Category Archives: Opinion

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #60: ADHD

Trouble with impulsivity and inadequate ability to pay attention characterizes most of the human race. It is particularly characteristic of childhood; while developing, all children are hyperactive and inattentive, compared with an adult standard.

Children and adults inflicted with extremes of these two neurodevelopmental problems have a particular difficulty in our complex, organized, and demanding society, and consequently“ excessive“ hyperactivity and inattention are presently considered a disease, with specific diagnostic criteria, and medicinal, psychiatric, and sometimes instrumental treatments.

ADHD is divided into predominantly inattentive, predominantly hyperactive/impulsive, and combined. I will concentrate on certain features of the attentive aspect.

I encourage you to read the excellent Mayo clinic article which covers most bases, including advice for parents and relatives who have to deal with these sometimes difficult individuals.

ADHD most commonly involves children. It leads to difficulty at school, and often suboptimal interpersonal relations. Drugs such as amphetamines and Ritalin are most commonly given, and seem to work; it is always amazing to see a stimulant quieting down an overactive child. Struggling college students often consume these same medications, since they seem to give a short term boost In concentration, ability to learn, and performance in tests.

Caffeine is the poor man’s drug and also sometimes helps. 60 years ago I worked in the UCLA clinic where we checked problem children for “split dominance”, where the children may throw with the right hand and kick with the left foot. There is no mention of this in the literature now, and indeed FADS have characterized the whole area.

My middle son had difficulty in school and was hard to get along with. I tried him on some amphetamine, but he wisely spit it out. He turned out to have dyslexia (poor reading ability), studied engineering in college,  and is running his own company; Entrepreneurs are often dyslexic.

Be very careful before labeling a child with the stigma of ADHD. Try loving and working with her more. If the situation is clear cut, make sure the least five of the nine criteria are present before agreeing to try drugs.

One of my grandchildren was very slow in learning, and was distracted easily. His mother persisted in sending him to a Montessori preschool, and when he went into his growth spurt (I like to think he myelinated his neural pathways), a miraculous change took place; He now seems very interested in many things and does excellent work at school.

You cannot lavish too much attention on developing children. ADHD thought present in somewhat less than 10% of children, particularly boys. It is also being increasingly recognized in adults, where it interferes with their personal, home, and occupational lives. Anxiety, depression, and other psychiatric problems may follow.

I wonder if inattention also afflicts some of my elderly friends; if they don’t pay attention to what they’re doing, they may well FALL, and curtail their lives. We could all pay better attention to what we are doing.

TOO MUCH ability to pay attention, however, could grade into obsessive compulsive disorder. In more extreme forms, ADHD is certainly real, and failure to intervene can result in distressing secondary problems. However, it is almost too convenient a category for assigning children. Haste in categorization may result in missing other problems.

When normal, our brains are amazingly fine tuned instruments. The best thing to do is keep them exercised, stimulated, and well nourished.

—Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #58: SPINAL STENOSIS

Spinal stenosis is a narrowing in the spinal canal. Constriction of the spinal nerves can produce pain that goes down one or both of the arms or legs, depending on the location of the stenosis. Malfunction of the nerves can cause numbness In the arms or legs, or weakness in muscles served by the affected spinal nerves.

Your doctor can confirm the diagnosis with imaging techniques such as MRI or CT scan.

The interesting part of this condition to me is the tremendous advances in surgical techniques that have taken place in the past decade. Many surgeries are now done through an endoscope, which limits the surgical disruption in the area. There is even a needle guided procedure to remove part of the ligament that is causing compression of the nerve.

Depending on the exact problem, small amounts of bone or other tissues can be removed, especially if the exact site of compression has been identified. If the extent of compression is more extensive, increasing amounts of bone is removed from the lamina (bony arches), facets , or nerve outlets (foramina) to give the nerves more room.

If there is slippage of the vertebra, a fusion is sometimes done. My understanding is that fusion is becoming less common. That being said, the Cloward procedure in the neck, with its approach from the front, is still sometimes used with neck pain.

Pain in the neck or back without any associated nerve malfunction is often best treated with physical therapy, steroid injections, or other conservative methods.

In my opinion spinal surgery is best done by trained neurosurgeons, who are familiar with minimally invasive surgery.

—Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #57: SCOLIOSIS

Scoliosis is a curvature of the spine most commonly starting in childhood or adolescence. The cause can be a muscle imbalance from cerebral palsy or other muscle problems, a birth defect,  an injury, or sometimes there is scoliosis that runs in the family and is hereditary. Occasionally it is caused by a difference in the length of the two legs.

The curvature is sometimes accompanied by a rotation of the spine, and will produce an asymmetry of the back. Perhaps one shoulder blade is higher than the other or one shoulder is lower than the other. Differences in the leg length can be seen by differences in height of the pelvis.

The problem can be silent, if mild. However it can affect the way the child walks, or even interfere with breathing if severe. If untreated and progressive, it can cause chronic back pain in adulthood. Treatment is accomplished by braces, or occasionally by screws placed in the side of the vertebra that can be adjusted.

I had a friend that was 70 years old whose back pain eventually forced surgery. Scoliosis should definitely be supervised by a Doctor who will use physical therapy, braces, or some other conservative treatment to avoid later difficulties.

Please refer to the Mayo clinic article for more information.

—Dr. C.

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DR. C’S JOURNAL: WOMEN AND AUTOIMMUNE DISEASE

Almost 80% of autoimmune diseases occur in women. Why should this be?

From the evolutionarily standpoint, perhaps up regulation of immunity conferred a survival advantage. Women spent a much greater percentage of the time pregnant in Hunter gatherer days than they do at the present time, and an active immune system may have been an advantage in getting both you and your child’s genes through the many ancient environmental hurdles.

Women differ from men in the prominence of the X chromosome, the female sex hormones, estrogen and progesterone, and, surprisingly, in their microbiome. All three areas may play a role in autoimmunity.

The X chromosome contains many genes directly tied to Autoimmune diseases. One of these is a gene for TLR-7, which is important in the innate immune response, and is linked to disorders such as lupus and scleroderma. Another Gene, TASL, increases the production of interferon, a common inflammatory factor.

Many autoimmune diseases are driven by estrogen. For instance, estrogen attaches to, and turns on the gene that codes for interferon gamma. It activates B cells which produce antibodies. Progesterone, another female hormone is elevated in pregnancy, and tends to switch on the TH-2 response, which produces more antibodies. AIRE, the immune regulator itself, is partially influenced by the sex hormones.

A severe asthmatic I was treating became pregnant, and her asthma marvelously improved. I had always thought that pregnancy turned OFF her asthma-linked TH-2 response, going against one of the observations above.

At the present stage of knowledge, individuals may respond in perplexing ways to interleukins, treatments and pregnancy. Cellular interactions are complex indeed.

The microbiome in the male tends to increase testosterone, which tends to down regulate the immune system. The reverse is true for the female microbiome.

The fact that identical twins may be discordant with autoimmune disease favors environmental factors, such as the microbiome and other extrinsics such as smoking, diet, stress and chemicals. Some of the males who get autoimmune diseases tend to be feminized, such as in the Klinefelter syndrome, which has an extra extra X chromosome, and an XXY genotype.

The use of the estrogen or progesterone in the form of contraceptives tends to increase the likelihood of autoimmune diseases. The observation that women are more susceptible to autoimmune diseases goes along with many of these genetic, hormonal, and environmental observations.

Please consult for Scientific American, September, 2021, P 40 for more information.

—Dr. C.

DR. C’S MEDICINE CABINET: LITHIUM OROTATE

Lithium’s big claim to medical fame is it’s beneficial effect on manic depressive disorders in approximately 1/3 of the cases. It seems to benefit the manic phase more than the depressive phase, and its effect  on isolated depression is uncertain.

A recent report states that lithium works by increasing CRMP 2, which has an effect on tubulin in nerve cells. This report has not yet been confirmed.

When lithium is effective, it must be given in a dose that is almost toxic. People taking this drug should have lithium levels on a regular basis, and be alert to its numerous side effects, diarrhea, lethargy, and the like. It may also have an adverse effect on thyroid function.

I started taking low doses of lithium orotate a while back because of the touted effects on memory, mitochondrial function, and the like. I thought that our hunter gatherer ancestors probably had some exposure to lithium from the Hot Springs present in many areas, and that maybe lithium was a physiologic necessity.  Sodium and potassium are highly regulated ions in the cell membrane of all cells, I thought, so why should not lithium, a kindred element, have some effect there.

Lithium carbonate is the form that is used for treatment of manic depressive disease, and lithium orotate has not been well studied.
When one starts taking a dietary supplement, it is hard to tell whether or not it has any effect. Our bodies are complicated, and even if something does have an effect, the bodies corrective mechanisms can nullify that effect, or even cause  a reverse effect,

After further thought, I plan to start phasing out my lithium orotate. Maybe once a week would be a reasonable dosage, if at all. With irregular dosages, if I notice that I feel better on a day when I take lithium orotate, I might change my mind.

—Dr. C.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #56: LUPUS

Lupus, which used to be called lupus erythematosus because of its butterfly rash and light sensitivity, is an auto immune disease, along with celiac disease and several other autoimmune diseases, it is the great imitator. It can affect almost any organ system.

The great variety of symptoms, and relative rarity leads to a difficulty in establishing the diagnosis. Eventually, you may be lucky enough to  find someone who figures it out.

The butterfly rash over the bridge of the nose and cheeks is the most typical finding but it’s not present in all patients. Rheumatoid symptoms, including fatigue fever and joint involvement is common. Chest pain and shortness of breath can occur. Headache confusion and memory loss occurs. Involvement of the kidneys can also occur, it is often the involvement that is life-threatening. These are symptoms maywax and wane over a number of years.

The cause of lupus may involve a black background of infection, the medication, or even sunlight. As with most auto immune diseases, the actual cause is obscure.

Laboratory findings may include an anemia, kidney or liver involvement, and especially anti-nuclear antibody’s. Most people with lupus have a positive ANA test, but not all people with these positive tests have lupus. Other test maybe necessary.

Treatment is usually with Drugs which diminish the immune system. Targeting the B-lymphocytes specifically with rituximab or bulimumab may be helpful.

Lupus, the wolf, can be stealthy and severe. Patients often have to be their own advocate in order to get properly treated.

Please see the following mail clinic article for more information.

—Dr. C.

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