October 2012

My Battle with Endometriosis and Migraines

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Twenty-Five Years for the Correct Diagnosis: Endometriosis

My name is Angela Wice and I am 35 years old. I had one child with natural birth in 2003 and was diagnosed with Stage IV endometriosis June 2006. My Journey has been long, depressing and still not over 25 years later. Here is my story.

 

Early Childhood and Early Troubles

I was a very busy active, athletic, child growing up.  I would say besides being born with jaundice, I was healthy until I turned 7 years old. I was rushed to the hospital because I started bleeding rectally. I was operated on within hours of being at the hospital for intestinal volvulus and appendectomy. They sewed my bowel to the pelvic wall so it wouldn’t happen again.

By the age of 10, I started to get chronic headaches and was told to stay away from chocolate, peanuts and cheese.

The Pain of Endometriosis

I got my first period when I was 13. The second time I got my period is when the pain started. I had the worst cramps ever, my legs would go numb, I was nauseated, I was bloated, and I was in so much pain I would vomit. I remember them saying that you should only bleed 1 TBSP a period and I was like “Are you kidding me, I do that in an hour!!”

My mother took me to the doctor the same year. The doctor did an ultrasound and a transvaginal one as well. The pain was so bad on the left side when she inserted it inside me but other than that nothing showed up but she did say that I possibly had endometriosis. That was at 14 years old, nothing was done about it. I was given Naproxen and that was that.

Endometriosis and Migraines

My first migraine happened when I was working at around 16 years old. My whole right side went numb including my tongue. I went to the hospital and they said it was an Aura Migraine.

By 17, I was far beyond constipated and the rectal pain I had was so severe and sporadic. To be honest, I never really put two and two together because I could just be driving and all of the sudden it felt like was being stabbed with a knife in my rectum. That never went away. It was constant.

I knew I was getting my period because I would, all of the sudden, not have constipation and I mean literally evacuate all my bowels at one time. That was my sign to start taking the Advil, and by the next morning or the middle of the night there it was. Sometimes if I didn’t take the Advil in time it was too late, nothing would work. I would pump my system with so much of it until my period was over. During my period I could not have a BM at all until my period ended. It was excruciating. I got fed up went to see a gastrologist. I had a colonoscopy and was told it was IBS, which I did not believe. That was the first of over 40+ doctors/specialist I was to see until I was diagnosed.

Endless Misdiagnosis

For the next 15 years it became a blur.  I was depressed, angry, frustrated, disappointed, rejected and in so much pain that never seemed to end.  I went to doctor after doctor only to be diagnosed with fibromyalgia, chronic fatigue syndrome, restless legs syndrome, thoracic outlet syndrome, TMJ, irritable bowel syndrome, chronic pain, cluster migraines, complicated migraines, neuropathic pain syndrome, overactive bladder, depression, anxiety and I developed an eating disorder (Bulimia).

I was at the end of my rope in 2006 and had another ultrasound only to find out my results were misplaced until I called 3 months later to find out that I had a 10cm complex cyst.  I was sent to an oncologist who took blood work CA125 to see if I had cancer. The first test done was 37 on my period and 78 when I was ovulating. He felt positive it was endometriosis and sent me to a local gynecologist who told me nothing could be done about the Endo and to take Lupron. I refused, as I had done my research. She then put me on Marvelon21 and sent me on my way. One thing changed for sure right away from taking the birth control pill and that was the chronic nausea was gone within a week, acne cleared up and my mind was right. I really felt like I got a new lease on life.

The Power of Patient Groups

I ended up on Medhelp and found a great group of women that to this day we still talk. We have a private group of about 20 women on Facebook called the BBBC (Bulge Battling Battalion Cysters). Some of the women had cancer, some were in remission, some had Endo etc. They were my support and still are, without them I would have surely not been here today.

I did my research and found the best Endo doctor in Ontario. It took 3 minutes for him to find the rectovaginal cyst that had caused me so much pain all of these years. I was in tears, tears of relief that finally, finally someone knew what was going on. He couldn’t do the surgery because I had previous bowel surgery so he sent me to his protégé and he operated on me a month later.

My story continues. More next week.

Fabricated Data: What Happened to Peer Review?

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Two independent reports published just this month call in to question the integrity of medical research publishing and the effectiveness of the peer review process.

Publish or Perish and Peer Review

Academic careers are made or destroyed on the number of publications one has in high ranking peer-reviewed journals. In many cases, it’s not the quality of the research but the quantity of publications. The industry insists that peer review is the gold standard that ensures only quality research is published. More and more, however, we are finding that this may not be the case and that economic interests often override ethical behavior.

Conflicts of Interest

Just last week, a report in the Archives of Internal Medicine found that 71% of committee chairpersons responsible for instituting clinical guidelines had significant conflicts of interest with industry. In many ways, those clinical guidelines set the tone for what will be accepted in leading medical journals. As we and others have reported before, publication bias, the tendency to publish only those studies that present positive results (e.g. support accepted clinical guidelines) in scientific journals is rampant and can seriously jeopardize patient care.

Even Worse: Fraud and Misconduct in Medical Publishing

Earlier this month a report published in the Proceedings of the National Academy of Sciences  found that in 2012, one in every 10,000 medical articles published is retracted. This is compared to one in every 100,000 articles that was retracted in 1975, a ten-fold increase. Strikingly, 67% of the retractions were due to misconduct and the vast majority (43%) for fraud or suspected fraud (fabricated or falsified data, plagiarism).

Information Laundering

The increased rate of fraudulent research retraction, combined with the high publication bias, the industry sponsored ghostwriting scandals, the recognized conflicts of interest on many peer review panels, and the overall lack of transparency in medical publishing make it very difficult for physicians or patients to trust the veracity of ‘clinical evidence’.  The lines between science and profit have been blurred so much that the integrity of the once revered peer review process is questionable.  According to the Richard Horton, editor of the Lancet:

“journals have devolved into information laundering operations for the pharmaceutical industry.”

A New Model

Much like the broken healthcare system where physicians are rewarded for the number of services and tests they provide rather than the quality of care or positive outcomes, medical publishing and by association medical research are tangled in skewed economic model; one that rewards quantity over quality and positive results over negative. If peer review is no longer the stopgap to medical information fraud that it once was, we need a new model. Some suggest open data and crowd-review are the answers.  We’ll explore the open data debate in subsequent posts. What do you think? Should raw, health or clinical trials data be open to all, presuming personal identity can be concealed?

 

Heart Rate Variability, Stress and New Apps for Measurement

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My mom was diagnosed with cancer when I began high school, and we noticed that every time she was stressed her white blood cell count increased significantly. This increase in disease-fighting cells, or leukocytes, is referred to as leukocytosis.

While cancer alone elevates white blood cell counts, Mayo Clinic states that severe emotional stress or physical stress can affect white blood cell count as well. My mom felt fairly certain that stress and the resulting leukocytosis was no help for fighting disease.

In 2001, researchers from the US National Institute on Aging published a study in the Journal of the American College of Cardiology that found an elevated white blood cell count was tied to heart attack and death. In 2002, scientists found an association between increased white blood cell count and insulin sensitivity. In fact, white blood cell count was often a predictor of type 2 diabetes.

Researchers are still trying to determine whether an increase in white blood cell count results in disease or vice versa, but there have since been a number of studies that indicate higher stress levels negatively impact health. Harvard researchers found high stress levels are a better predictor of death in cancer and heart attack patients than smoking, while another study tied stress to subsequent heart attacks.

If stress causes leukocytosis, and both leukocytosis and stress is associated with disease, tracking and reducing stress seems like a reasonable concept. Luckily, SweetWater Health is making stress management easier for the masses.

Innovative Ideas for Managing Stress

I met with the COO of SweetWater Health, Jo Beth Dow, at the Health 2.0 Conference in San Francisco, where she presented the company’s stress detection and management app, SweetBeat. What struck me was Dow’s genuine interest in helping others improve their health.

By strapping a waterproof heart rate monitor to your chest, you can track heart rate data on your iPhone (the device will soon be compatible with Android phones) so you can see how your activities affect your stress levels. While giving the presentation, Dow’s heart rate was very high, naturally due to the stress of speaking in front of a large audience.

The SweetBeat app is designed to encourage you to monitor your heart rate and heart rate variability, with the hope that you will be able to identify stressful activities and either mitigate these activities or practice helpful coping strategies, such as breathing slowly and regularly. In fact, a breath pacer appears when users of SweetBeat show high stress levels, as a reminder to just breathe.

Dow noted that drinking alcohol increased stress levels, and going from one alcoholic drink to two elevated stress levels remarkably. When we become aware of how our bodies respond to particular events, we can be more careful when making lifestyle choices.

Stress Management Tied to Weight Loss

Ronda Collier, the CEO of SweetWater Health, said stress management plays an important role in weight loss. Collier explains, “[s]tress releases hormones such as cortisol that can signal the body to retain fat or even cause fat cells to grow.” A study published in the International Journal of Obesity in March of 2011 found that lower stress levels were associated with weight loss.

Weight gain may also be a result of food sensitivities, according to Dr. Mark Hyman. In order to help individuals identify and eliminate foods they are sensitive to, SweetBeat offers a food sensitivity test, based on studies of immunologist Dr. Arthur F. Coca. Dr. Coca found an increased heart rate in subjects that ingested foods the body was sensitive to, so naturally, SweetBeat can help determine whether one is sensitive to a particular food or not.

Heart Rate Variability Indicates Wellness

The SweetBeat app captured my interest because I didn’t know much – if anything – about heart rate variability. Heart rate variability is just that: the varying time between heartbeats. Turns out, a high heart rate variability indicates good health, which was not what I expected.

Dow explained, comparing heart rate variability to a rubber band. When a rubber band is in good working order, it immediately snaps back to its initial shape. In this same sense, the heart is in good working order when it can respond quickly to stimuli from the nervous system. When a rubber band is old, however, it doesn’t have the same elasticity and may not spring back so easily, just as an older heart may not respond as quickly to the brain.

Low heart rate variability has been connected to heart attack, and monitoring heart rate variability is a good way of tracking your health and determining if necessary changes need to be made to improve overall well-being.

Dow shared that an athlete using SweetBeat noticed his low heart rate variability. Though SweetWater Health associates warned the athlete, his doctor dismissed any admonitions. Soon after, the athlete suffered a heart attack and the doctor contacted SweetWater Health to ask about the SweetBeat monitor.

The Health 2.0 showcased a number of applications that worked to improve patient health, and SweetBeat was among them. I look forward to seeing what technologies are on the market next year.

The Bottom Line: BPA and Endocrine Disruptors

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Unless you have been living under a rock for the past ten years, you probably know about BPA. Bisphenol A is a chemical used in the manufacturing of some hard plastics and liners for canned foods, including infant formula. In recent years, more and more plastic products, especially items like baby bottles, have adopted the “BPA-free” label. Why? It turns out that BPA mimics some effects of estrogens in the body.  BPA and chemicals like it, known collectively as endocrine disruptors, have been implicated in a disturbing variety of health problems, ranging from early puberty to cancer. The U.S. Food and Drug Administration banned the use of BPA in manufacturing of baby bottles and sippy cups in July, 2012. However, its use in can liners and other plastic products is still essentially unregulated. The science of endocrine disruptors is still in its infancy, and consumers are left to decide what constitutes an acceptable level of exposure. So, how concerned should we be?

Is BPA Safe?

This turns out to be a complicated question. The vast majority of studies on BPA and other endocrine disruptors have been done in rodents, whose endocrine systems are not equivalent to those of humans. Many of the early studies of these compounds exposed animals to doses much higher than humans might ever experience or administered the compounds via routes that were unlikely in humans (e.g. intravenously). There was also a widespread lack of consistent methodology across studies, with different labs examining different endpoints, so that results were nearly impossible to compare and interpret. Recent efforts by the FDA, National Institutes of Health and Centers for Disease Control have helped to coordinate multiple, large scale studies and improve methodology.

The Good News and the Bad News about BPA

Based on these more recent studies, there’s good and bad news. The good news: recent estimates of exposure levels for infants are 10-fold lower than previous estimates (0.24 micrograms/kg body weight/day vs. 2.4 micrograms/kg body weight per day) [1]. This may be partly due to increased inaccurate assumptions about how parents prepare bottles. Also, studies in primates, whose endocrine metabolism is closer to humans, suggest that most orally-administered BPA is rapidly metabolized to an inactive form and excreted [2].

Now, the bad news.  A recent study, in which pregnant rhesus monkeys were exposed continuously to low concentrations of BPA, similar to those found in human tissues, found that the ovaries of female fetuses had more unenclosed follicles [3]. This could mean that the female offspring of exposed monkeys would have fewer viable eggs and diminished reproductive success as adults, though this study did not follow the offspring to adulthood. Another study examined the effects of BPA on human breast epithelial cells grown in culture [4]. BPA increased expression of genes involved in DNA repair, including the BRCA1 and BRCA2 genes. Women who carry specific mutations in these genes are at five times greater risk for developing breast and ovarian cancers than the general population. The study suggests that women who carry these mutations may be unable to repair DNA damage induced by BPA and may be especially vulnerable to its effects on estrogen-sensitive tissues.

How Concerned Should We Be about BPA?

So, back to our original question: how concerned should we be? While exposure levels are probably fairly low, and much of the BPA we ingest is likely metabolized, there are certain populations, including pregnant women, infants and women at high risk for breast and ovarian cancer, who should be especially concerned. In the absence of tighter regulatory controls on BPA use in manufacturing, there are simple steps consumers can take to reduce their exposure. Bottom line, am I going to stop buying canned foods? Not entirely, but fresh is always nutritionally superior to canned anyhow. Do I buy BPA free bottles for my infant son? Absolutely.  Do I spend a lot of time worrying about my family’s exposure to BPA? No. Not because it’s not important, but because there are many other known endocrine disruptors in our environment, and probably many more that haven’t yet come to our attention. BPA is just a small piece of a very complex puzzle.

References

[1]Department of Health and Human Services. Memorandum: Exposure to Bisphenol A (BPA) for infants, toddlers and adults from the consumption of infant formula, toddler food and adult (canned) food. 2009

[2]Doerge D.R., Twaddle N.C., Woodling K.A., Fisher J.W.  Pharmacokinetics of bisphenol A in neonatal and adult rhesus monkeys, Toxicology and Applied Pharmacology 2010; 248: 1–11.

[3] Hunt P.A., Lawson C., Gieske M., Murdoch B., Smith H., Marre A., Hassold T., Vandevoort C.A. Bisphenol A alters early oogenesis and follicle formation in the fetal ovary of the rhesus monkey. PNAS USA;  2012 Sep 24. [Epub ahead of print].

[4] Fernandez S.V., Huang Y., Snider K.E., Zhou Y., Pogash T.J., Russo J. Expression and DNA methylation changes in human breast epithelial cells after bisphenol A exposure. International Journal of Oncology 2012; 41(1): 369-77.

Aggressive Prostate Cancer without Symptoms

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This (retired) journalist usually writes about people other than himself. Because conditions warranted, I decided to answer friends and family who were concerned about my health. I just found out the most devastating part of my prostate cancer diagnosis, that it was a rare surprise case. Let me tell you and yours how it feels. One early morning (middle of the night) I sat up and wrote this in one-take.

The Maples and Prostate Cancer

I am a fairly emotional person. Apparently I display it only through my work. Now, that I think about it, all of my feature reporting for TV and Radio has been based on what I feel must be right. Then I would find someone with those virtues and extol them. These found me.

Just the other day as I got out of my car a man (and his wife) came towards me from their position of waiting. I thought it might be for a bus, but they were not in the correct spot. Maybe he would ask. Then he told me they were waiting for a taxi to “go see the maples.” My first impression was that they were Japanese. He corrected me. “We are Korean, visiting from Chicago. We came by the big GreyHund last night. I have been here 35 years and no learn English.”

I convinced him his language was fine. I did not tell him he was miles away from the color of “the maples.”  Then the taxi came to take them back downtown. They could not get a hotel there last night since they had no credit card.  Somebody referred them five miles out of the center city for a fifty-dollar night. We met; I did not really help. I did not give directions miles away to the colorful trees. But he felt the need to talk about it. He came to me with her in tow. Then they were gone.

At their elderly age they were ready to get up and go to see things. They had no plan. They just went. They had a purpose. And they just went. Happily.

This was the same day I went… to hear the beginning of my prognosis for prostate cancer which has become very aggressive since we first took note in early December, last year.  Since then, there has been a plan and a purpose but it did not seem obvious to me. Every three months I receive a hormone shot to maintain the speed of the cancer growth into the lymph system.  Happily, the PSA (prostate specific antigen) test shows a great reduction in numbers indicating cancer. But that is almost too late.

Spreading Prostate Cancer

A full-body bone scan early this year indicated the presence of lesions in my liver, possibly in my pelvis, and maybe more. A month ago it was determined with a new MRI that a major growth on my left femur just below the hip was the reason for a major complaint while attempting walking. That curtailed my part-time position as a tour-guide inside the Lucas Oil Stadium for a while.

Immediate surgery to “burn” the tumor off the bone with RFA (radio frequency ablation) proved it was the same cancer which had traveled from the prostate.

Prostate Cancer without Early Symptoms

Confirmation is one thing. Consternation is another. We are advised as older males to be constantly vigilant for the prostate problem.  It can arrive in young males too. It is the most prevalent cancer in males, after skin cancer. Prostate cancer can start with no symptoms. Apparently mine started without me. It was immediately labeled aggressive and has been so. I have been told not all cancers are detected. I have one which slipped through.

No Cure just Maintenance

The doctors mentioned many months ago that there would be no cure, just maintenance. Maybe two to five years of maintenance. They mentioned it again this past week… along with the fact that several other methods could be used, including some new ones just on the market. Each month there will be a shot (Xgeva) to maintain the bone loss (which allowed the tumor outside the femur) plus another attempt to curtail the growth in the lymph system.

Many friends constantly ask the regular question “what did the doctor say?” This, then, is an effort to compile the words he said along the way. Mostly it has been a wait and see procedure. Now, it will be a more aggressive approach to an aggressive cancer.

For now, there is no radiation or chemo planned but that may change.

I am an emotional man who lives alone, but I am not lonely. I have many friends around the world. And I have my family here in Indianapolis, my hometown.  On the way home from the doctor I became suddenly aware of my future while listening to one of my favorite styles of music. It prompted many tears… of realization of how good I have it with my medical treatment.

I have a plan. I am pleased, too, that I met that Korean couple just passing through Indianapolis to see “the maples.”  I will continue to follow this adventure of mine, as far as it goes

Personal Story: My Thyroid Cancer

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I am a Professor of Economics at Vanderbilt University, VU. I teach and do research. My life is my work and my family. Inside me there is Myrna Holtz, a kid from very humble beginnings on a small farm in rural Alberta, a nerd who loved math puzzles and books but had few of either. Through my own research and through helping others with theirs, I want to contribute to our ability to understand social and economic interaction. I want to be close to my family and now to increase awareness of thyroid cancer and its potential effects. Here is my story.

Some History

In 2008 and 2009 I felt fatigued.  My home treadmill rested, unused. In September 2009, my VUMC (VU Med Center) physician palpated my thyroid and detected no problem. Two months later, after a quick swipe of my throat, my gynecologist found that my thyroid was enlarged. We both notified my VUMC physician. He responded (recorded on a VUMC web interface for patients) with, effectively, “See you when you next come in.” I thought, “Oh, that’s good, no problem then. Maybe I had a cold.” But as time progressed, I pressed and pressed again for an appointment with my physician. Finally, in mid-May 2010, after five and a half months, I had an appointment. When my VUMC physician palpated my thyroid, he immediately detected the enlargement and ordered an ultrasound, which I had the same day.

Too Busy to Call: Hearing about my Thyroid Cancer from a Stranger

A few days later, out of the blue, some unknown person phoned to schedule an appointment for me with an endocrinologist and to advise me that I would probably need surgery. What! How could something treated so casually by my VUMC physician be serious? Was it really? If so, why had my physician not seen me sooner? Why had he himself not called? Maybe it was only another surgery opportunity.

My former VU physician always called me “Myrna”. I called him “Dr. Hock”. A trusting patient is like a small child who places her hand in the hand of a benevolent, caring adult. The asymmetry in use of titles reflects this relationship of trust and confidence; the patient wants to be confident that the physician is competent, knowledgeable, and will take care of her. But maybe the asymmetry is designed to keep the physician in a position of unquestioned superiority, above the patient. I started to call my former VUMC physician “Rich”. And he switched, immediately, to “Professor Wooders”. It was almost funny.

With all confidence in VUMC gone – this was the most disturbing but not my first negative experience – I searched for a specialist on the internet and in September 2010 saw Dr. Erik Alexander, at Brigham and Women’s (B&W) in Boston. Erik advised me to have a thyroidectomy and also recommended a surgeon, Dr. Francis Moore, also of B&W. Dr. Moore interviewed me on November 10th, 2010, and I had a total thyroidectomy on November 11th. 2010

The Diagnosis: Thyroid Cancer

B&W Pathology reported a tall cell papillary thyroid cancer with extrathyroidal extension (minimal). Not good. Tall cell thyroid cancer has an estimated mortality rate about 16 times that of papillary cancer generally. At least one study proposes that tall cell thyroid cancer can become anaplastic cancer, which is extremely aggressive. “Extrathyrodial extension” means that the cancer has extended beyond the thyroid capsule. With extrathyroidal extension, for individuals over forty-five thyroid cancer becomes Stage III. Whether the extrathyroidal extension occurred during VUMC’s delay is unknown, but I believe it is likely; my VUMC physician was unable to detect the enlargement of my thyroid in September 2009, but detected it immediately in May 2010.  I complained to VUMC.

Post-Surgery Treatment

My treatment involved thyroid hormone withdrawal to raise my TSH (thyroid stimulating hormone) and a low-iodine diet lasting some weeks followed by ablation with radioactive iodine (RAI).  “Glowies” are not allowed to fly so I had the RAI at VUMC. The endocrinologist at VUMC referred me to his nurse for instructions for the procedure.  I was not following the VUMC standard procedure of injection of Thyrogen (a form of TSH) to raise TSH but instead hormone withdrawal. The instructions for my procedure were somewhat garbled. I sought and obtained clarification, but still it was anxiety-provoking.

In January 2011, three men in hospital garb brought my RAI pill into a small, cold room at VUMC where I had been waiting on a small, cold hard chair. Might they be like three co-authors, each of whom relies on the other two to catch any mistakes? Might something else have been garbled? But I was at VUMC to swallow the pill so I swallowed the pill.

A few days after swallowing the pill, standard procedure is to have a whole body scan to see where the RAI was soaked up. I lie in a cold machine in a cold room, while in the adjoining small room with a glass window and open door several hospital personal watched monitors, laughed and giggled. Was it funny? Most important, though, the RAI was soaked up where it was supposed to be – in the thyroid bed.

Surgery and Treatment Side Effects: Hyperthyoidism

After my surgery I had a sore throat. But the frequent sensation of clutching around my neck, the heaviness in my chest, my sometimes racing heart, and extreme fatigue seemed to only get worse. Last year, 2011, was a very bad year. I had MRIs, electrocardiograms, nuclear stress electrocardiograms, nuclear perfusion tests, CT scans with contrast, and blood tests for everything. But no explanations of my symptoms were offered. The symptoms intensified.

It now seems that I was suffering effects of hyperthyroidism.  To suppress the activity of any remaining thyroid cells, thyroid cancer patients are prescribed high levels of levothyroxine (thyroid hormone). Individuals react differently to hyperthyroidism. I had multiple symptoms – fatigue, anxiety, palpitations, and an atrial fibrillation. (At the time of my atrial fibrillation I was in Sydney. My wonderful daughter-in-law came to the hospital. I was so glad that she was there to keep watch.  By the way, there everyone – doctors, paramedics, nurses – called each other by their first names. I was “Mrs. Wooders”.)    It might have helped to know that my symptoms were those of hyperthyroidism, not of the return of cancer. See http://www.myrnacatharsis.com/what-it-is-like/ for more of the story.

All Clear

My first post-thyroidectomy exam was on August 20th, 2011 at B&W. There was no observable evidence of cancer. It was wonderful. The sun shone, the trees glistened, the streets of Boston were filled with happy, smiling people.

Last March we reduced my levothyroxine. And, as time passes, it becomes less and less likely that I will have any recurrence. Back in rural Alberta, I had learned to “never let them see you cry” so I tried to keep my thyroid cancer private. This spring I decided to go public; I let my colleagues in VU Economics know in an email and via my website: Myrna’s Catharsis. I found the Thyca website (Thyroid Cancer Survivors Association) and learned that my experience with extreme hyperthyroidism had been shared by others.  See: What it is Like.)

In the spring of 2012, my tests looked very fine. My treadmill squawked a bit with its first use this summer, but now runs smoothly! Except for emotional scarring, I feel back to normal. If I have to increase my levothyroxine again, I will recognize symptoms of hyperthyroidism. If I have a recurrence, I think that it will not be for some years; I am hoping for forty. It may be useful for other thyroid cancer patients to know the symptoms that may occur as a result of their treatment, for persons in positions of power over others to better understand that thyroid cancer survivors may be hyper (or hypo) thyroid. And for physicians to recognize that not all thyroid cancers are slow growing so a patient with an enlarged thyroid should not be ignored.

Some fantastic reference books that I found along my journey:

Kenneth Ain,  A specialist in thyroid cancer, author, with Sara Rosenthal, of The Complete Thyroid Handbook, which includes a discussion of various levels of care, including “standard community care” – what one might expect of their local GP.

Another excellent, more technical and specialized book is Thyroid Cancer: A Patient’s Guide By D. Van Nostrand, G. Bloom, L. Wartofsky

This article was posted previously on ThyroidChange and re-posted with permission.

From Myrna Wooders (www.myrnacatharsis.com)

Quick News: Oral Contraceptives and Staphylococcus Infections

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A reader asked us if there was a connection between oral contraceptives, recurrent yeast infections and/or the rate of general illness. At the time, we were unable to find any research on these topics. Indeed, the only studies we could find on oral contraceptives and yeast infections were either conducted 40 years ago or on rodents.

However, just this week we found a study published last month showing that women taking oral contraceptives were almost twice as likely to be persistent carriers of nasal staphylococcus aureus than women who were oral contraceptive free or men. Staphylococcus or staph, is the bacteria that causes a host of infections including the MRSA or methicillin resistant staphylococcus aureus strain that is resistant to antibiotics. The two most common locations for this pathogen to reside are in the nose and on the skin.

Carrier Status and Infection

Approximately 20% of the population are persistent carriers of s. aureus, increasing their risk for infection especially with surgical procedures or when combined with impaired immune function. About 30% of the population are intermittent carriers and  50% of the population are non-carriers.

The increased rate of persistent carrier status in women who use oral contraceptives is notable especially considering the rise in MRSA infections observed in athletes and emanating from locker rooms. Oral contraceptive use is common among female athletes. A recent study indicated a significantly higher prevalence of MRSA bacteria on the surfaces of women’s locker rooms, compared to men’s locker rooms.

Our reader’s observation that while on the pill she seemed more susceptible to illness might very well be correct. Whether oral contraceptives are linked to recurring yeast infections remains unclear. What is clear, however, is that much more research must be done on the interaction between oral contraceptives and immune function.

 

 

 

Controversy, GMO Research & Women’s Health

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If you’ve been on the internet at all over the last several weeks, you’ve likely come across these pictures- the white rats with grotesquely large mammary tumors warning of the dangers of GMO foods. A controversial and not yet even officially published study out of France on the Long term toxicity of Roundup herbicide and a Roundup-tolerant genetically modified maize is responsible.

In this 2 year study (compared to the 90-120 days for most previous protocols) researchers purportedly demonstrated the ill-effects of glyphosate (active ingredient in Roundup herbicide) and its adjuvants (putatively inactive ingredients that enhance the absorption, distribution or metabolism of the active ingredient), but also inadvertently, and despite the rampant criticism of the study, may have identified a mechanism of action for the growth of these tumors; a disruption of the estrogen pathway perhaps linked to primary kidney and liver damage. Moreover, and again perhaps inadvertently, the research points to a possible player in the development of fibroid type tumors.

How GMO Research is Conducted

There is great debate over the safety of herbicide rendered or engineered, genetically modified organisms (GMO) within the food and water supply. Studies on the side of industry, suggest no major ill-effects, while those on the side of environmentalist indicate differently.  Research design likely contributes to the disparate findings. Much research to date has been short-term (90-120 days) and/or has limited the analysis to testing or manipulating only the active ingredient in the herbicide (glyphosate) and not the variety adjuvants found in the total herbicide formulation and that would be dispersed into the natural environment (food, water) post herbicide use.

The current study sought to remedy some of those short-comings and approximate what humans might be exposed to with current regulatory standards in place and in an ‘natural environment’ where exposure rates and types would necessarily vary. (Whether lab rats can approximate human physiology or the lab can be considered a ‘natural environment’  are debates for another day).

The Seralini GMO Study

Using healthy male and female Sprague-Dawley rats, the researchers evaluated the long-term (two years), across a life-span effects, of eating Roundup treated foods (maize) and water with Roundup residue at levels below the currently parts per billion standard and consistent with what humans might be exposed to in the current environment. Control rats were fed non-GMO diets and the test rats were fed varying levels of GM maize (11%, 22% and 33% of the total diet) and water with Roundup – well below the approved levels found in the environment.

Tumors, Toxicity, Death and the GM Diet

Compared to control rats fed a non-GM diet, those fed the GM-maize and Roundup water, died five times sooner and developed huge tumors, often greater than 25% of their body weight and requiring euthanasia to reduce suffering. There were distinct differences between the male and female treated animals. The females died more quickly and developed primarily mammary tumors, followed by a lower percentage of pituitary tumors and kidney and liver toxicity. While the males, demonstrated more severe kidney and liver disease along with skin tumors. The females were more susceptible to the Roundup in the water and both groups were equally susceptible to both the lower and higher percentage (11% and 33%) exposure to GM food, suggesting a threshold effect for disease initiation rather than a cumulative or additive effect.

Endocrine Disruption

The endocrine effects were also telling and pointed to sex-dependent differences in the tumor and disease expression. The ratio of testosterone to estradiol was disrupted in both males and females. Males in the highest Roundup treatment group (33% of total feed maize), demonstrated double the levels of circulating estradiol (see Evolution or Extinction of Men for details on male endocrine disruption) when compared to the control group. Whereas the exposed females showed increased testosterone levels.

Potential Fibroid Connection

The explosive growth of tumors in the female treated rats is notable both because of the large size and location of the tumors (mammary and pituitary) but more so perhaps because of the nature and physiology of the tumors themselves. In all but two cases, the tumors were non-cancerous, non-infective or non-metastatic.  The tumors were benign adenomas and fibroadenomas, those commonly found in human women as they age (also common in this strain of lab rat as it ages). Fibroadenomas are comprised of fibrous and glandular tissue located in the breast. Fibroids are similar in tissue composition, but are found in the uterus.  In the present study, fibroadenomas were found in the mammary tissue and adenomas in the pituitary gland. There was no mention of uterine fibroids or adenomas in other female reproductive regions. Similarly, although, the authors make no such claim regarding the expression of fibroid type tumors, relative to hormone changes and concurrent liver dysfunction (where the enzymes and proteins involved in the hormone regulation reside), I surmise that perhaps there is a connection there as well.  It is conceivable that the combined insult of aging and environmental toxins on liver function alters hormone pathways sufficiently to promote this type of tumor growth.

Controversy and Criticism

As this study was released both pro- and anti-GMO factions got their pants in a bunch. On the anti-GMO side, this study represented proof-positive that GMO foods were bad. The results of this study, and in particular, the pictures of the tumor-ridden rats went viral on the internet. On the pro-GMO side, the criticism was as swift as it was vitriolic, with claims ranging from poor methodology, to outright scientific fraud.  I suspect the truth lay somewhere in between.

My Take

Releasing to press first. This merited all sorts of criticism, most of which has no bearing on the actual study but does suggest a less than forthright approach to media relations. However, given the politics surrounding this topic, one can understand this PR approach.

Sprague-Dawley rats are prone to tumors. Yes, they are and as they age, tumors become more frequent. But here we have a little pot and kettle action going on. Sprague-Dawley and other outbred strains of rats and mice, all have predilections for certain diseases and tumors, but are nevertheless what is used in all industry supported (even the studies supporting the safety of GMO) and academic research. The choice of lab rat/mice is important, but even within specific strains there is huge variability. Nullifying the study because the researchers used the same strain of lab rats that other researchers also use, is a weak criticism at best and more than a little disingenuous. Perhaps a better criticism would be the use of lab rats in general to extrapolate human physiology.

Sprague-Dawley rats are prone to tumors as they age. Well guys, so are women. By the time a woman reaches age 50, upwards of 70% of women have fibroid type tumors. And frankly, aging, whether in animals or humans, increases disease expression. Our bodies just don’t work as well when we are older. Simply measuring the effects of a toxin for a short period of time in youthful animals does not, in any way, mirror the real life of the animal or a human, where effects are cumulative over time and sometimes even multiplicative and synergistic.

The study was too long and the control rats were dying too. Life is longer than adolescence. If one wants to evaluate how a treatment or toxin affects an organism over time and as it ages, one has to evaluate across that life span. This study compared tumor progression, disease and death rates between the non-GM controls and the GM fed groups, across the rodent’s life span, which is about 2+/- years. As the rodents aged, both groups developed tumors and some died, but there were more tumors and earlier deaths in the experimental group.

Failure to observe or measure is not synonymous with non-existence. Neglecting to measure a particular toxin or analyte, a specific symptom or disease process, or failing to evaluate long term effects does not mean that the toxin, analyte, symptom or disease process in question did not happen or does not exist. It simply means that you chose not to measure it. So claiming that a 3-month study in youthful rodents nullifies results from a longer study, regardless of any other methodological issues with either study, is an utterly false, and more than a little dishonest argument.

The dose response-curve was not linear. Damn it, how dare our complex physiology not conform to the simplicity of linear statistics. A common dose-response reaction is highly linear, where a small dose elicits a similarly small response and a larger dose increase the response size. This is not case when dealing with endocrine disruptors. Hormone systems are complex and highly non-linear. Hormone reactions occur at extremely low doses and often interact synergistically with other factors and respond differently over time and with cumulative exposures. This was the case in the current study.

In spite of the flaws with this study and contrary to the criticism, the Seralini study represents one of the only, if not the only, long term evaluation of the effects of Roundup and GM feeding on health. Long term studies, even in rodents, are not common place. They should be.

The next long term study (and there should be many more) should include different strains of rodent, measure additional hormones and steroidogenic proteins altered with liver disease and if they want to be really ingenious, look at the estrogen, androgen and progesterone receptor densities in the tumors.

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