thyroid including fatigue, cold intolerance, achiness, having low body temperatures, or unexplained inappropriate weight gain.

Nerve Entrapments

A pinched nerve can cause nerve pain in many places in the body. Two of the more common ones are low back pain from sciatica and pains in the hand and sometimes wrist from carpal tunnel syndrome. Sciatica usually goes away without surgery by using intravenous colchicine (see chapter 14 of Pain Free 1-2-3), and carpal tunnel syndrome usually resolves after 6 to 12 weeks with vitamin B6 (250 mg a day), thyroid hormone, and wrist splints (see chapter 19).

Reflex Sympathetic Dystrophy (CRPS)

This usually manifests as horribly severe pain in one hand or foot but can certainly spread elsewhere. See the end of this chapter in the Pain Free 1-2-3 book for a detailed discussion on effective treatment.

How Can I Make the Neuropathic Pain Go Away?

Neuropathic pain occurs biochemically, making it a very fluid system that can often be quickly modified, resulting in pain relief. Many different chemicals (neurotransmitters) in your body may be involved in your pain, and therefore it is worth trying different types of medications to see which ones work best in your case. For many, treating the nutritional and thyroid deficiencies and eliminating the muscle spasms, which are compressing your nerves, may be enough to eliminate your pain. Others may need to take medications to suppress the pain while we look for ways to eliminate the underlying cause. The best way to tell which chemicals are involved in your nerve pain is to simply try different medications (individually and, if needed, in combination) to see what eases your pain. Basically, it is like trying on different shoes to see what fits best. The good news is that we have a large assortment of "shoes" that you can try on and that are likely to help you.

It is, of course, critical to begin by eliminating the underlying causes of neuropathy and giving the nerves what they need to heal. This includes the nutritional support we've discussed. In addition, the involvement of free radicals in nerve excitation was found in 1995, supporting the use of antioxidants in nerve pain. Since that time, the antioxidant lipoic acid (300 mg 2 times a day) has been shown to be helpful in diabetic neuropathy and should be tried in other neuropathies as well. You will be amazed at how much benefit you may get over time simply from optimizing nutritional support.

In addition, if you are tired, cold intolerant, experience achiness, have low body temperatures, or have weight gain I think it is reasonable to consider a therapeutic trial of natural thyroid hormone regardless of your blood levels. It may take 3 to 6 months for the thyroid and/or nutritional therapies to begin working, but regardless of the cause of your neuropathy, this treatment may result in nerve healing. It is reasonable to begin medications along with the nutritional support so that you can get pain relief as quickly as possible. If only a small area is involved, it makes sense to begin with a Lidocaine® patch (called Lidoderm). Otherwise, I prefer to begin with Neurontin® and/or tricyclic anti-depressants. All of the recommended oral nutrients discussed earlier, except lipoic acid, Acetyl-L-Carnitine, and the 1,600 unit mega dose of vitamin E, are contained in the Energy Revitalization System vitamin powder and B-complex. For carpal tunnel syndrome, add 200 mg of B6 to the powder.

Below are just some of the different categories of prescription treatments that can be helpful for nerve pain. They (along with the natural treatments) are discussed in more detail in my book Pain Free 1-2-3. Begin with the nutritional and thyroid support as noted above. You can then add the medications below as needed in the order that they're listed.

Lidocaine® patch, 5%. This Novocain®-like patch is applied directly over the area of maximum pain. It can be cut to fit the area, and up to four patches can be used at a time (although the package insert says only three). It is left on for 12 hours and then removed for 12 hours each day, although recent reports have suggested that the patch can be left on up to 18 hours and still be safe and effective. Results will usually be seen within two weeks. Because the effect is local, side effects are minimal. The most common side effect is a mild skin rash from the patch. It should not be used if you have an allergy to Novocain/lidocaine. The patches are most likely to be helpful if the pain is localized to a moderately sized area. Even in a large area, however, patches can be used on the most uncomfortable spots. The main downside of the patches is that they are expensive. If you have prescription insurance, however, they will usually be covered.
Neurontin® and other seizure medications. Newer anti-seizure medications, and some of the older ones, can also be very helpful for neuropathic pain. Neurontin has been shown to be helpful for both shingles and diabetes pain. Common side effects include sedation, dizziness, and sometimes mild swelling in the ankles when first starting therapy. These side effects can often be avoided by starting with a low dose and raising the dose slowly. A common total dose for Neurotonin is 600 mg, 3-4 times a day.
Tricyclic anti-depressants. These include medications such as Elavil®, Tofranil®, nortriptyline or doxepin.
Topical Gels. A wonderful new addition to the treatment of pain in general, and especially nerve pain, is the use of prescription topical gels. New gels have been developed that markedly increase the absorption of medications through the skin. By using a low dose of many different medications in the cream, one can get a powerful effect locally with minimal side effects. It is best to have a knowledgeable compounding pharmacist (e.g., ITC Pharmacy 303-663-4224) guide you and your physician in the prescribing of these creams and gels. To explore an example of how to treat with these creams combined with nutritional support, let's use the example of diabetic neuropathy. One must, of course, begin with proper control of the elevated blood sugars. Nutritional support with high levels of vitamin B12, B6, and inositol are also important in diabetic nerve pain as are many other nutrients, such as vitamins C and E, magnesium, antioxidants and bioflavonoids (all in the Energy Revitalization System). In addition, lipoic acid 300 mg 2 times a day has been shown to be helpful for diabetic neuropathy. A compounded gel containing (as one of many possible mixes) Ketamine 10%, Neurontin® 6%, clonidine 0.2%, and nifedipine should be added to painful areas (apply 1 g 3 times a day as needed). The nutritional support can actually make the pain go away over time, while the cream/gel can add symptomatic relief. Other medications discussed in this chapter can then be added as needed to assist in the neuropathic pain.
Anti-depressants such as Effexor or Cymbalta.
Ultram (Tramadol®). This is an interesting medication that works on many areas of pain and in many different types of pain. It has been shown to be effective for nerve pain in a placebo-controlled study after four weeks.
Topamax (Topiramate®)
Lamictal (Lamotrigine®)
Lyrica (Pregabalin) or Gabitril (Tiagabine®)
Keppra®
Trileptal® (oxcarbazepine)
Dilantin®
Capsaicin®
Narcotics. Narcotics are only modestly helpful but are considered an accepted treatment for neuropathic pain.
Benadryl® (diphenhydramine). Sometimes we get help from unexpected places. Studies have shown in both humans and animals that antihistamines can help pain—in spite of our not knowing why this works. It has even been found to be helpful in patients who failed treatment with heavy narcotics. It is recommended that you start with 25 mg every 6-8 hours and adjust the dose to the optimum effect.

Most people find that long term the nutritional and topical therapies will eliminate or at least give marked relief from their nerve pain. For immediate control, 1-2 medications by mouth are usually enough, but I give this long list (and more treatments are discussed in my book) so that you know that you have options and can get pain free. To find a physician who knows how to treat pain, see the American Academy of Pain Management website.

Even with severe nerve pain, you can get pain free now, using the best of natural and prescription therapies!

[Used with permission from Pain Free 1-2-3 (McGraw Hill 2006) by Jacob Teitelbaum, M.D.]

Hypnosis and Fibromyalgia

Jacob Teitelbaum, MD — Tue, 21 Oct 2008 05:44:06 -0700

Is your doctor “putting a curse on you?" Odd as this may sound, this is what is occurring in much of how physicians approach their patients. Let’s look at the power of words in the healing process, using fibromyalgia pain and hypnosis as examples. We have progressed to the point where we can actually see the areas associated with fibromyalgia pain light up on brain scans. As an aside, there are not many idiots who still believe that the pain is not real, but the brain scan changes should help those few recover from being fools.

Most sensation (whether it is hot, cold, wet or pain) can be modified using hypnosis. I paid my way through medical school as a children's hospital intensive care unit nurse, and learned hypnosis in medical school. My goal was to help decrease the pain of dressing changes being done for children in the burn units. I have been impressed at our ability to use our mind to increase or decrease pain and other physical processes.

In this study, functional MRI scans were done to look for activation of pain areas in people with fibromyalgia. Interestingly, simply suggesting that pain would lower did decrease both the pain and MRI changes. This suggests that the suggestions your physician gives you (e.g., there is hope vs. "no one can get you well") become self fulfilling prophecies. If fact, statements like "no one can get you well" used to be called putting a "curse" on someone. Yet this is what physicians often do—ignoring how their words have the power to harm as well as heal.

What makes these "curse" statements by physicians so nasty is that they are wrong and borne of ignorance. Most physicians these days are aware, almost exclusively, of only the most expensive medications, surgery and procedures. They believe this puts them scientifically on the cutting edge, not realizing that what they think is science is really slick advertising by drug companies masquerading as educational activities. A quick check of which companies sponsor a conference and what percentage of speakers are promoting these companies' products (for big bucks) should quickly disabuse one from thinking the conference is much more than an advertisement. Journals also are effected by the drug advertising (ever wonder why you never see ads for cars or golf clubs in medical journals? No one would be insane enough to pay for those ads—except that it buys "good relationships" with the journal's handlers. The silver lining to this problem is that the scientific literature is also full of studies showing effective treatment for many "untreatable" medical problems. These are usually so cheap, though, that doctors never hear about them (they tend to be in smaller journals with less drug ads). So what the physician is really saying is that "there are no extremely expensive medications for your problem that the drug company propaganda has indoctrinated me about, so I can't help you." Tell them thanks for their honesty, and go find a holistic physician who has looked at the rest of the science—and who usually can help. (see the American Board of Holistic Medicine to find a doctor). To do your own medical sleuthing, get a medical report on your illness from Jan Guthrie at the Health Resource. I never cease to be amazed at studies they find showing help for "untreatable" problems.

But back to the study... suggestions of pain relief given under hypnosis were even more effective at decreasing pain sensation and the amount of stimulation of pain areas in the brain. All this goes to show that your ability to affect the outcome of your illness should not be underrated. In fact, a large part of the Art of Medicine is working with you to mobilize your own internal healing abilities. That medicine has derisively called your ability to affect healing the "placebo effect," suggesting that only the doctor has the power to help you—and that anything you do on your own shows you are crazy—shows how aggressively the medical establishment works to disempower you. But you do have the ability to often heal yourself given good information. As it is said "Knowledge is Power!"

Health Care and the Elections—Part 3

Jacob Teitelbaum, MD — Thu, 16 Oct 2008 08:34:26 -0700

What are the candidates’ positions on natural health care/complimentary medicine?

This is a critical question when it comes to healing our health care system, and in today’s blog entry, I will answer the following question I received on this topic from Minerva:

Dear Dr. T,

I would like to know what Obama's position is on natural health care such as naturopathic doctors, acupuncturists and so on. Does his plan include such health care professionals or would the field be segregated from his health care plan? Many of Americans are turning to such treatments. I would like to know where he stands, in detail, regarding all natural medicine health care practitioners.

Thank you,

Minerva

Dear Minerva,

At this time I have not seen where either candidate has addressed the critical issue of the public’s right to access to care using natural therapies, and I doubt either side will have a chance to do so before the election.

I am honored to have been invited to join Senator Obama's health advisory team. By way of background, a key issue for me is the restoration of the balance between the art and science of medicine. The art is being lost as practitioners have been decreasing time to spend with patients and are being blocked from using scientifically proven safe, effective and low cost natural therapies. Meanwhile, the "science" of medicine has been hijacked by drug companies that package their advertising so effectively that physicians confuse science and marketing. This is especially so as repeated studies have shown that studies paid for by drug companies are about 40-2,000% more likely to report a positive result than if done independently. This means that our pharmaceutical "science" has been bought off to the point of being a scam.

The cost of our allowing this to happen? Many billions of dollars in sales of dangerous drugs of modest effectiveness, and tens of thousands of unnecessary deaths. This occurs despite scores of safe, proven and low cost natural options going unused—often because AMA based medicine through the medical boards and state medical societies maintain their medical monopoly by removing the licenses of physicians who use natural therapies. They do this even when boxes of research studies support the treatments, the patients are thrilled that they become well (and have suffered no harm)—simply because holistic M.D.s are refused the right to peer review that all other physicians are guaranteed by law. Meanwhile, preventing four-year trained naturopathic physicians the right to apply their training by preventing the enactment of proper "Scope of Practice Rights" is simply the maintenance of the medical monopoly at the cost of Americans' health, freedom, and resources.

Including other well trained specialties (such as four-year N.P.s) will be an important part of healing the system and keeping it from going bankrupt. The science is clear that this is needed. What is needed are independent open minded experts who will apply the science, instead of stacking the committees who make the choices with "experts" on the drug company payroll. This need becomes obvious when you look at the science, which shows:

1. Using cholesterol meds like Lipitor for primary prevention is a $12+ billion per year scam (lowering heart attack deaths 1.4%, while owning a cat is associated with a 30% decreased risk and optimizing thyroid levels could drop a woman's risk 69%).

2. Imitrex (for $25) is no more effective than Excedrin Migraine (only 50 cents) in head on studies, and vitamin B2 (riboflavin 400 mg a day—for only 10 cents) decreases migraine frequency approximately 68% in repeat placebo controlled studies.

3. Carpal tunnel syndrome resolves in most cases with simply a wrist splint and vitamin B6 after six weeks—as opposed to treating with $2,000-$4,000 worth of surgery.

4. 16,500 Americans die unnecessarily each year from arthritis medication, spending about $3-4 billion a year on these meds and another $3-4 billion for hospitalizations to treat the drugs' side effects. Natural remedies (e.g., willow bark, boswellia, etc) have been shown to be as, or more, effective than the medications, while being very safe and very low cost.

I am sure that you and your colleagues are very familiar with the above. I could give hundreds of other examples where our financially driven heath care system is off track and dangerous, and where N.P.s and other practitioners can, with the proper support, help heal it.

I have had the honor or lecturing at many AANP and other naturopathic conferences. I am impressed that the four-year N.P. colleges have greater scientific rigor than most medical schools, and have had the honor of testifying at the state legislature level in support of expanded Scope of Practice for N.P.s. Like all specialties, it should be up to N.P. specialties who have documented proper training and certification testing to create their own Scope of Practice guidelines.

The above reflects my opinions and I cannot speak for either of the candidates. What I can say is that I whole heartedly support Senator Obama and trust him to do the right thing here. This trust is supported by those I have seen to be in charge of his health policy reform team. I have found no one on the drug company or health insurance company payrolls. Instead, I have found dedicated patient advocates determined to do that which is best for the public. I think this bodes well for healing our health care system by doing what works and is safe (which natural remedies clearly are) instead of our current model of doing that which is most expensive—regardless of its safety or value.

I will be proposing that the public have the right to safe and effective natural therapies and practitioners. I will NOT be recommending that the new system be required to pay for them. Rather I propose studies on cost effectiveness of these treatments so that the system can opt to include them by showing their safety, effectiveness and value. Whether any treatment is covered should NOT be based on "does this treatment have any benefit?" as we currently do but rather what is the value of the treatment (based on a mix of effectiveness, safety, and cost). This is how most people would want to do their health care shopping. Using the above approach, I think many natural alternatives (and their practitioners) will be shown to be a better choice than standard options.

I invite you to contact us further after the election, so I (and others on Barack's team who favor the public's right to have access to safe and effective natural remedies) can work with you and the groups looking to help American's get well. With our current system giving the most expensive care in the world while the W.H.O. grades our health care as being on par with Albania, I think there will be enormous opportunities for change. Adding our political will at the needed times will be important. But with the Barack team, expect that you will be speaking to those who care about the public—and not trying to convince those with entrenched financial interests. I think that with Obama we have the greatest opportunity to create a healthy health care system, including natural options, that I have seen in my lifetime.

I hope this is helpful. Feel free to contact me at endfatigue@aol.com.

Jacob Teitelbaum, M.D.

Are Medical Guidelines Helpful? Plus, Obama vs. McCain Health Reform

Jacob Teitelbaum, MD — Tue, 30 Sep 2008 10:52:33 -0700

Are Medical Guidelines Helpful? They are to drug companies. Unfortunately the cholesterol, diabetes and other medical society groups' committees that write the medical guidelines are so dominated by doctors on the drugs companies' payroll that the guidelines may do more harm than good. This is supported by a new study which found: "If guidelines are universally ignored, their impact on treatment and outcomes is minimal. Certain patients may be harmed by adherence to specific guidelines." (Read more.)

This week, I would also like to continue our discussion of the Health Care Reform plans promoted by our two excellent presidential candidates. This week, let's start with the issue of wasted health care dollars. As a physician who has practiced 30 years, I find our system to be incredibly inefficient—starting with both the time wasted on unnecessary paperwork, and the money wasted on repeat testing that occurs because old records are not available. In addition, computers can create most of the patients' medical record before they even see the physician, effectively gathering information entered by the patient. It can even analyze the information, allowing it to recommend the doctor consider certain tests and treatment options. As physicians now have only about five minutes on average per patient visit (which is another medical disaster), a computerized "physician's assistant" can free up the physician's time so they can actually listen to the patient, and then teach them and answer their questions.

If the idea of a physician's assistant computer program seems unlikely to happen, I am happy to note that it already has. I created and patented one years ago which I, and many other physicians, use for patients with CFS and fibromyalgia. These incredibly complex patients require over an hour simply for records review and review of their history. The computer program creates a complete medical record (except for the physical exam) of the patient's case, and analyzes the symptoms and labs to determine the probable contributing diagnoses. It also tailors a treatment protocol to that patient's case, supplying detailed patient instructions. It includes a detailed screening for cancer, and other medical symptoms that can be live saving when caught early, and is easily filled in online by the patient at home. This allows the physician to use their time to properly care for the patient, and allows even new physicians the benefit of the expert's experience in each specialty and illness.

So let's compare our presidential candidates' plans for bringing medicine into the 21st century using the power of computers:

Barack Obama’s Plan for Using Electronic Heath Information Technology:

"Lowering costs through investment in electronic health information technology systems—Obama and Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records, and will phase in requirements for full implementation of health IT. Obama and Biden will ensure that patients' privacy is protected."

By my reading, Obama’s plan:

1. Clearly notes the issue—Most medical records are still stored on paper, which makes it hard to coordinate care, measure quality or reduce medical errors and which costs twice as much as electronic claims.

2. Clearly states how he will address the issue—“Obama and Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records, and will phase in requirements for full implementation of health IT.”

In addition to sounding good, these words actually suggest a familiarity with the technical issues involved. Obama and Biden will ensure that patients' privacy is protected.

John McCain's Plan for Using Electronic Heath Information Technology:

"INFORMATION TECHNOLOGY: Greater use of information technology to reduce costs. We should promote the rapid deployment of 21st century information systems and technology that allows doctors to practice across state lines."

By my reading, McCain’s plan basically says "yes, we should do something," with no real plan. Sadly, I find much of his health plan in general to be very weak on the details. Even worse is that his key statement is about "technology that allows doctors to practice across state lines." This is a meaningless statement as it is the state medical boards which determine who can practice in each state and thus across state lines—not the technology. This suggests to me that the candidate is very weak in his understand of what is actually occurring in health care—causing his "weak on details" problem.

I invite you to read each candidates health policy at their own websites:

Barack Obama's Health Care Policy

John McCain's Health Care Policy

In addition, if you are a health practitioner or are involved with setting health policy, I invite you to read An Open Letter on Health Care in the 2008 Presidential Election to see what other physicians think about the candidates policies.