How Neuropathy affects us all

The rule on this blog is generally, absolutely no advertising however this video from a medical practice in Georgia, USA is so full of useful and accurate information that will hit all the right notes with neuropathy patients, that an exception can definitely be made. As it turns out, the good doctor's promise of a scroll-down text (which could also have been very useful) and a link to the details of his practice and how he proposes to help neuropathy patients at the end of the video, are missing; so the problem of promoting someone's business doesn't arise. I'm not sure why the information at the end isn't there - perhaps it's a YouTube thing but please don't let that put you off watching the video...it's only 4.52 minutes and the man knows how we feel!

How Important Is Vitamin B In The Treatment Of Nerve Damage

Today's post  from cidpneuropathysupport.com (see link below) looks at the role of Vitamin B in both the prevention of and treatment of neuropathy. This article looks at it from the inflammatory neuropathy angle but it can be argued that all neuropathy is inflammatory by nature. The nerves become inflamed and/or damaged through inflammation and a vitamin B deficiency is often seen as contributing to that. That said, you need to be tested by your doctor to establish a deficiency before embarking on vast amounts of supplements. For neuropathy patients with a normal Vitamin B level, there'll be enough extra in your daily multivitamin. There are also different forms of vitamin B and excessive amounts can bring about side-effects - best discuss it with your doctor.

CIDP Type Neuropathy and Vitamin B
Author: Shiraz Abbas May 27, 2017

Studies are now suggesting that vitamin B may have an important role in healing or easing the pain of peripheral neuropathy and CIDP type of neuropathy in particular.

Peripheral neuropathy is a disorder of the peripheral nerves. It is often characterized by weakness of limbs, numbness and pain. CIDP type neuropathy is a form of neuropathy in which there is a progressive and gradual destruction of the nerves through inflammation.

The vitamin B family of vitamins (also known as B complex vitamins) are critical for the proper functioning of the human body. They play a role in our immune system, energy, and red blood cell formation. Vitamin B12 is particularly important for neurological health and is a vitamin of choice to help treat neuropathy.

Vitamin B is commonly used to treat neuropathy. According to one study, people given high doses of vitamin B for four weeks had their pain reduced and saw improvement in their vibration perception threshold (VPT), that is, a testing that is used to measure large nerve fiber function in the body. People with lesser doses in a 8 week span saw lesser improvement.

Deficiency in B vitamins may lead to neurological problems. B12 in particular is important for the development of the central and peripheral nervous system. It has a critical role in maintaining the myelin sheath which ensures the transmission of nerve signals in the central and peripheral nervous system.

In neuropathy, especially CIDP type neuropathy, the signals between the spinal cord and other parts of the body are disrupted. With CIDP in particular, the myelin sheath is gradually but progressively damaged through inflammation and hence leading to an impairment of the transmission of nerve signals. This process of demyelination leads to axonal destruction. The disease is thus characterized by the following symptoms: weakness of the limbs, numbness, tingling sensation and pain. Loss of sensation and activity also happens depending on where the damage is occurring.

As B vitamins, particularly vitamin B12 play a role in maintaining a healthy peripheral nervous system, the vitamin may also play a role in the reconstruction of the nerves and more particularly the myelin sheath and hence helping the reduction of pain and improving sensation.

Some people with neuropathy may not be able to absorb vitamin B12 due to the loss of the “intrinsic factor” that is produced in the stomach and hence the loss of ability to absorb B12 through the digestive tract. In these cases like these, B12 may be injected into the body. Please check with your doctor if you have digestion problems with it comes to B12.

For those who can absorb it through the digestive tract, the following foods are high in B12 in addition to B12 supplements:

Beef Liver (71 mcg for a three-ounce serving, provides 2951% of the daily recommended intake).
Mackerel (16 mcg for a three-ounce serving, provides 661% of the daily recommended intake).
Sardines (8 mcg for a three-ounce serving, provides 333% of the daily recommended intake).
Read Meat (5 mcg for a three-ounce serving, provides 208% of the daily recommended intake).
Salmon (4 mcg for a three-ounce serving, provides 167% of the daily recommended intake).


Shiraz Abbas is the founder and manager of the CIDP Neuropathy Support Group. He is also one of the main community educators of IVIG therapy. He resides in Fresno, California. Shiraz can be contacted through our free CIDP advice service at 1-855-782-0574.

http://cidpneuropathysupport.com/cidp-neuropathy-and-vitamin-b/

How Do Anti Convulsants Work For Neuropathy

Today's post from painhq.org (see link below) looks at a common treatment for neuropathic pain and that is anti-convulsants or anti-epilepsy drugs. Many people living with neuropathy are prescribed these drugs after anti-depressants have failed and they are generally a pre-cursor to opiates (if they don't work for you). It is wise to consult carefully with your doctor (especially with Lyrica)depending on which anti-convulsant is prescribed and what the cause of your neuropathy is, as the side effects can be significant and for certain groups these drugs haven't been proven to work at all. It is a useful article in that it explains what they are and how they work and very often patients are not given this information by their doctors because it's assumed the patient will have difficulty understanding the science behind the drug's working process.

Anticonvulsants 
No author or date available
 
What are Anticonvulsants?

Anticonvulsants are a group of drugs that were designed to help manage seizures, but have since been used in the treatment and management of neuropathic pain. It is a fairly large and diverse family of drugs, sometimes referred to as ‘anti-seizure medications’ or ‘antiepileptics’. These drugs are thought to work through a number of different mechanisms: some may block different neurotransmitters; others may affect nerve signalling and ‘firing’ through binding to different receptors; altering ion channels in the brain; or ‘stabilizing’ some of the nerve cell membranes to ‘quiet’ pain signalling. On balance, it is thought that through these various mechanisms anticonvulsants affect pain communication pathways for patients with neuropathic pain.

How do they work?

Anticonvulsants were first used in pain management because it was thought that the nature of pain was somewhat similar to that of epileptic seizures – too much nerve cell firing. A number of these drugs have been shown to block the signals from damaged neurons which would normally communicate pain within the body.

What kinds are there? 
 
Gabapentin (Neurontin): Gabapentin works by binding to the calcium channels in neurons. These calcium channels help communicate pain within the body and, when blocked, help to dull the signal. Gabapentin is one of the only drugs used to treat neuropathic pain that is solely metabolized through the kidney (most are metabolized through the liver). It is considered one of the ‘first line’ medication treatments for most neuropathic pain syndromes. It is often used for treating post-herpetic neuralgia and diabetic neuropathy. 

Pregabalin (Lyrica): Developed as a more potent follow-up to Gabapentin, Pregabalin has been prescribed for postherpetic neuralgia, diabetic peripheral neuropathy and central neuropathic pain. Pregabalin is also associated with a lower risk for dependency and potential abuse. 
 
Carbamazepine (Tegretol) / Oxcarbazepine (Trileptal): Carbamazepine works by binding to sodium channels in neurons and limiting pain signals. Used It is frequently used to treat trigeminal neuralgia, but also diabetic neuropathy and potentially other forms of neuropathic pain (though more research is necessary). 

Valproate (Sodium valproate, valproic acid): Valproate helps block calcium channels and increases the levels of GABA in the brain. The calcium channels help to communicate pain while GABA helps to black dull pain signals in the brain by blocking communication channels and affecting nerve transmission. More evidence is needed to determine the use of Valproate in the treatment of neuropathic pain. 

Lamotrigine (Lamictal): Lamotrigine helps to block sodium channels and helps to regulate signals between neurons. Used it is sometimes used in the treatment of trigeminal neuralgia, diabetic neuropathy and central neuropathic pain. There are increased risks of side effects in woman using Lamotrigine, which also poses certain risks for pregnancies. 

Topiramate (Topamax): Topiramate has a number of mechanisms of action including sodium channels, calcium channels, GABA receptors, AMPA receptors and carbonic anhydrases. More evidence is needed to determine the use of Topiramate in the treatment of neuropathic pain.

Levetiracetam (Keppra): Levetiracetam works by binding to calcium channels in neurons, though it’s mechanisms aren’t fully understood. It can be used in the treatment of peripheral neuropathic pain. 

Lacosamide (Vimpat): Lacosamide works by binding to sodium channels in neurons, which prevents them from firing. Lacosamide also targets the cell which have been active for a longer period of time; in other words, damaged, over-active nerve cells that are sending pain signals (versus healthy cells). Lacosamide is used in the treatment of diabetic peripheral neuropathy.

What kind of Anticonvulsant is most effective for you?

Gabapentin (0)

Pregabalin (0)

Carbamazepine (0)

Valproate (0)

Lamotrigine (0)

Lacosamide (0)

Levetiracetam (0)

Topiramate (0)

Related evidence

Hearn L, Derry S, Moore RA. Lacosamide for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2012 Feb 15;2:CD009318. doi: 10.1002/14651858.CD009318.pub2.
Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ. Pregabalin for acute and chronic pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007076. DOI: 10.1002/14651858.CD007076.pub2
Moore R, Wiffen PJ, Derry S, Toelle T, Rice AS C. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD007938. DOI: 10.1002/14651858.CD007938.pub3
Price MJ. Levetiracetam in the treatment of neuropathic pain: three case studies. Clin J Pain. 2004 Jan-Feb;20(1):33-6.
Wiffen PJ, Derry S, Moore RA, Aldington D, Cole P, Rice AS, Lunn MP, Hamunen K, Haanpaa M, Kalso EA. Antiepileptic drugs for neuropathic pain and fibromyalgia - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2013 Nov 11;11:CD010567. doi: 10.1002/14651858.CD010567.pub2.
Wiffen PJ, Derry S, Lunn MPT, Moore R. Topiramate for neuropathic pain and fibromyalgia in adults. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD008314. DOI: 10.1002/14651858.CD008314.pub3
http://www.painhq.org/learning/knowledge-base/category/treatments/traditional-medicine-and-surgery/anticonvulsants

HOW TROUBLED MARRIAGE DEPRESSION HISTORY PROMOTE OBESITY

The double-whammy of marital hostility and a history of depression can increase the risk for obesity in adults by altering how the body processes high-fat foods, according to new research.

In the study, men and women with a history of depression whose arguments with spouses were especially heated showed several potential metabolic problems after eating a high-fat meal. They burned fewer calories and had higher levels of insulin and spikes of triglycerides -- a form of fat in the blood -- after eating a heavy meal when compared to participants without these risk factors.

The reduced calorie-burning in the seven hours after a single meal -- 118 fewer calories, on average, by previously depressed people with marital discord -- translates to weight gain of up to 12 pounds in a year. And the multiple problems add up to the potential for metabolic syndrome -- the presence of at least three of five factors that increase the risk for heart disease and diabetes.

"These findings not only identify how chronic stressors can lead to obesity, but also point to how important it is to treat mood disorders. Interventions for mental health clearly could benefit physical health as well," said Jan Kiecolt-Glaser, director of the Institute for Behavioral Medicine Research at The Ohio State University and lead author of the study.

"Our results probably underestimate the health risks because the effects of only one meal were analyzed. Most people eat every four to five hours, and often dine with their spouses," said Kiecolt-Glaser, also a professor of psychiatry and psychology. "Meals provide prime opportunities for ongoing disagreements in a troubled marriage, so there could be a longstanding pattern of metabolic damage stemming from hostility and depression."

Kiecolt-Glaser announced the new findings with co-author Martha Belury, professor of human nutrition at Ohio State, during the New Horizons in Science briefings at ScienceWriters2014, an annual conference hosted by Ohio State.

They discussed the research as part of their presentation "Metabolism: A new link between marital stress, depression and health."

The researchers recruited 43 healthy couples, ages 24 to 61, who had been married for at least three years. As part of the study, participants completed a range of questionnaires that included assessments of marital satisfaction, past mood disorders and depressive symptoms.

During the two daylong study visits, all participants ate eggs, turkey sausage, biscuits and gravy that totaled 930 calories and 60 grams of fat. The meal was designed to mimic common fast-food options, and matches the calories and fat in a Burger King double whopper with cheese or a Big Mac and medium fries at McDonald's.

Two hours later, the couples were asked to discuss and try to resolve one or more issues that researchers had previously judged to be most likely to produce conflict. Common topics were money, communication and in-laws.

Researchers left the room during these videotaped discussions, and later categorized the interactions as psychological abuse, distress-maintaining conversations, hostility or withdrawal.

After the meals, participants' energy expenditure -- or calories burned by converting food to energy -- was tested for 20 minutes of every hour for the next seven hours. Researchers obtained this data by using equipment that measured inhaled and exhaled airflow of oxygen and carbon dioxide. Blood samples were drawn several times after the meals to measure glucose, insulin and triglycerides and compare them to baseline levels.

Participants with both a mood disorder history and a more hostile marriage burned an average of 31 fewer calories per hour and had an average of 12 percent more insulin in the blood than low-hostility participants in the first measurement after the meal; the level didn't match other participants' lower levels until two hours after eating. Insulin contributes to the storage of fat.

The peak in triglycerides in the high-hostility and depressed participants four hours after eating exceeded all others' levels. High levels of triglycerides are considered a risk factor for cardiovascular disease.

"Insulin stimulates food intake and the accumulation of fat tissue in the abdomen, and adding that on top of the lower energy expenditure creates a higher likelihood for obesity," Belury said. "But it doesn't stop there: Elevated triglycerides lead to heart disease. Along with high insulin, elevated triglycerides indicate metabolism of sugars and fats is impaired. These are hallmarks of increased risk for heart disease and diabetes."

How Many Weeks Is A Full Term Pregnancy

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Your due date is very close now, but doctors don't consider your baby "full term" until 39 weeks. Spending the next two weeks in the womb allows your baby's brain and .Why Is 40 Weeks so Important? you want to be sure you deliver a full term baby if possible. How long is full term? Pregnancy lasts for about 280 days or 40 weeks..Pregnancy, also known as gravidity or gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one .But first, let's think about what is a so-called full-term pregnancy. Actually, this is a normal pregnancy which resulted in that childbirth has taken place from .New guidelines redefine "full-term pregnancy." Giving Birth Before Your Due Date: - Full Term: Between days and days.Best Answer: a normal pregnancy should last 38 weeks if you count from the day of conception. However, the day of conception is not always easy to .Your baby's development at 37-40 weeks of pregnancy. At 37 weeks, your pregnancy is considered full-term. The baby's gut digestive system now contains meconium .Until now, a "term" baby was defined as one born anytime from 37 weeks to 42 weeks - now doctors will define full pregnancy under narrower window.'Full-term' pregnancy gets a new, narrower definition. Generations of mothers-to-be have heard that babies born any time between weeks of .Continued. Term is "a biologic continuum between weeks and those babies born early in term are different than those babies born at full term," he .

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How Much Weight Should You Gain During Pregnancy

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Video embedded How much weight should I gain during my pregnancy? It depends on how much you weighed before you conceived and whether that's the appropriate weight .How many pounds should you pack on during pregnancy? WebMD explains how much weight to gain, what to eat, What if You Gain Too Much Weight During Pregnancy?.The amount of weight you should gain depends on At what rate should I gain weight during my pregnancy? How much you should gain depends on your weight before you .Use our pregnancy weight gain calculator to estimate how much weight you should gain during pregnancy and find Weight Gain Pregnancy Weight Gain Calculator.Pregnancy Weight Gain Calculator How much weight should you gain while you're pregnant? Keep tabs on your pregnancy pounds with our pregnancy weight gain calculator..Learn how much weight you should gain during pregnancy and how it's distributed in your body. Get the answers to all your pregnancy weight gain pregnancy weight .We have advice about weight gain in pregnancy and how your BMI affects how much you should gain Weight gain in pregnancy. Weight gain during pregnancy: .Video embedded How much weight should you gain during pregnancy? It depends on your body mass index BMI before you get pregnant. BMI is a measure of body .Weight Gain During Pregnancy; After Pregnancy. Be sure to talk to your health care provider if you are uncertain about how much weight you should gain during your .American Pregnancy Association . One question you may have pertains to how much weight you can expect to gain during the next several months. Why is weight gain .

How Useful Is Amitriptyline For Neuropathy

Today's post from meassociation.org.uk (see link below) discusses whether Amitriptyline actually works in reducing neuropathic pain and comes to some worrying conclusions, at least from the patient's point of view. Amitriptyline is one of the first ports of call for doctors prescribing medication for neuropathy and has been for decades and it has to be said that many people seem to benefit from it. However, the tests and studies shown here seem to indicate that it has little effect in reality. Remember, Amitriptyline is an anti-depressant so it may be logical that some neuropathy patients feel better having taken it, especially if the stress of the disease has caused them to be depressed, or their muscles and joints to reflect their stress. It's something you really need to discuss with your doctor and make sure you are convinced by his or her arguments for taking it. Amitriptyline is by no means the only treatment for neuropathy that is surrounded by controversy and dispute. More posts on the subject can be found by looking in the alphabetical list to the right of the blog.

TGI Friday! Our weekly round-up of recently published research study abstracts and news
by Tony Britton on December 21, 2012

From Cochrane Database Syst Rev 12 December 2012.Amitriptyline for neuropathic pain and fibromyalgia in adults.

Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ.
Pain Research and Nuffield Department of Clinical Neurosciences, University of Oxford, Pain Research Unit, Churchill Hospital, Oxford, Oxfordshire, UK, OX3 7LE.

Abstract

BACKGROUND

Amitriptyline is a tricyclic antidepressant that is widely used to treat chronic neuropathic pain (pain due to nerve damage) and fibromyalgia, and is recommended in many guidelines. These types of pain can be treated with antidepressant drugs in doses below those at which the drugs act as antidepressants.

OBJECTIVES

To assess the analgesic efficacy of amitriptyline for chronic neuropathic pain and fibromyalgia.To assess the adverse events associated with the clinical use of amitriptyline for chronic neuropathic pain and fibromyalgia.

SEARCH METHODS

We searched CENTRAL, MEDLINE, and EMBASE to September 2012, together with reference lists of retrieved papers, previous systematic reviews, and other reviews; we also used our own handsearched database for older studies.

SELECTION CRITERIA

We included randomised, double-blind studies of at least four weeks’ duration comparing amitriptyline with placebo or another active treatment in chronic neuropathic pain or fibromyalgia.

DATA COLLECTION AND ANALYSIS

We extracted efficacy and adverse event data, and two study authors examined issues of study quality independently. We performed analysis using two tiers of evidence. The first tier used data meeting current best standards, where studies reported the outcome of at least 50% pain intensity reduction over baseline (or its equivalent), without the use of last observation carried forward (LOCF) or other imputation method for dropouts, reported an intention-to-treat (ITT) analysis, lasted 8 to 12 weeks or longer, had a parallel-group design, and where there were at least 200 participants in the comparison. The second tier used data that failed to meet this standard and were therefore subject to potential bias.

MAIN RESULTS

Twenty-one studies (1437 participants) were included; they individually involved between 15 and 235 participants, only four involved over 100 participants, and the median study size was 44 participants. The median duration was six weeks. Ten studies had a cross-over design.

Doses of amitriptyline were generally between 25 mg and 125 mg, and dose escalation was common.There was no top-tier evidence for amitriptyline in treating neuropathic pain or fibromyalgia. Second-tier evidence indicated no evidence of effect in cancer-related neuropathic pain or HIV-related neuropathic pain, but some evidence of effect in painful diabetic neuropathy (PDN), mixed neuropathic pain, and fibromyalgia.

Combining the classic neuropathic pain conditions of PDN, postherpetic neuralgia (PHN) and post-stroke pain with fibromyalgia for second-tier evidence, in eight studies and 687 participants, there was a statistically significant benefit (risk ratio (RR) 2.3, 95% confidence interval (CI) 1.8 to 3.1) with a number needed to treat (NNT) of 4.6 (3.6 to 6.6).

The analysis showed that even using this potentially biased data, only about 38% of participants benefited with amitriptyline and 16% with placebo; most participants did not get adequate pain relief.

Potential benefits of amitriptyline were supported by a lower rate of lack of efficacy withdrawals; 8 out of 153 (5%) withdrew because of lack of efficacy with amitriptyline and 14 out of 119 (12%) with placebo. More participants experienced at least one adverse event; 64% of participants taking amitriptyline and 40% taking placebo. The RR was 1.5 (95% CI 1.4 to 1.7) and the number needed to treat to harm was 4.1 (95% CI 3.2 to 5.7). Adverse event and all-cause withdrawals were not different.

AUTHORS’ CONCLUSIONS

Amitriptyline has been a first-line treatment for neuropathic pain for many years. The fact that there is no supportive unbiased evidence for a beneficial effect is disappointing, but has to be balanced against decades of successful treatment in many patients with neuropathic pain or fibromyalgia.

There is no good evidence of a lack of effect; rather our concern should be of overestimation of treatment effect. Amitriptyline should continue to be used as part of the treatment of neuropathic pain or fibromyalgia, but only a minority of patients will achieve satisfactory pain relief. Limited information suggests that failure with one antidepressant does not mean failure with all.It is unlikely that any large randomised trials of amitriptyline will be conducted in specific neuropathic pain conditions or in fibromyalgia to prove efficacy.


MEA note
Our medical adviser, Dr Charles Shepherd, comments: Low dose amitriptyline, along with some other sedating tricyclic drugs, is one of the commonest drugs to be prescribed for the relief of moderate to severe pain in ME/CFS, especially where this has a neuropathic quality, that has not responded to other types of treatment. Some people with ME/CFS gain considerable benefit whereas others fail to do so and/or experience a range of side-effects. The MEA has an information leaflet on amitriptyline.

From Journal of Clinical Sleep Medicine, 11 December 2012

Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review

Melinda L. Jackson, Ph.D.; Dorothy Bruck, Ph.D.
School of Social Sciences and Psychology, Victoria University, Victoria, Australia

http://www.meassociation.org.uk/?p=13975

HOW LEARNING TO TALK IS IN THE GENES

Researchers have found evidence that genetic factors may contribute to the development of language during infancy

Scientists from the Medical Research Council (MRC) Integrative Epidemiology Unit at the University of Bristol worked with colleagues around the world to discover a significant link between genetic changes near the ROBO2 gene and the number of words spoken by children in the early stages of language development.

Children produce words at about 10 to 15 months of age and our range of vocabulary expands as we grow -- from around 50 words at 15 to 18 months, 200 words at 18 to 30 months, 14,000 words at six-years-old and then over 50,000 words by the time we leave secondary school.

The researchers found the genetic link during the ages of 15 to 18 months when toddlers typically communicate with single words only before their linguistic skills advance to two-word combinations and more complex grammatical structures.

The results, published in Nature Communications today [16 Sept], shed further light on a specific genetic region on chromosome 3, which has been previously implicated in dyslexia and speech-related disorders.

The ROBO2 gene contains the instructions for making the ROBO2 protein. This protein directs chemicals in brain cells and other neuronal cell formations that may help infants to develop language but also to produce sounds.

The ROBO2 protein also closely interacts with other ROBO proteins that have previously been linked to problems with reading and the storage of speech sounds.

Dr Beate St Pourcain, who jointly led the research with Professor Davey Smith at the MRC Integrative Epidemiology Unit, said: "This research helps us to better understand the genetic factors which may be involved in the early language development in healthy children, particularly at a time when children speak with single words only, and strengthens the link between ROBO proteins and a variety of linguistic skills in humans."

Dr Claire Haworth, one of the lead authors, based at the University of Warwick, commented: "In this study we found that results using DNA confirm those we get from twin studies about the importance of genetic influences for language development. This is good news as it means that current DNA-based investigations can be used to detect most of the genetic factors that contribute to these early language skills."

The study was carried out by an international team of scientists from the EArly Genetics and Lifecourse Epidemiology Consortium (EAGLE) and involved data from over 10,000 children.

How Do Clinical Studies Work Vid

Today's animated video produced by Roche, looks at how clinical studies work. It's short and to the point and gives a little more information regarding clinical trials and studies. As neuropathy patients, we are used to the next 'hopeful treatment' being announced and entering the trial stages but we rarely think about what sort of process that is. Because it can be a very long process, the initial excitement at hearing of a potential new discovery can very quickly wear off and lead to frustrations that nothing is being done but there is little doubt that trials and studies are vital to ensure safety and achieve the necessary proof that something is what it says it is.

Drawn to Science: Clinical trials  
Published on 28 May 2014

Clinical trials are essential to providing the scientific data to determine whether new drugs, diagnostics or procedures are both safe and effective when used to diagnose and treat people.

Carefully conducted clinical trials are performed in human volunteers to provide answers to important questions. Every new treatment is usually tested in three phases of clinical trials before regulatory agencies consider it safe and effective. Depending on product type and development stage, investigators initially enroll volunteers and/or patients into small pilot studies and subsequently conduct progressively larger scale comparative studies. As positive safety and efficacy data are gathered, the number of patients typically increases. Clinical trials can vary in size, and can involve a single research entity in one country or multiple entities in multiple countries.

For more information about clinical trials at Roche visit http://www.roche.com/research_and_dev...


 https://www.youtube.com/watch?v=5zXuON7Rueo

How Does A Carer Cope

Today's post from satonmybutt.wordpress.com (see link below) is a much-needed look at chronic illness from the viewpoint of the carer. In this case, it's the patient who generously acknowledges the debt he has to his partner and fully realises that taking carers for granted is a big mistake. Of course, patients who are in chronic and unrelenting pain are entitled to feel sorry for themselves at times but they can forget the effect their illness is having on friends, family and carers. It doesn't do any harm to remind ourselves every now and then that we're not the only victims here.

My side 
April 24, 2015 By SatonmyButt

I asked my wife to write a post from her point of view and it was posted yesterday, it seems to have been well received because of its honesty because people who are unwell or disabled never fully understand how it feels to be the carer.

One of the parts that I enjoyed reading was how it feels for her to hear me saying I’m in pain, from my side I have sometimes wondered about the response or lack of response I get from saying it. I’m obviously in pain every hour of every day and I handle a level of about 5, but on days when the pain soars I do tend to vocalise that and its hard when there is no comforting response from my wife.
As she said in her blog, first she has heard it so many times that she has become numb to hearing it, secondly as my wife she finds it hard to know her husband is in constant pain and so as a defence mechanism she uses that numbness to protect herself from that thought.
The problem is that when we are in pain, we are also more sensitive and so its upsetting. I’m not sure what I actually need from my wife when I tell her that I’m in pain, I do know that I need to vocalise because it somehow helps?

It’s extremely hard to explain to your wife/husband what it’s like to live with chronic pain, its hard to explain to anyone! I could be laid on the settee with my wife beside me, my miniature dachshund asleep under the blanket and my two daughters in the room and yet I can still feel like I’m alone, I’m obviously not talking about physically alone but a loneliness that is felt because I’m in pain and its constant, I am going through a whole multitude of feelings and this is constant it’s not a momentary pain that I need help through its forever.

About eight years ago I was changing the water bowl in one of my scorpion enclosures, this one was a rescue and so we had a rough idea of what type it was but we couldn’t be 100% sure, so it was ID’d as an Arizona bark scorpion which is still fatal if you have an underdeveloped immune system. I had several scorpions and knew how to handle them, this one was so quiet and unlike the others doing enclosure maintenance wasn’t a problem as it just ignored me.



I guess I became a little too comfortable with its subdued ways and so one day whilst changing the water I was caught off-guard when it turned and stung me! Back then I could walk and I went to my wife who was hoovering and said “a scorpion stung me!” “Which one” she replied, “the desert one” and she calmly told me to go and sit down and she would be there in a minute. She was calm because she knew that if my heart was beating faster then any venom would be pumped around my body quicker, she was amazing and she drove me to the hospital.

The reason I have retold this story is because the pain was quite intense and it lasted a good few days and she fussed around me constantly, she was checking I was okay, how was my pain. Over a short period of time its possible to be that way towards a loved one in pain, its even possible over an extended period but its been about seven years that I have been in pain and no one can possibly be asking and fussing for that amount of time, thinking about it like that, I realise it would even drive me mad!

I know that it’s possibly harder for my wife as a carer than I could ever imagine, she looks after me making sure I’m showered, making sure I have drinks and my meds, then she has to cope knowing I’m in pain and putting up with me when the pain makes me grouchy and intolerable, also having to see me when I can’t take anymore and I just lay there crying.
I’m so glad I don’t have to be on the other side!

About SatonmyButt

Disabled husband, father, gramps. I have CRPS, CFS and arthritis. I have a dry sense of humour and I enjoy a good moan. I don't care about race, colour, sexual preference or religion, I do care if you are respectful to others.

https://satonmybutt.wordpress.com/2015/04/24/my-side/

How Long Is Dog Pregnancy

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How Long Is Pregnancy

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How long it last i don't have the answer but the reason you cramp is because your body is getting ready to being pregnant--you will get like sharp shooting pains on .Wondering how far along your pregnancy is? Find out how long pregnancy lasts and discover how to date your pregnancy based on your last menstrual period. - BabyCentre.Pregnancy, also known as gravidity or gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one .How Long Is Each Trimester? Some just break it up into three chunks of 13 weeks, but most add on an extra week for a grand total of 40 weeks of pregnancy..A pregnancy is suppose to last 40 weeks but not really because they add the 2 weeks between your LMP and your conception date. It's weird, so actually it's .What do you need to know about taking a pregnancy test? How to understand the difference between various types of pregnancy tests..How soon can you know if you're pregnant? Learn the common early signs of pregnancy from WebMD..Are you ready to start trying for a baby? Learn how long it takes to get pregnant, conception rates, and how you can get pregnant faster..How long a healthy pregnancy lasts can vary by as much as five weeks, even when doctors precisely determined the date of conception, a new study suggests..How long a healthy pregnancy lasts can vary by as much as five weeks, even when doctors precisely determined the date of conception, a new study suggests..

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TODAY Parents is the premiere destination for parenting news, advice community. Find the latest parenting trends and tips for your kids and family on TODAY.com..Pill nowadays is the most popular pregnancy termination option. Medical Pill - is a method of in early pregnancy 6-7 weeks .Other medical and health news. First study to link antibiotic resistance with exposure to the disinfectant chlorhexidine Telemedicine, in addition to clinical care .Lilypie Baby Days are free custom ticker graphics that update each day to display your child's age, or how far along your pregnancy is. There are Pregnancy, Birthday .How Long Can You Wait to Have a Baby? Deep anxiety about the ability to have children later in life plagues many women. But the decline in fertility over the course .

HOW TO PREVENT DEPRESSION RISK AMONG TEENS

If you wish to shield your kids from depression, driving home the point that personalities can be changed may help, a study suggests.

A low-cost, one-time intervention that educates teenagers about the changeable nature of personality traits may prevent an increase in depressive symptoms, the findings showed.

"We were amazed that a brief exposure to the message that people can change - during a key transition, the first few weeks of high school - could prevent increases in symptoms of depression," said lead researcher David Scott Yeager from University of Texas at Austin in the US.

Adolescence is a challenging transitional period marked by puberty and also changes in friendship networks and status hierarchy.

Research suggests that many lifelong cases of major depression emerge during this developmental period.

For the study, researchers conducted a longitudinal intervention study with about 600 adolescents.

Students were randomly assigned to participate in the treatment intervention or a similar control activity, though they were not aware of the group assessment.

A follow-up 9 months later showed that rates of clinically significant depressive symptoms rose by roughly 39 percent among students in the control group, in line with previous research on depression in adolescence.

Students who learned about the malleability of personality, on the other hand, showed no such increase in depressive symptoms, even if they were bullied.

The data revealed that the intervention specifically affected depressive symptoms of negative mood, feelings of ineffectiveness and low self-esteem.

The study appeared in the journal Clinical Psychological Science.

How Your Neuropathy May Be Diagnosed Vid

Today's video from mskcc.org (see link below) is produced by the memorial Sloan Kettering Cancer Center and is naturally aimed at chemotherapy patients who have suffered nerve damage due to the drugs. It goes on to explain how a diagnosis is made and what possible procedures are used to do that. However, the testing procedures apply to neuropathy from all causes and it is therefore a useful guide to what may happen during your diagnostic process whether you have cancer or not. However, mainly due to cost, most doctors will come to the conclusion that you have peripheral neuropathy long before the results of such tests are known and decide not to carry them out. This doesn't mean that they are neglecting you, it just means that they are making a reasoned diagnosis based on the evidence they already have. Thanks to the unique symptoms of neuropathy, your own story may well give them enough to go on and begin treatment.

Video: Diagnosing Chemotherapy-Induced
Peripheral Neuropathy
Memorial Sloan Kettering Cancer Center

Memorial Sloan Kettering occupational therapist Gabrielle Miskovitz explains that your doctor or therapist will first review your chemotherapy regimen, symptoms, and preexisting medical conditions to identify causes of peripheral neuropathy. Your specialist may then examine your skin for cuts and injuries, which can occur due to decreased sensitivity from neuropathy, and also evaluate your reaction to light touch, sensitivity to sharp and dull stimulation, finger muscle strength, reflexes, balance, and autonomic symptoms.

Some doctors recommend neurophysiologic tests such as electromyography, nerve conduction studies, and quantitative sensory tests to further examine peripheral nerve function, although findings from these tests do not always correspond with symptoms. Your doctor may also recommend laboratory and imaging tests to look for metabolic disturbances, nutritional deficiencies, and other possible causes of nerve damage.
Physical and occupational therapists may perform several additional tests to assess the impact of chemotherapy-induced peripheral neuropathy on your balance, stability, and fine motor skills. Based on this assessment, your therapists will help you determine your functional goals and select the appropriate therapy to reduce the risk of injury and improve your quality of life.

http://www.mskcc.org/videos/diagnosing-chemotherapy-induced-peripheral-neuropathy