Transverse myelitis is a rare disease of the central nervous system involving inflammation in the spinal cord. Transverse’ refers to the inflammation being across the width of the spinal cord and ‘myelitis’ refers to the specific part of the spinal cord affected.

What is Spinal Cord? The spinal cord carries messages (nerve impulses) from the brain to the body and from the body to the brain. It is made up of different types of cells. The cells responsible for transmitting messages are called neurons. Neurons have long extensions called axons which carry the messages up and down the spinal cord. Axons are arranged in bundles called tracts. Some of the tracts carry motor function messages which stimulate muscles to produce movement and some of them carry sensory messages which control sensations such as touch, pain and temperature. To increase the speed at which the messages travel, most axons are surrounded by a whitish fatty substance called myelin which forms a protective covering (sheath) around them. Myelin is produced by specialised cells called oligodendrocytes.

Transverse myelitis is a disease causing injury to the spinal cord with varying degrees of weakness, sensory alterations, and autonomic dysfunction (the part of the nervous system that controls involuntary activity, such as the heart, breathing, the digestive system, and reflexes). The inflammation causes swelling which can block messages (nerve impulses) travelling along the spinal cord. The inflammation can also damage or destroy the myelin sheath surrounding the axons in the spinal cord, probably by damaging the specialised cells which produce myelin (the oligodendrocytes). Messages (nerve impulses) cannot be transmitted properly as myelin is stripped off the axons causing scarring.

The inflammation most commonly occurs in the thoracic section of the spinal cord (the middle section below the neck and above the stomach). The damage affects this area but it can also affect the areas of the spinal cord below the thoracic section: the lumbar section (lower back) and the sacrum (between the hips). Most people with transverse myelitis experience weakness and a change in sensation (unusual feelings) in the lower half of the body and have problems with their bowel and bladder.

Transverse myelitis may be caused by viral infections, spinal cord injuries, immune disorders (including systemic lupus erythematosus, Sjogren’s syndrome, sarcoidosis and multiple sclerosis) or insufficient blood flow through the blood vessels in the spinal cord. It may occur as a complication of such disorders as optic neuromyelitis, multiple sclerosis, smallpox, and measles, or as a complication of chickenpox or rabies vaccinations. Transverse myelitis may be caused by viral infections, spinal cord injuries, immune disorders (including systemic lupus erythematosus, Sjogren’s syndrome, sarcoidosis and multiple sclerosis) or insufficient blood flow through the blood vessels in the spinal cord. It may occur as a complication of such disorders as optic neuromyelitis, multiple sclerosis, smallpox, and measles, or as a complication of chickenpox or rabies vaccinations.

Who gets TM?

Transverse myelitis occurs in adults and children, in both genders, and in all races. Females have a higher risk of transverse myelitis than males. No genetic pattern is known. Transverse myelitis is not related to family history. A peak in incidence rates (the number of new cases per year) appears to occur between\ ages 10 and 19 years and 30 and 39 years. Although only a few studies have examined incidence rates, it is estimated that about 1,400 new cases of transverse myelitis are diagnosed each year in the United States, and approximately 33,000 Americans have some type of disability resulting from the disorder.

Causes

Immune System – Although a cause cannot be established in cases of idiopathic transverse myelitis, the inflammation is thought to be the result of the immune system mistakenly attacking the spinal cord. This is called an autoimmune reaction.

Virus and Infection – Transverse myelitis often develops at the same time as, or soon after, a viral or bacterial infection. The cases of transverse myelitis are also believed to be the result of an autoimmune reaction. Rather than the viral or bacterial infection itself directly causing the inflammation, it is thought that the immune system is stimulated to fight the infection and, mistakenly, also attacks the spinal cord. Viruses that can infect the spinal cord directly are herpes viruses, including the one that causes shingles and chickenpox (zoster) and West Nile virus. Other viruses may trigger an autoimmune reaction without directly infecting the spinal cord.

Vaccinations – Transverse myelitis can also develop after vaccinations, although this is very rare. Again, it is thought that the immune system is triggered to respond to the vaccination and mistakenly attacks the spinal cord.

Multiple sclerosis is a disorder in which the immune system destroys myelin surrounding nerves in the spinal cord and brain. Transverse myelitis can be the first sign of multiple sclerosis or represent a relapse. Transverse myelitis as a sign of multiple sclerosis usually manifests on only one side of your body.

Neuromyelitis optica (Devic’s disease) is a condition that causes inflammation and loss of myelin around the spinal cord and the nerve in the eye that transmits information to thebrain. Transverse myelitis associated with neuromyelitis optica usually affects both sides of the body.

Because some affected individuals also have autoimmune diseases such as systemic lupus erythematosus, Sjogren’s syndrome, and sarcoidosis, some scientists suggest that transverse myelitis may also be an autoimmune disorder. In addition, some cancers may trigger an abnormal immune response that may lead to transverse myelitis.

Symptoms

There are four classic symptoms of transverse myelitis (TM). Patients may have only one symptom, or a combination of the following –

• Weakness of the legs and/or arms – Some patients report stumbling, dragging one foot or notice that both legs seem heavier than normal. Depending on the level of involvement within the spinal cord, coordination or strength in the hands and arms may also be affected.
• Sensory alteration – Patients who are experiencing altered sensitivity usually report numbness, tingling, coldness or burning. Up to 80% of patients experience heightened sensitivity to touch. Some even report that wearing clothes or a light touch with a finger causes significant pain.
• Pain – Up to half of those with TM report pain as the first symptom of the disorder. It can be localized to the back, or appear as sharp, shooting pain that radiates down the legs, arms or around the torso. Loss of the ability to experience pain or temperature sensitivity is one of the most common sensory changes.
• Bowel and bladder dysfunction – Some patients report bowel or bladder dysfunction as their first symptom of TM. This may mean an increased frequency or urge to urinate or defecate, incontinence, difficulty voiding, and sensation of incomplete evacuation or constipation.

Treatment

• Intravenous Steroids – Although there are no clinical trials that support a unique approach to treat patients experiencing TM, it is well recognized as a standard of care that patients suspected to have acute myelitis receive high-dose intravenous methyl-prednisolone for 3-5 days, unless there are compelling reasons not to. The decision to offer continued steroids or add a new treatment is often based on the clinical course and MRI appearance at the end of 5 days of steroids.
• Plasma Exchange (PLEX) – This is often used for those patients with moderate to aggressive forms of TM who don’t show much improvement after being treated with intravenous and oral steroids. Again, there has not been a clinical trial that proves PLEX effectiveness in TM but retrospective studies of patients with TM treated with IV steroids followed by PLEX showed a beneficial outcome. PLEX also has been shown to be effective in some patients with other autoimmune or inflammatory central nervous system disorders. Patients particularly benefit from early treatment, and will typically be started on PLEX within days of starting steroids. Particular benefit has been shown if started within the acute or subacute stage of the myelitis or in those patients who exhibit active inflammation on MRI. However, because of the risks implied by this procedure this intervention is determined by the treating physician on a case-by-case basis.
• Antiviral medication – Some people who have a viral infection of the spinal cord may be treated with antiviral medication.
• Pain medication – Chronic pain is a common complication of transverse myelitis. Medications that may lessen muscle pain include common pain relievers, including acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).
• Cyclophosphamide – It is a chemotherapy drug that is often used to treat lymphomas or leukemia, is sometimes used. Patients receiving this treatment are carefully monitored for potential complications that may arise from immunosuppression.

Alternative Treatment

Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system (CNS). CNS is made up of brain, spinal cord and optic nerves.

Multiple Sclerosis is caused by a disturbance of immune function. Generally, the antibodies produced by the immune system help protect the body against invaders of the human body (viruses, bacteria etc). In this condition, the disturbance allows cells of the immune system to attack myelin, the insulating sheath surrounding the nerve fibers (axons) located in the CNS which helps messages (electrical impulses) travel quickly and smoothly between the brain and the rest of the body. When the myelin is damaged, electrical impulses cannot travel quickly along the never fiber pathways in the brain and spinal cord. The loss of myelin is called demyelination. The disruption caused to electrical conductivity results in fatigue and disturbances of vision, strength, co-ordination, balance, sensation and bladder & bowel functions.

The situation produced my demyelination can be better understood by taking an example of an electrical lamp. When the insulating surface, surrounding an electric lamp cord, is disrupted by cracks or tears on it, the lamp will short circuit and the light bulb will flicker or no longer illuminate. Similarly, loss of myelin sheath surrounding the nerve fibers results in short circuits in nerves traversing the brain and spinal cord, hence resulting in the symptoms of MS. As oppose to a single wire pathway in a lamp cord, there are numerous nerve pathways in the brain and the spinal cord .i.e. CNS. The damage to myelin – resulting in dense, scar like tissue, occur in many places throughout CNS, hence the name ‘Multiple Sclerosis’ or many scars.

There are 4 types of MS. Their names are according to the way the disease acts on the body over time. They are:

• Relapsing Remitting MS (RRMS) – It is the most common disease course, characterized by clearly defined attacks of worsening neurological function. People with RRMS have temporary periods called relapses, flare-ups or exacerbations- are followed by partial or complete recovery periods (remissions), during which symptoms improve partially or completely and there is no apparent progression of disease. About 85% of people with MS are initially diagnosed with RRMS.
• Secondary Progressive MS (SPMS) – SPMS follows after the relapsing-remitting course. In SPMS, symptoms worsen steadily over time, with or without the occurrence of relapses or remissions. Most people who are initially diagnosed with RRMS will eventually transition to SPMS.
• Primary Progressive MS (PPMS) – This type of MS is not very common. It is characterized by slowly worsening the symptoms from the beginning with no relapses or remissions. About 10 percent of people with MS are diagnosed with PPMS.
• Progressive Relapsing MS (PRMS) – It is the least common of the four disease course and is characterized by steadily progressing disease from the beginning and occasional exacerbations along the way. People with this form of MS may or may not experience some recovery following these attacks; the disease continues to progress without remissions. About 5% of people with MS are diagnosed with PRMS.

Causes

Multiple Sclerosis is most commonly diagnosed between 20 to 50 years of age, although onset may be earlier. While anyone can get MS, it is 2 to 3 times more common in women than in men. In the US, approximately 10,000 to 15,000 new cases of MS are diagnosed every year. Around 2.5 million people have been diagnosed with MS, worldwide.

Although the exact cause of MS may remain unknown, but studies suggest that a combination of several factors may be involved.

• Environmental & Immunological Factor

The environmental theory proposes that an environmental factor triggers the immune system to cause the symptoms of MS. Studies have explored the possibility that exposure to viral or bacterial infections, environmental toxins, duration of sunlight, changes in temperature and humidity, or diet might in some way produce or aggravate MS.

The immune system appears to go out of control and attack the myelin sheath. Mainstream medicine usually sees this as an immune system malfunction, but actually the immune system is working just fine. The immune system’s job is to distinguish self – that which belongs in the human body – from non-self; the immune system then does its best to destroy that which is non-self and doesn’t belong and can cause harm.

The problem occurs when the body’s own cells combine with something else, forming a self/non-self hybrid that the immune system goes after. If these outside toxins combine with nerve cells and the immune system attacks the damaged cells, lesions or damage occur on the myelin and MS symptoms can result.

• Exposure to Heavy Metals – One of the biggest culprits is the toxic metal mercury, which is especially attracted to the brain and to nerve cells. Its greatest source is usually right in your own mouth, in the form of those silver to black metal fillings. Studies suggest that dental workers have a much higher incidence of MS than the general population due to their greater mercury exposure.
• Harmful Chemicals – Chemicals present in pesticides and solvents are oil-soluble, and the myelin sheath is mostly fat and hence these chemicals are attracted to it. These chemicals combine with the myelin, causing the kind of immune system attack as described earlier.
• Dental Cause – Mercury poisoning is not the only problem that can be caused by metal fillings. Metal in the mouth can cause the Battery Effect, in which a mixture of metals combined with saliva can put out measurable electrical charges. Since the nervous system is electrical, these opposing, random charges can stimulate and disrupt nervous system signals. Fluoride found in most water supplies and added deliberately for the unproven purpose of preventing cavities, is a nerve poison. It is best to drink filtered water and to not use fluoride toothpaste, supplements, or dental treatments.
• Viral and Other Infectious Agents – Research and studies show that common virus or other infectious agent may play a role in the cause of MS. Environmental studies suggest that some factor – probably infectious – must be encountered before the age of 15 in order for MS to develop later in life. Several viruses and bacteria, including Epstein-Barr, Chlamydia, pneumonia, measles, canine distemper, and human herpes virus-6 have been or are being studied to determine if they may trigger MS.
• Vitamin D Deficiency – Vitamin D plays a role in the body’s immune and nervous systems and how they work. Studies suggest that children who are exposed to s of sun are less likely to develop MS than someone who grows up in a place where there is little sun.
• Mycotoxins – Patients with autoimmune disease are actually living or working in environments that have toxic mold. Toxic molds produce mycotoxins, which are volatile organic compounds (VOC), which can be toxic to genetically susceptible people.
• Leaky Gut – In order to absorb nutrients, the gut is somewhat permeable to very small molecules. Many things including, gluten, infections, medications and stress can damage the gut, allowing toxins, microbes and undigested food particles – among other things – directly into your bloodstream. Leaky gut is the gateway for these infections, toxins and foods like gluten to begin to cause systemic inflammation that leads to autoimmunity.
• Gluten – Gluten is a huge problem for most people these days because we hybridized it, modified it and it’s in everything. The most severe of all is that, it can wreak havoc on the gut and set the body up for a leaky gut. Once the gut is leaky, gluten can get into the bloodstream and confuse the body’s immune system. When the proteins in the consumed food resemble the proteins that make up myelin, the immune system can get confused and accidentally attack the myelin coating your nerves. This process is called molecular mimicry and can occur with inflammatory foods like gluten and dairy.

• Genetic Factors

Though MS is not hereditary, having a first degree relative i.e. parent or sibling with MS condition may significantly increase an individual’s chances of developing MS. Studies suggest that there is a higher prevalence of certain genes in populations with higher rates of MS. Similar genetic factors have been found in some families where there is more than one patient with MS.

The most significant genetic link to MS has been identified in the major histocompatability complex (MHC), a cluster of genes on chromosome 6 that are essential for immune system function. Rare MS cases may be due to variations in interleukin-7 (IL-7) and interleukin-2 (IL-2) gene receptors, which are also related to immune system regulation.

Symptoms

The symptoms of multiple sclerosis depend largely on which particular nerve fiber pathway is involved in the CNS. Tingling, numbness, sensations of tightness, or weakness may result when loss of myelin occurs in the spinal cord. If the nerve fibers to the bladder are affected, urinary incontinence may follow. If the cerebellum of the brain is affected, imbalance or incoordination may result. Since the plaques of MS can arise in any location of the CNS, it is easy to understand why no two MS patients have exactly the same symptoms.

The symptoms are divided into 3 following parts:

1. More Common Symptoms
   • Fatigue
   • Numbness or Tingling
   • Weakness
   • Dizziness & Vertigo
   • Walking Difficulties
   • Spasticity – Refers to feelings of stiffness and a wide range of involuntary muscle spasms; can occur in any limb, but it is much more common in the legs.
   • Vision Problems
   • Bladder & Bowel Problems
   • Cognitive Changes – Refers to a range of high-level brain functions affected in 50% of people with MS, including the ability to learn and remember information, organize and problem-solve, focus attention and accurately perceive the environment.
   • Depression
   • Sexual Problems
   • Emotional Changes 

2. Less Common Symptoms
   • Speech Problems
   • Swallowing Problems
   • Tremor – Respiration problems occur in people whose chest muscles have been severely weakened by damage to the nerves that control those muscles.
   • Itching
   • Headache
   • Hearing loss

3. Secondary & Tertiary Symptoms
   • Bladder dysfunction can cause repeated urinary tract infections.
   • Inactivity can result in loss of muscle tone and disuse weakness (not related to demyelination), poor postural alignment and trunk control, decreased bone density (and resulting increased risk of fracture), and shallow, inefficient breathing
   • Immobility can lead to pressure sores.
   • Social, Vocational and Psychological complications

Treatment for MS 

• Conventional Medicine

Conventional medication focuses only on treating the symptoms and not on getting out the root cause of the disease.            Most drugs available in the market are designed to slow down the development of the disease and reduce the number of relapses rather than treating the root cause.

• Interferons – Avonex, Betaseron, Extavia, and Rebif are all interferon beta products. The interferon drugs seal off the blood brain barrier and inhibit the T-lymphocytes (T cells) – type of white blood cell that circulate around our bodies, scanning for cellular abnormalities and infections, from being activated. This prevents the T cells from entering the central nervous system and destroying myelin, and ultimately the nerve axons.
• Capaxone – The struacture of capaxone is similar to that of myelin protein. The effects of this drug are usually less dramatic than the interferon, but the side effects only include chest pain, shortness of breath, and flushing.
• Tysabri – Tysabri was the first humanized monoclonal antibody approved for the treatment of MS. Tysabri works by blocking the receptors on white blood cells that allow them to enter the brain and spinal cord.
• Lemtrada – Lemtrada is administered as intravenous infusions – for five consecutive days initially and for three consecutive days one year later. Because of its safety profile, Lemtrada should generally be reserved for people who have had an inadequate response to two or more MS therapies.
• Aubagio – Aubagio (teriflunomide) is a pyrimidine synthesis inhibitor that inhibits the function of specific immune cells that have been implicated in MS. The prescribing information contains a boxed warning about the potential for liver damage in the parent compound (leflunomide). Also, Aubagio should not be used during pregnancy.

These drugs have different mechanisms of action and unique side effect profiles.

Functional Treatment

At our center, we study the patient’s entire medical history and perform Comprehensive Diagnostic workup which gives us the root cause of the disease.

• Chelation Therapy – We are exposed to heavy metals in a number of different ways: amalgams, fish consumption, and the environment. It is one of the causes of MS. The Center for Occupational and Environmental Medicine specializes in safely treating toxicity from heavy metals such as lead and mercury. It involves detoxifying our body from all the heavy harmful metals.
• Removing Gluten from the diet – People with MS should completely remove gluten from their diet as its simply an inflammatory food.
• Total Body Stress Load – The body’s total stress load is derived from multiple sources including allergies, exposure to toxins, infections, and emotional stresses. It is important to evaluate and manage all factors of the total stress load if we are to regain and maintain our health.  The old saying “the straw that broke the camel’s back” appropriately illustrates this concept, as we envision the camel as the body and the straw as the stresses.
• Healing the Gut – Healing the gut is very essential for healing the disease.
• Immune System Support – Supplements like vitamin D, omega-3 fish oils, and glutathione are powerful immune modulators, which means that they can help support the immune system. Vitamin D has been shown to help regulate the immune system. Omega 3 fish oils help to reduce inflammation in the entire body. Glutathione is the most powerful antioxidant in the body which can help reduce inflammation and improve detoxification in the body.

The treatment method also includes the following:

• Acupuncture and acupressure
• Alexander Technique
• Aromatherapy
• Chiropractic
• Cannabis and cannabis extracts
• Herbal medicine
• Honey bee venom
• Hyperbaric oxygen therapy
• Homeopathy
• Massage
• Reiki
• Relaxation and meditation
• Shiatsu
• T’ai chi

At our center, we find the root cause of your illness and reverse your disease. You say Multiple Sclerosis, we say It can be cured…

Monoclonal gammopathy of undetermined significance or MGUS is a disorder where plasma cells (specialized bone marrow cells that secrete antibodies/immunoglobulins) begin to function abnormally, producing increased quantities of an immunoglobulin that does not work normally. When this immunoglobulin is produced from genetically identical (clonal) plasma cells, it is able to be identified on a blood test (serum protein electrophoresis). This abnormal protein is called a paraprotein (monoclonal gamma globulin, hence “monoclonal gammopathy”).

MGUS is linked to the immune system, which helps the body fight infection and disease. The immune system is made up of organs such as the bone marrow, the spleen, lymph nodes (or lymph glands) and a type of white blood cell called lymphocytes.

Lymphocytes are made in the bone marrow (inside the bones). The two main types of lymphocytes are Bcells and T-cells. Some B-cell lymphocytes develop into plasma cells and make antibodies to help fight infections. Antibodies are made from a protein called immunoglobulin.

MGUS occurs when particular plasma cells produce abnormally large amounts of one type of antibody. This abnormal antibody or immunoglobulin is called a paraprotein (or M-protein). The paraprotein doesn’t do anything useful, and it isn’t harmful.

MGUS is not a cancer. Some cancers, such as myeloma (a cancer of the plasma cell) and lymphoma (cancer of the lymphatic system), also produce large amounts of paraproteins. Although the levels of paraprotein are raised in MGUS, they’re not as high as the amount produced in people with cancer. Most people with MGUS remain well and never have any problems related to it. A small number of people may go on to develop more serious problems, so everyone with MGUS has regular checks.

MGUS is much more common in older people over 70. The cause of MGUS is unknown. It’s more common in people with conditions that affect the immune system, such as rheumatoid arthritis and certain infections.

Causes

The cause of MGUS is not fully understood at this time. It is thought that genetic damage to a single plasma cell gives this cell a survival advantage, leading to proliferation of this plasma cell. It is known that there is an increased risk of MGUS in first-degree relatives of patients with MGUS and myeloma. This does not mean all first-degree relatives will get MGUS, only that the risk is increased compared to the general population. It is not known at this time if this is due to shared genetic factors, or shared environment (same upbringing).

Risk Factors

Factors that increase the risk of monoclonal gammopathy of undetermined significance include –

• Age – The risk of monoclonal gammopathy of undetermined significance increases as people get older. The highest incidence is among adults age 85 and older.
• Race – Blacks are more likely to experience this condition than are whites.
• Sex – Monoclonal gammopathy of undetermined significance is more common in men than it is in women.
• A family history – If other people in the family have monoclonal gammopathy of undetermined significance, the risk of developing the disorder may be higher.

Symptoms

MGUS does not typically cause any symptoms. There is no evidence of bone damage, kidney damage, anemia (low levels of red blood cells), or elevated calcium levels. The average risk of progression to multiple myeloma is one percent per year. The risk of progression to malignancy is about 20 to 25 percent of people during their lifetime.

It has always been recognized that some cases of MGUS progressed to symptomatic multiple myeloma but recent studies have shown that multiple myeloma is consistently preceded by MGUS.

Complications

Some people with monoclonal gammopathy of undetermined significance develop a more serious condition, such as multiple myeloma or other cancers or blood disorders.

Doctors can’t definitively predict who will go on to develop a more serious condition, but they can determine who has the greatest risk. The doctor takes into account several factors when determining the risk, including –

• The amount of M protein in the blood
• The type of M protein
• The amount of another small protein (free light chain) in the blood

The risk of developing a more serious condition increases the longer people had monoclonal gammopathy of undetermined significance. Also, the more risk factors people have, the higher the risk of developing a more serious condition.

Other complications associated with monoclonal gammopathy of undetermined significance include fractures and blood clots.

Treatment

MGUS does not require any active treatment, however monitoring is recommended.  Monitoring of MGUS includes regular clinical assessment and follow up measurements of serum protein. The serum protein should be checked after 3 months and then again at 6 months to establish a firm diagnosis of MGUS.

A risk-assessment model can predict the risk of progression to multiple myeloma. This model uses the size and type of the abnormal protein and a special blood test called the serum free light chain assay.

If some have monoclonal gammopathy of undetermined significance and bone loss, the doctor may recommend treatment with medications called bisphosphonates that help increase the bone density. Examples of bisphosphonates include alendronate (Binosto, Fosamax), risedronate (Actonel, Atelvia), ibandronate (Boniva) and zoledronic acid (Reclast, Zometa).

Alternative Treatment

Alpha lipoic acid is an antioxidant that is commonly used in supportive therapy for peripheral neuropathy in people treated for multiple myeloma. It is an antioxidant that is normally made in the body, but people can also take extra alpha lipoic acid through supplements.

Calcium – People with MGUS may take calcium along with vitamin D to help support their bones. However, bone breakdown during multiple myeloma also releases unhealthy amounts of calcium in the blood, so patients should consult their doctors before considering calcium supplements.

Curcumin, a compound found in the spice turmeric, may work to kill myeloma cells and prevent them from multiplying. For those who have the pre-cancer conditions monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma, curcumin may slow progression to active multiple myeloma, but this has not yet been supported by clinical research.

Fish oils commonly contain plenty of omega-3 fatty acids, which may boost peripheral nerve health. For this reason doctors sometimes recommend them for MGUS.

Green Tea – A compound found in green tea, called epigallocatechin-3-gallate (EGCG), may aid in killing myeloma cells and prevent MGUS. However, it may also block the anti-cancer activity of Velcade, leading researchers to advise people with multiple myeloma undergoing Velcade therapy to avoid green tea products and EGCG supplements.

Magnesium may help with peripheral neuropathy. It also helps regulate calcium levels and can help strengthen bone. Green leafy vegetables, almonds, cashews, and halibut are all good sources of this essential mineral.

Iron – Anemia (low red blood cell counts) is a symptom of multiple myeloma and is also a common side effect of many myeloma treatments. Iron supplements may help certain people with their anemia.

Potassium – Doctors may recommend potassium for people getting treated for MGUS.

B vitamins, including vitamin B-1 (thiamine), vitamin B-2 (riboflavin), vitamin B-6, vitamin B-12, and folic acid, are important for the formation of red blood cells, enhance the immune and nervous systems, and more.

Vitamin C – As an antioxidant, vitamin C helps protect cells from environmental damage that may lead to cancer. It also functions in protecting the immune system.

Vitamin D works with calcium to build bone, and recent research suggests it might be important in reducing some signs and symptoms of MGUS.

Vitamin E – For those suffering from MGUS, vitamin E supplements may help. This antioxidant vitamin may protect nerves during therapy, especially with Velcade or thalidomide.

Reference –

http://www.nejm.org/doi/full/10.1056/NEJMoa054494

http://www.macmillan.org.uk/information-and-support/diagnosing/causes-and-risk-factors/pre-cancerous-conditions/mgus.html

http://www.melbournehaematology.com.au/fact-sheets/mgus-monoclonal-gammopathy-of-undetermined-significance.html

http://www.leukaemia.org.au/blood-cancers/myeloma/mgus

http://www.bloodjournal.org/content/102/10/3759?sso-checked=true

http://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=411379

http://www.mayoclinic.org/diseases-conditions/mgus/basics/definition/con-20026422

http://myeloma.org/pdfs/IMWG_Pub/2010-Leukemia-Kyle-MGUS%20and%20Smoldering%20MM.%20IMWG%20Perspectives.pdf

Leukoplakia is a white or gray-white patch in the mouth that cannot be wiped off. The patches usually develop slowly, over weeks or months. They are rarely cancerous. A test called biopsy may be done to determine if they are cancerous or not. A biopsy involves removing a small section of the patch so it can be examined in a lab. If the patch is small, all of it is removed.

Leukoplakia is more common in people exposed to –

• Chewing tobacco
• Cigarette, cigar or pipe smoke
• Sun on the lips
• A mouthwash or toothpaste that contains sanguinarine

Leukoplakia is often seen on the lip or inside the cheeks or gums. Patches vary in size. Leukoplakia is usually benign (not cancer). On average, 4% to 5% of these patches develop into oral cancer. Patches in some areas of the mouth are more likely to be cancer –

• On the tongue
• On the lip
• Under the tongue, on the “floor” of the mouth

People infected with HIV sometimes have a condition called oral hairy leukoplakia. It consists of hairy, painless white patches. Usually the patches are on the sides of the tongue. They can be one of the first signs of HIV infection

Leukoplakia usually isn’t dangerous, but it can sometimes be serious. Although most leukoplakia patches are noncancerous (benign), some show early signs of cancer. Many cancers on the floor of the mouth — beneath the tongue — occur next to areas of leukoplakia.

Causes

Leukoplakia affects the mucus membranes of the mouth. The exact cause is not known. Doctors think it may be due to irritation such as –

• Rough teeth
• Rough places on dentures, fillings, and crowns
• Smoking or other tobacco use (smoker’s keratosis), especially pipes
• Holding chewing tobacco or snuff in the mouth for a long period of time
• Drinking a lot of alcohol
• The disorder is most common in elderly persons.

A type of leukoplakia of the mouth called hairy leukoplakia is caused by the Epstein-Barr virus. It is seen mostly in persons with HIV/AIDS. It may be one of the first signs of HIV infection. Hairy leukoplakia can also appear in other people whose immune system is not working well, such as after a bone marrow transplant.

Symptoms

Leukoplakia causes patches on the tongue, gums, or inside of the cheeks. These patches may appear as –

• White, gray, or red in color
• Thick, slightly raised, or hardened on the surface
• There may be pain or signs of infection. The patches may also be sensitive to touch, heat, or spicy foods.

In some cases, leukoplakia looks like oral thrush, which is an infection also associated with HIV infection and suppressed immune function.

Untreated leukoplakia can turn into cancer. Some types of leukoplakia carry a higher risk of turning into cancer than others.

Treatment

If the patches do not fade as expected, the doctor may advise:

• Topical medications or solutions that are applied to the patches
• Medicated mouthwashes
• Oral medications, such as retinoids, vitamin A, beta carotene, or lycopene
• Antiviral medications—if the leukoplakia is due to viral infection (more common in people with suppressed immune function)
• Treat dental causes such as rough teeth, irregular denture surface, or fillings as soon as possible.
• Stop smoking or using other tobacco products.
• Do not drink alcohol.

Removal of leukoplakic patches – Patches may be removed using a scalpel, a laser or an extremely cold probe that freezes and destroys cancer cells (cryoprobe).

Prevention

• Avoiding all tobacco products – This is one of the best steps you can take for your overall health, as well as being one of the main ways to prevent leukoplakia. Talk to your doctor about methods to help you quit. If friends or family members continue to smoke or chew tobacco, encourage them to have frequent dental checkups. Oral cancers are usually painless until fairly advanced.
• Avoiding or limiting alcohol use – Alcohol is a factor in both leukoplakia and oral cancer. Combining alcohol and smoking may make it easier for the harmful chemicals in tobacco to penetrate the tissues in your mouth.
• Eating plenty of fresh fruits and vegetables – These are rich in antioxidants such as beta carotene, which reduce the risk of leukoplakia by deactivating harmful oxygen molecules before they can damage tissues. Foods rich in beta carotene include dark yellow, orange, and green fruits and vegetables, including carrots, pumpkin, squash, cantaloupe and spinach.

If removing the source of the irritation does not work, the doctor may suggest applying medicine to the patch or using surgery to remove it.

Alternative Treatment

Vitamin A is very useful in the treatment of leukoplakia. Vitamin A can help improve general health and immunity of your body. It is very effective in treating leukoplakia and preventing remissions. Retinoids are derived from vitamin A and used in ointments to treat leukoplakia topically.

Vitamin E is a natural antioxidant and helps protect cell membranes from any harm due to free radicals. It is very beneficial in the treatment of leukoplakia and is recommended to be taken along with vitamin A to get its best health benefit.

Vitamin C is widely prescribed for the treatment of leukoplakia. Vitamin C is an antioxidant and helps to keep the body cells healthy. It also helps in the regeneration of new skin cells.

Vitamin B6 plays a vital role in production of new red blood cells and is also useful in strengthening the immune system. It is indicated for people suffering from leukoplakia as it has been observed that people with vitamin B6 deficiency are more likely to develop this condition.

Vitamin B9 – Also known as folic acid, this vitamin is very useful in the treatment of leukoplakia. It plays an important role in the synthesis of nucleic acid and helps to repair the DNA and RNA.

Beta-carotene – this compound has been the universal treatment supplement in all patients. he efficacy of the compound and its ability to deal with leukoplakia.

Reference –

http://www.colgate.com/en/us/oc/oral-health/conditions/mouth-sores-and-infections/article/leukoplakia

http://www.webmd.com/oral-health/guide/dental-health-leukoplakia

http://www.dermnetnz.org/site-age-specific/oral-leukoplakia.html

http://www.webmd.com/oral-health/guide/dental-health-leukoplakia

https://umm.edu/health/medical/ency/articles/leukoplakia

http://www.cancerresearchuk.org/about-cancer/type/mouth-cancer/about/types-of-mouth-and-oropharyngeal-cancer

http://www.mountsinai.org/patient-care/health-library/diseases-and-conditions/leukoplakia

http://www.pcds.org.uk/clinical-guidance/leukoplakia

http://www.aocd.org/?page=Leukoplakia

http://www.herbs2000.com/disorders/leukoplakia.htm

http://www.herbs2000.com/disorders/leukoplakia.htm

Hidradenitis suppurativa or HS is a skin disease that affects areas bearing apocrine sweat glands and hair follicles; such as the underarms, groin and buttocks, and under the breasts in women.

Also known as acne inversa, HS is a chronic inflammatory disease of the terminal follicular epithelium, often occurring in areas rich in apocrine glands. Originally thought to arise from these glands, the condition is now believed to begin through follicular abnormalities.

It may be associated with other follicular-dysfunction processes such as acne, boils in the scalp (folliculitis decalvans) or pilonidal cyst. The process arises in the mid-to-deep dermis and does not seem to be caused by bacterial agents.

It is typically characterized by erythematous, tender, sterile nodules of various sizes that develop insidiously in the inguinal, perianal, submammary, and axillary regions. These nodules may progress to frank abscesses that not only drain to produce a very foul odor but also further develop tunneling, cavitations and sinus tracts in the affected areas, leading to the development of scars and keloids. Rarely, contractures and immobility may result.

This painful condition can cause social isolation and depression . Depending on the severity of symptoms, HS will often significantly impact the quality of life of patients, begging the need for more effective treatment regimens and therapeutic options.

Causes

No one knows for sure what causes HS. Because it occurs after puberty, hormones likely play a role. The person’s immune system also seems to play a role.

It is possible that HS develops when the person’s immune system overreacts. HS begins in the hair follicles (where hair grows out of the skin). Like everyday acne, HS forms when the hair follicles clog with bacteria and other substances. It is possible that HS develops in people who have an immune system that overreacts to the plugged hair follicle.

Hormones are involved in the control of apocrine sweat glands and certainly play a part in the disease. Hidradenitis suppurativa affects women more often than men. It does not start before puberty or after the menopause. It may get better during pregnancy, but is often worse before menstrual periods. Some patients do well with hormone treatments.

Bacteria play a part too, but a variety of germs, and not just one special type, is found in the spots. It is not clear whether they cause the disease, or just flourish within it.

There may be a link with acne.

Lifestyle also seems to play a role. It seems that smoking, being overweight, or taking lithium may trigger HS. These things do not cause HS. If a person is susceptible to getting HS, any of these could make HS appear for the first time or worsen existing HS.

Although the exact cause is still unknown, dermatologists have learned the following from studying HS –

• It is not contagious.
• Poor hygiene does not cause HS.
• About one-third of people who get HS have a blood relative who has HS

Risk Factors

Hidradenitis affects 2-3% of the US population, but the number may be higher because so few people discuss this painful condition with their doctors. Other factors associated with developing hidradenitis, include being –

• Female: Hidradenitis affects four times more women than men
• African American
• Obese
• A smoker

Hormonal influences are also thought to influence who will develop the condition, but there is no clear evidence that this is the case.

Symptoms

Hidradenitis suppurativa commonly occurs around hair follicles, where many oil and sweat glands are found, such as in the armpits, groin and anal area. It may also occur in areas where skin rubs together, such as the inner thighs, under the breasts or between the buttocks. Hidradenitis suppurativa can affect a single area or multiple areas of the body.

Signs and symptoms of hidradenitis suppurativa include –

Blackheads – Small pitted areas of skin containing blackheads — often appearing in pairs or a “double-barreled” pattern — are a common feature.

Red, tender bumps – These bumps, or lesions, often enlarge, break open and drain pus. The drainage may have an unpleasant odor. Itching, burning and excessive sweating may accompany the bumps.

Painful, pea-sized lumps – These hard lumps, which develop under the skin, may persist for years, enlarge and become inflamed.

Leaking bumps or sores – These open wounds heal very slowly, if at all, often leading to scarring and the development of tunnels under the skin.

Hidradenitis suppurativa often starts after puberty with a single, painful bump that persists for weeks or months. For some people, the disease progressively worsens and affects multiple areas of their body. Other people experience only mild symptoms. Excess weight, stress, hormonal changes, heat or excessive perspiration can worsen symptoms.

Complications

Hidradenitis suppurativa often causes complications when the disease is persistent and severe. These complications include –

Scars and skin changes – Severe hidradenitis suppurativa may leave rope-like scars, pitted skin or patches of skin that are darker than normal.

Restricted movement – Open sores and scar tissue may cause limited or painful movement, especially when the disease affects the armpits or thighs.

Obstructed lymph drainage  – The most common sites for hidradenitis suppurativa also contain many lymph nodes. Scar tissue can interfere with the lymph drainage system, which may result in swelling in the arms, legs or genitals.

Social isolation – The location, drainage and odor of the sores — singly or in combination — can cause embarrassment and reluctance to go out in public, leading to depression.

Treatment

Antibiotics

• Topical clindamycin, with benzoyl peroxide to reduce bacterial resistance
• Short course of oral antibiotics for acute staphylococcal abscesses, eg flucloxacillin
• Prolonged courses (minimum 3 months) of tetracycline, metronidazole, cotrimoxazole, fluoroquinolones or dapsone for their anti-inflammatory action
• Six-to-twelve week courses of the combination of clindamycin (or doxycycline) and rifampicin for severe disease

Antiandrogens – Long-term oral contraceptive pill; antiandrogenic progesterones drospirenone or cyproterone acetate may be more effective than standard combined pills. These are more suitable than progesterone-only pills or devices.

Immunomodulatory treatments for severe diseases –

• Intralesional corticosteroids into nodules
• Systemic corticosteroids short-term for flares
• Methotrexate, ciclosporin, and azathioprine
• TNFα inhibitors adalimumab and infliximab, used in higher dose than required for psoriasis, are the most successful treatments to date

Other medical treatments –

• Metformin in patients with insulin resistance
• Acitretin (unsuitable for females of childbearing potential)
• Isotretinoin – more effective for acne
• Colchicine

Surgeries –

• Incision and drainage of acute abscesses
• Curettage and deroofing of nodules, abscesses and sinuses
• Laser ablation of nodules, abscesses and sinuses
• Wide local excision of persistent nodules
• Radical excisional surgery of entire affected areaa
• Laser hair removal

Self Help –

• Weight loss; follow low-glycaemic, low-dairy diet
• Smoking cessation: this can lead to improvement within a few months
• Loose fitting clothing
• Daily unfragranced antiperspirants
• If prone to secondary infection, wash with antiseptics or take bleach baths
• Apply hydrogen peroxide solution or medical grade honey to reduce malodour
• Apply simple dressings to draining sinuses
• Analgesics, such as paracetamol (acetaminophen), for pain control.

Alternative Treatment

Zinc – One nutrient that may be helpful in this condition is zinc. Zinc may help lower androgen levels that can lead to excess oil production and gland blockage, and have anti-inflammatory properties.

Anti-inflammatory Therapies – From a naturopathic approach, HS may be addressed using nutrients, herbs and dietary strategies that offer anti-inflammatory properties. Lowering any inflammatory triggers and possible contributing compounds like cytokines in the body may improve redness and aggravation of lesions. Identifying food triggers may be a start – in the patients I have seen with this condition decreasing intake of dairy and refined sugar seemed to provide some relief, although triggers are likely patient specific. An IgG food sensitivity test may help guide dietary elimination if triggers are unclear.

Weight Management – There is a high correlation in presence of HS and obesity, and studies suggest that degree of obesity corresponds with severity of disease. In patients who are overweight or obese, body mass may be contributing in several ways this condition. Excess adipose tissue has been shown to increase levels of inflammation and affect hormone levels, which may aggravate the inflammatory lesions involved in HS. Increased body weight may also aggravate friction in folds and predispose to obstruction and irritation of lesions that are present, while another possible explanation for this connection is a common underlying genetic predisposition to obesity and HS that is currently being investigated. (7) Weight loss as a treatment for HS has been investigated in one small study demonstrating a 15% weight loss is associated with significant disease improvement (8). HS is however not uncommon in patients of normal body weight, in whom weight loss would not be likely to influence disease progression, and in some patients weight loss an leave skin folds that increase friction. This observation also suggests that weight could be more of an aggravating factor that a cause of this condition.

Reference –

http://familydoctor.org/familydoctor/en/diseases-conditions/hidradenitis-suppurativa/treatment.html

http://www.medicinenet.com/image-collection/hidradenitis_suppurativa_picture/picture.htm

http://dermatologytimes.modernmedicine.com/dermatology-times/news/hidradentitis-suppurativa-therapy-options-progressing?page=0,1

http://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/basics/symptoms/con-20027334

http://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/basics/symptoms/con-20027334

http://www.dailystrength.org/c/Hidradenitis-Suppurativa/support-group

http://www.dermnet.com/images/Hidradenitis-Suppurativa

http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=387

http://www.earthclinic.com/cures/hidradenitis_suppurativa.html

Guillain-Barré syndrome (GBS) is a rare disorder in which a person’s own immune system damages their nerve cells, causing muscle weakness. It is an  important cause of acute neuromuscular paralysis.

The term GBS is often considered to be synonymous with acute inflammatory demyelinating polyradiculoneuropathy (AIDP), but with the increasing recognition over the past few decades of variants, the number of diseases that fall under the rubric GBS has grown to include axonal variants and more restricted variants such as Miller Fisher syndrome (MFS).

In GBS the nerve insulation (myelin) and sometimes even the inner covered part of the nerve (axon) is damaged and signals are delayed or otherwise changed. The resultant antibodies attack the myelin sheath, and sometimes the axon, causing paralysis and muscular weakness as well as strange sensations, as the sensory nerves of the skin may be affected.

The syndrome appears to be triggered by acute viral or bacterial illnesses, such as respiratory or gastrointestinal infections, occurring one to three weeks earlier. However, other events such as pregnancy, dengue fever, surgical procedures, insect bites and Bell’s palsy have also been shown to cause GBS. Usually, the symptoms start in the feet or legs and progress up the body over a few days or weeks. The disorder can be mild, moderate or severe, with life support needed in the worst cases. The exact cause is unknown and there is no known cure. Most people spontaneously recover, although some will be left with permanent disabilities.

In the United States, for example, an estimated 3,000 to 6,000 people develop GBS each year on average, whether or not they received a vaccination. Anyone can develop GBS; however, it is more common among older adults. The incidence of GBS increases with age, and people older than 50 years are at greatest risk for developing GBS.

Causes

The precise cause of Guillain-Barre is unknown. Some of the cases have followed a lung infection or a gastrointestinal infection. The following infections have been associated with Guillain-Barre – 

• Campylobacterjejuni infection. Campylobacteris the most common bacterial cause of diarrhea in the United States. Campylobacterinfection is also the most common risk factor for Guillain-Barre. It is often found in undercooked food, especially poultry.
• Influenza (the flu)
• Cytomegalovirus (a strain of the herpes virus)
• Epstein-Barr virus infection (mononucleosis)
• Mycoplasma pneumonia (‘atypical pnueumonia’ caused by bacteria-like organisms)
• HIV or AIDS
• Hodgkin disease, a malignant disease of the lymphatic system
• Systemic lupus erythromatosus, an autoimmune disease of the skin and other organs

There is no evidence to suggest that Guillain-Barrè syndrome is contagious.

Symptoms

Symptoms of Guillain-Barré syndrome can develop quickly over a few hours. The muscle weakness often gets progressively worse within a few days or weeks.

Symptoms often start in your feet and hands before spreading to your arms and legs. Initially, you may have:

• Pain, tingling and numbness
• Progressive muscle weakness
• Co-ordination problems and unsteadiness (you may be unable to walk unaided)

The weakness usually affects both sides of your body and may get worse over a period of several days.

In mild cases of Guillain-Barré syndrome, your muscles may only be slightly weakened. However, in more severe cases, the muscle weakness can progress to:

• Temporary paralysis of the legs, arms and face
• Temporary paralysis of the respiratory muscles
• Blurred or double vision
• Difficulty speaking
• Difficulty chewing or swallowing (dysphagia), resulting in the need to be fed through a tube
• Difficulty with digestion or bladder control
• Fluctuations in heart rate or blood pressure

Some people with Guillain-Barré syndrome don’t experience any pain, while others have severe pain in their spine, arms and legs.

Emergency symptoms (seek medical help right away) –

• Breathing temporarily stops
• Cannot take a deep breath
• Difficulty breathing
• Difficulty swallowing
• Drooling
• Fainting
• Feeling light-headed when standing

Treatment

Conventional Treatment

• Plasma Exchange or Plasmapheresis – Plasma exchange is a method by which whole blood is removed from the body and processed so that the red and white blood cells are separated from the plasma, or liquid portion of the blood. The blood cells are then returned to the patient without the plasma, which the body quickly replaces. Scientists still don’t know exactly why plasma exchange works, but the technique seems to reduce the severity and duration of the Guillain-Barré episode. This may be because plasmapheresis can remove antibodies and other immune cell-derived factors that could contribute to nerve damage.
• Immunoglobin therapy – In this therapy the patient is given intravenous injections of the proteins that, in small quantities, the immune system uses naturally to attack invading organisms. Researchers have found that giving high doses of these immunoglobulins, derived from a pool of thousands of normal donors, to GBS patients can lessen the immune attack on the nervous system. Investigators don’t know why or how this works, although several hypotheses have been proposed.
• Steroid Hormones (corticosteroids) – This is helpful in reducing the severity of Guillain-Barré, but controlled clinical trials have demonstrated that this treatment not only is not effective but may even have a deleterious effect on the disease.
• Medications – Muscle and joint pain can be treated with over-the-counter analgesics such as aspirin. If necessary, stronger pain medication (e.g., acetaminophen with hydrocodone) may be prescribed. Muscle spasms can be controlled with relaxants such as diazepam (Valium). Unpleasant sensation problems, such as painful tingling, can be treated with tricyclic antidepressants (TCAs) or anticonvulsants such as gabapentin (Neurontin). Corticosteroids, which often effectively treat the symptoms of autoimmune disorders, actually worsen GBS and should not be used. However, they often are used to treat CIDP.

Herpes is one of the most common sexually transmitted infections. It is caused by the herpes simplex virus (HSV). Genital herpes is usually spread by having vaginal, oral, or anal sex. One in five women ages 14 to 49 has genital herpes.

There are two types of HSV –

• HSV-1 most often causes infections of the mouth and lips, called cold sores or “fever blisters.” Symptoms are often milder than genital herpes, and you may get fewer outbreaks.2 It can spread to the genital area during oral sex and cause genital herpes. If HSV-1 spreads to the genital area, it is still HSV-1.
• HSV-2 is the most common cause of genital herpes. It is spread through vaginal, oral, or anal sex. HSV-2 can spread to the mouth during oral sex. If HSV-2 spreads to the mouth or lips during oral sex, it is still HSV-2.

Genital herpes is characterized by recurrent clusters of vesicles and lesions at the genital areas or below the waist. The female genital areas are on or near the pubis, vulva, labia, clitoris, buttocks or rectum. The areas for male genital herpes include on or around the penis, the inner thigh, buttocks, or rectum. Proctitis, or inflammation of the rectum, can be due to HSV.

The herpes simplex virus (HSV) is easily human transmissible. It is passed from one person to another by close, direct contact. The most common mode of transmission is through vaginal, anal or oral sex. When somebody becomes infected with HSV, it will generally remain dormant.

Most people who are infected with HSV do not know it because their symptoms are so slight – many people have no discernible symptoms.

Causes

HSV-1 and HSV-2 can be found in and released from the sores that the viruses cause, but they also are released between outbreaks from skin that does not appear to be broken or to have a sore.

Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection, but you can get herpes from kissing. Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected.

HSV-1 can cause genital herpes, but it more commonly causes infections of the mouth and lips – so-called “fever blisters.” HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection. Genital HSV-1 outbreaks recur less regularly than genital HSV-2 outbreaks.

The following can be ways of becoming infected –

• Having unprotected vaginal or anal sex
• Having oral sex with a person who gets cold sores
• Sharing sex toys
• Having genital contact with an infected person.

Infection of a baby can occur during vaginal delivery if the mother has genital herpes, particularly if it is the first attack. Babies infected in this way can become severely ill. The obstetrician and midwife should be told of past genital herpes infections so the risk of this complication can be minimised.

Risk Factors

People are at risk if they –

Are a woman – Women are more likely to have genital herpes than are men. The virus is sexually transmitted more easily from men to women than it is from women to men.

Have multiple sexual partners – Each additional sexual partner raises the risk of being exposed to the virus that causes genital herpes.

Symptoms

Many people with genital herpes never have sores. Or they have very mild symptoms that go unnoticed or are mistaken for insect bites or another skin condition.

If signs and symptoms do occur during the first outbreak, they can be severe. This first outbreak most often happens within 2 days to 2 weeks of being infected.

General symptoms may include –

• Decreased appetite
• Fever
• General sick feeling (malaise)
• Muscle aches in the lower back, buttocks, thighs, or knees
• Swollen and tender lymph nodes in the groin

Genital symptoms include small, painful blisters filled with clear or straw-colored fluid. Areas where the sores may found include –

• Outer vaginal lips (labia), vagina, cervix, around the anus, and on the thighs or buttocks (in women)
• Penis, scrotum, around the anus, on the thighs or buttocks (in men)
• Tongue, mouth, eyes, gums, lips, fingers, and other parts of the body (in both genders)

Before the blisters appear, there may be tingling, burning, itching, or pain at the site where the blisters will appear. When the blisters break, they leave shallow ulcers that are very painful. These ulcers crust over and heal in 7 to 14 days or more.

Other symptoms may include-

• Painful urination
• Vaginal discharge (in women) or inability to empty the bladder that requires a urinary catheter

A second outbreak can appear weeks or months later. It is usually less severe and it goes away sooner than the first outbreak. Over time, the number of outbreaks may decrease.

Complications

Other sexually transmitted infections – Having genital sores increases the risk of transmitting or contracting other sexually transmitted infections, including AIDS.

Newborn infection – Babies born to infected mothers can be exposed to the virus during the birthing process. This may result in brain damage, blindness or death for the newborn.

Bladder problems – In some cases, the sores associated with genital herpes can cause inflammation around the tube that delivers urine from the bladder to the outside world (urethra). The swelling can close the urethra for several days, requiring the insertion of a catheter to drain the bladder.

Meningitis – In rare instances, HSV infection leads to inflammation of the membranes and cerebrospinal fluid surrounding the brain and spinal cord.

Rectal inflammation (proctitis) – Genital herpes can lead to inflammation of the lining of the rectum, particularly in men who have sex with men.

Treatment

Medications – Antiviral medication, such as acyclovir or valcyclovir, can lessen the severity of an outbreak, lower the chances of passing the virus to a partner and shorten the time it takes for a sore to heal. Medication works best if it is started as soon as possible after an outbreak begins.

As recurrent outbreaks are milder, treatment is not usually necessary.

Episodic treatment and suppressive treatment

• Episodic treatment – This is generally for patients who have less than six recurrences in one year. A five-day course of antivirals is prescribed each time symptoms appear.
• Suppressive treatment – If a patient has more than six recurrences in a year, or if symptoms are very severe, antiviral treatment may last longer. The aim here is to prevent further recurrences. Some patients may have to take acyclovir twice daily for several months. Although suppressive treatment significantly reduces the risk of passing HSV to a partner, there is still a risk.

Pregnant women may be treated for herpes during the last month of pregnancy to reduce the chance of having an outbreak at the time of delivery. If there is an outbreak around the time of delivery, a C-section will be recommended to reduce the chance of infecting the baby.

Tenofovir vaginal gel protects women from herpes simplex – tenofovir, an anti-HIV mediation, when formulated as a vaginal gel, was found to reduce herpes simplex infection risk, scientists from the USA, Belgium and Italy reported in the journal Cell Host & Microbe. They explained that when in the vaginal gel formulation, higher concentrations of the drug reach the vaginal cells compared to tenofovir’s orally administered equivalent.

To reduce the risk of developing or passing on genital herpes:

• Use condoms when having sex – although condoms are recommended, they provide a “modest” reduction in the risk of acquiring HSV-2, compared to other STIs, researchers reported in Archives of Internal Medicine (July 13th, 2009 issue).
• Do not have sex while symptoms are present (genital, anal, or skin-to-skin)
• Do not kiss when there is a cold sore around the mouth
• Do not have many sexual partners
• Male circumcision cuts risk of genital herpes infection, as well as HPV

Some people find that stress, being tired, illness, friction against the skin, or sunbathing may trigger recurrences of symptoms. Avoiding such triggers, if they can be identified, may help reduce the number of recurrences.

Alternative Treatment

Many herbal and dietary supplement products claim to help fight herpes infection by boosting the immune system. There has been little research on these products, and little evidence to show that they really work. Some are capsules taken by mouth. Others come in the form of ointment that is applied to the skin. Popular herbal and supplement remedies for herpes simplex include –

• Echinacea ( Echinacea purpurea )
• Siberian ginseng ( Eleutherococcus senticosus )
• Aloe ( Aloe vera )
• Bee products that contain propolis, a tree resin collected by bees
• Lysine
• Zinc

Supplements

• Lysine – Studies suggest that lysine may help reduce the number of recurring outbreaks of cold sores. A few studies also suggest that lysine may help shorten the length of an outbreak. Lysine can increase the amount of calcium that the body absorbs.
• Propolis – A resin made by bees, propolis is loaded with antioxidants that help fight infection and boost immune function. Studies show that, it can stop HSV-1 and HSV-2 from reproducing.
• Zinc – Zinc is effective against HSV-1 and HSV-2. In one small study, people who applied zinc oxide cream to cold sores saw them heal faster than those who applied a placebo cream.
• Vitamin E – Topical application of vitamin E helps to relief pain and aid the healing of oral herpetic lesions.
• Vitamin C – Ascorbic acid has been shown to inactivate a wide range of viruses in vitro, including Herpes simplex virus, and to enhance immune function.
• Lithium – Preliminary evidence suggests that oral or topical lithium is beneficial. Lithium inhibited the replication of HSV-1 and HSV-2 in vitro at concentrations that did not inhibit host cell replication.

Herbs

• Lemon balm – Several studies suggest that topical ointments containing lemon balm may help heal cold sores.
• Aloe (Aloe vera) – Preliminary evidence suggests that aloe gel used topically may improve the symptoms of genital herpes in men.
• Rhubarb cream (Rheum palmatum) – A topical cream made from sage (Salvia officinalis) and rhubarb was as effective as Zovirax in healing cold sores.
• Eleutherococcus or Siberian ginseng – Siberian ginseng reduced the frequency, severity, and duration of outbreaks. People with high blood pressure, certain heart conditions; diabetes; obstructive sleep apnea; hormone-related cancers such as breast cancer, ovarian cancer, or uterine cancer; narcolepsy (frequent day time sleeping); mania; or who are pregnant or breastfeeding should not take Siberian ginseng.
• Peppermint oil (Mentha x piperita) – Peppermint oil helps to stop a number of viruses from reproducing, including herpes.
• Tea Tree Oil – This substance has been hailed as a veritable cure-all when it comes to any ailment that involves open sores.
• Samento extract – This substance is available in both pill and liquid form. It is extracted from a plant found in many rain forests around the world and is thought to be a major immune system booster. Most herpes outbreaks happen when the immune system is at a low point and the virus is able to cause an outbreak.

Mind Body Treatment

Having genital herpes can impact your social and emotional life. In fact, if you have herpes, it is common to feel depressed, angry, and even guilty. Worrying about possible rejection by someone with whom a person wants to be intimate is also common. Joining a support group where members share experiences and problems can help relieve the stresses associated with having genital herpes. This may also include –

• Relaxation Techniques
• Self Hypnosis
• Emotional Support

There are a number of natural options available for the prevention and treatment of Herpes simplex infections. These medications can be used to alleviate the symptoms of an outbreak and shorten its course or to suppress recurrences, reduce the number outbreaks and prevent spreading the disease.

Reference –

http://kidshealth.org/teen/sexual_health/stds/std_herpes.html

http://www.nhs.uk/conditions/genital-herpes/Pages/Introduction.aspx

http://www.womenshealth.gov/publications/our-publications/fact-sheet/genital-herpes.html

http://www.medicalnewstoday.com/articles/151739.php

http://patient.info/health/genital-herpes

http://smartsexresource.com/topics/herpes-simplex-virus

http://www.pamf.org/teen/sex/std/std/herpes.html

http://www.dermnetnz.org/viral/genital-herpes.html

http://www.fpa.org.uk/sexually-transmitted-infections-stis-help/genital-herpes

https://www.dred.com/uk/signs-of-genital-herpes.html

http://www.thebody.com/content/art6539.html

https://www.aad.org/public/diseases/contagious-skin-diseases/herpes-simplex

https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/herpes

http://www.herpes.com/genitalinfo.shtml

http://www.eadv.org/patient-corner/leaflets/eadv-leaflets/genital-herpes/

http://www.medicalnewstoday.com/articles/151739.php?page=2

http://articles.mercola.com/sites/articles/archive/2010/08/07/honey-works-better-than-drugs-for-herpes.aspx

http://www.medicinenet.com/genital_herpes_in_women_overview/article.htm

http://www.myhomeremedies.com/topic.cgi?topicid=237

http://health.howstuffworks.com/wellness/natural-medicine/home-remedies/home-remedies-for-genital-herpes.htm

Edema is swelling or puffiness of parts of the body caused by fluid retention i.e. excess fluid is trapped in the body’s tissues. Edema happens most often in the feet, ankles, and legs, but can affect other parts of the body, such as the face, hands, and abdomen. It can also involve the entire body.

Normally the body maintains a balance of fluid in tissues by ensuring that the same of amount of water entering the body also leaves it. The circulatory system transports fluid within the body via its network of blood vessels. The fluid, which contains oxygen and nutrients needed by the cells, moves from the walls of the blood vessels into the body’s tissues. After its nutrients are used up, fluid moves back into the blood vessels and returns to the heart. The lymphatic system (a network of channels in the body that carry lymph, a colorless fluid containing white blood cells to fight infection) also absorbs and transports this fluid. In edema, either too much fluid moves from the blood vessels into the tissues, or not enough fluid moves from the tissues back into the blood vessels. This fluid imbalance can cause mild to severe swelling in one or more parts of the body.

There are many types of edema. The most common ones are –

• Peripheral edema – In the feet (pedal edema), ankles, legs, hands and arms.
• Cerebral edema – In and around the brain (cerebral edema).
• Eye edema – In and around the eyes, e.g. macular edema, corneal edema, periorbital edema (puffiness around the eyes. Macular edema is a serious complication of diabetic retinopathy.

Pregnant women and older adults often get edema, but it can happen to anyone. Edema is a symptom, not a disease or disorder. In fact, edema is a normal response to injury. Edema becomes a concern when it persists beyond the inflammatory phase. Widespread, long-term edema can indicate a serious underlying health problem.

Causes

Edema has many possible causes –

• Blood clots – Clots can cause pooling of fluid and may be accompanied by discoloration and pain. In some instances, clots may cause no pain.
• Edema can occur as a result of gravity, especially from sitting or standing in one place for too long. Water naturally gets pulled down into your legs and feet.
• It can happen from a weakening in the valves of the veins in the legs (a condition called venous insufficiency). This problem makes it hard for the veins to push blood back up to the heart, and leads to varicose veins and a buildup of fluid in the legs.
• Certain diseases — such as congestive heart failure and lung, liver, kidney, and thyroid diseases can cause edema or make it worse.
• Some drugs, such as medications that you are taking for your blood pressure or to control pain, may cause or worsen edema.
• An allergic reaction, severe inflammation, burns, trauma, clot(s), or poor nutrition can also cause edema.
• Too much salt from your diet can make edema worse.
• Being pregnant can cause edema in the legs as the uterus puts pressure on the blood vessels in the lower trunk of the body.
• Edema can be a side effect of some medications, including:
  • High blood pressure medications
  • Nonsteroidal anti-inflammatory drugs
  • Steroid drugs
  • Estrogens
  • Certain diabetes medications called thiazolidinediones
• Menopause – Around the period of the menopause, as well as after, hormone fluctuations can cause fluid retention. Hormone replacement therapy after the menopause can also cause edema.
• Malnutrition and/or bad diet – Dietitians say low consumption of thiamine (vitamin B1), as well as insufficient vitamins B6 and B5, may contribute toward fluid retention. Low levels of albumin may also play a part – low albumin levels can also be caused by kidney disease.

Symptoms

The fluid build-up may cause swelling in one particular part of the body, after an injury, for example, or may be more general. Generalized edema is usually seen in health disorders such as heart failure or kidney disease. Symptoms include –

• Swollen and puffy skin
• Skin discoloration
• Skin that “pits” when pressed
• Stiff, tender and painful joints
• Weight gain or weight loss
• Raised blood pressure and heart rate

Complications

If left untreated, edema can cause –

• Increasingly painful swelling
• Difficulty walking
• Stiffness
• Stretched skin, which can become itchy and uncomfortable
• Increased risk of infection in the swollen area
• Scarring between layers of tissue
• Decreased blood circulation
• Decreased elasticity of arteries, veins, joints and muscles
• Increased risk of skin ulcers

Treatment

Diuretics – These are drugs that raise the rate of urination, providing a means of forced diuresis. Diuresis is the increased production of urine by the kidney. There are several types of diuretics – they increase the excretion of water from the body in various different ways. Diuretics are not suitable if the patient is pregnant, or has chronic venous insufficiency (weakened valves in the veins of the legs).

Oxygen therapy – Oxygen delivered through the nose may improve poor vision caused by diabetic macular edema.

Antiangiogenesis therapy (controlling blood vessel growth) – The beneficial effects of anti-angiogenesis drugs in the treatment of the glioblastomas (deadly brain tumors) appear to result primarily from the reduction of edema.

Alternative Treatment

Pycnogenol was shown in both pre-clinical and clinical studies to strengthen capillary walls and prevent edema. Research has shown Pycnogenol actually seals the brittle capillaries and stops the outflow of blood into tissue which causes the swellings, edema and microbleedings. Coupled with its anti-inflammatory properties and patent for reducing platelet aggregation, these are the fundamental mechanisms of action behind Pycnogenol for edema.

B vitamins are essential for proper functioning of several metabolic processes in the body and for red blood cell formation. Deficiency of B vitamins, especially vitamins B-1 and B-2, can lead to edema and swelling.

Flavonoids – A new class of largely unstudied vitamins are referred to as flavonoids. They provide the intense flavors in food, such as capsacin in cayenne, and the pigments, such as anthocyanin in blueberries. High doses of flavonoids are demonstrated by controlled studies to effectively reduce edema and aid in many potential causes. The best sources are fresh herbs and spices combined with colored vegetables and fruits.

Thiamine – B1 deficiency is one known cause of fluid retention. The presence of other deficiency side effects suggest positive diagnosis. These include aching and stiff jointed in the swollen areas.

Pantothenic Acid – Vitamin B5 is directly linked to edema. One of the primary functions of this vitamin is the excretion of excess fluids. Deficiency also results in such symptoms as nausea, insomnia, and muscle cramping.

Vitamin B6 is another vitamin linked directly to heart and circulatory health. Failure of the heart and vessel walls to maintain the right amount of pressure results in fluid retention.

Magnesium is needed for nerve conduction and to provide muscular strength. Because it can close some calcium channels on the membranes of neurons, high levels of magnesium can reduce the activity of nerves in the nervous system. Loop diuretics and thiazide diuretics can promote magnesium loss in the kidneys. This is an unfortunate side effect involving another unwanted side effect of diuretics: potassium loss.

Alfalfa – Provides necessary minerals. Has chlorophyll which detoxifies the body.

Calcium – Replenishes minerals lost in the edema correction process.

Cornsilk – Combination of herbs and corn silk that have been known to reduce the formation of sediments in the kidneys and helps to reduce water retention.

Horse Chestnut – Horse Chestnut seed contain Aescin which has helped to effectively reduce post-surgical edema.

Dandelion leaf is itself a diuretic, so it should not be used while taking diuretic medications.

Grape seed extract for antioxidant support. Evidence suggests that using grape seed extract may improve chronic venous insufficiency, which causes swelling when blood pools in the legs.

Acupuncture – Acupuncture may improve fluid balance.

Massage– Therapeutic massage can help lymph nodes drain.

Reference –

https://www.nlm.nih.gov/medlineplus/edema.html

http://www.medicalnewstoday.com/articles/159111.php

https://my.clevelandclinic.org/health/diseases_conditions/hic_Edema

http://www.cancer.net/navigating-cancer-care/side-effects/fluid-retention-or-edema

http://www.healthline.com/symptom/swollen-ankle

https://umm.edu/health/medical/altmed/condition/edema

http://www.medscape.com/viewarticle/524606

http://www.cvphysiology.com/Microcirculation/M010.htm

http://www.whattoexpect.com/pregnancy/symptoms-and-solutions/edema.aspx

http://www.drugs.com/health-guide/edema.html

http://www.msdmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/edema

http://www.fpnotebook.com/renal/Edema/Edm.htm

http://www.news-medical.net/health/What-is-Edema.aspx

http://www.strokecenter.org/professionals/brain-anatomy/cellular-injury-during-ischemia/edema-formation/

Cytomegalovirus or CMV is a common virus that infects people of all ages. Most CMV infections are “silent,” meaning most people who are infected with CMV have no signs or symptoms. However, CMV can cause disease in people with a weakened immune system and in babies infected before birth. About 1 in 150 children is born with congenital (present at birth) CMV infection. The word “Cytomegalovirus” comes from the Greek word cyto meaning “cell”, and the Greek word megalo meaning “large”.

Other members of the herpes virus family cause chickenpox, infectious mononucleosis, fever blisters (herpes simplex type I) and genital herpes (herpes simplex type II). Like other herpes viruses, CMV infection can become dormant for a while and may reactivate later. The virus is carried by people and is not associated with food, water or animals.

Although the virus is not highly communicable, it can be spread from person to person by direct contact. The virus is shed in the urine, saliva, blood, breast milk, semen and to a lesser extent in other body fluids. Transmission can also occur from an infected mother to her fetus or newborn and by blood transfusion and organ transplants. People who have received an organ transplant are particularly susceptible to CMV infection because they are given drugs that suppress the immune system (immune-suppressants) to prevent rejection of the transplant. In people with a weakened immune system, disease often results from reactivation of the dormant virus.

Types of CMV

• Acquired CMV, or primary CMV – a first-time infection.
• Recurring CMV – the patient is already infected, the virus is dormant and then becomes active due to a weak immune system.
• Congenital CMV – CMV infection occurs during pregnancy and affects the fetus (unborn baby).

Causes

CMV can spreads from person- person in Acquired or Primary CMV, through – Saliva – includes coughs and sneezes

• Semen
• Blood
• Urine
• Vaginal fluids
• Breast milk – the benefits of breastfeeding far outweigh CMV risks. If the baby is born premature the medical team will advise on how the baby should best be fed.
• Sexual Contact

If the surface was infected with saliva or urine, somebody touches it and then touches the inside of their nose or mouth,  there’s a possibility of getting infected with CMV by touching the infected surface.

Recurring CMV is possible under following cases –

• Organ transplant recipients who are taking immunosuppressant medication
• Patients with HIV
• Patients receiving chemotherapy
• Patients who have been taking oral steroid for over three months.

Congenital CMV cases occur when the woman is infected with CMV for the first time, either during her pregnancy or shortly before it starts.

At times the mother may have a previously dormant CMV infection, which recurs during pregnancy. The mother most likely has a weakened immune system. In such cases the virus may be transmitted to the developing embryo/fetus.

Symptoms

In Primary CMV –

• An elevated body temperature (fever), often prolonged
• Night sweats
• Tiredness, general feeling of illness, uneasiness
• Sore throat
• Swollen glands
• Joint pain
• Muscle pain
• Lack of appetite
• Weight loss.

Symptoms may normally go away after two weeks.

In Recurring CMV –   Symptoms of recurring CMV vary, depending which organs are affected. The most likely affected areas are the eyes, lungs or digestive system. Symptoms may include –

• An elevated body temperature – fever
• Diarrhea, gastrointestinal ulcerations, and gastrointestinal bleeding
• Panting – shortness of breath
• Pneumonia with hypoxemia – low blood oxygen
• Ulcers in the mouth; sometimes they can be fairly large and unpleasant
• Problems with vision, including floaters, blind spots and possibly blurred vision. In some cases symptoms may be more severe.
• Hepatitis – inflamed liver, often characterized by prolonged fever
• Encephalitis – brain inflammation, which may include behavioral changes, seizures, and even coma.

Congenital CMV –

• Hearing Loss
• Jaundice
• Pneumonia
• Purple Skin splotches or a rash (possibly both)
• Enlarged liver
• Enlarged spine
• Below-normal birth weight
• Seizures – uncontrolled electrical activity in the brain, which may cause a physical convulsion.
• Red spots under the skin

Rare symptoms may include –

• Autism
• Central vision loss, scarring of the retina, uveitis (swelling and irritation of the eye)
• Cognitive difficulties (including learning difficulties)
• Deafness (varying degrees)
• Epilepsy
• Impaired vision
• Problems with physical coordination
• Seizures
• Small head. 

Treatments

Healthy people who are infected with CMV but who have no symptoms usually do not require medical treatment.

Medications – Antiviral medicine may be needed to treat congenital CMV or active CMV in someone with a weakened immune system. The antiviral medications against CMV include the following:

• Ganciclovir (Cytovene) – Side effects include fever, rash, diarrhea, anemia, and low white blood cell and platelet counts.
• Valganciclovir (Valcyte)
• Foscarnet (Foscavir) – It is toxic to the kidneys and can cause seizures due to an imbalance of minerals and electrolytes.
• Cidofovir (Vistide)

Patients infected for the first time who experience symptoms may find that OTC (over-the-counter, no prescription required) painkilling medications, such as Tylenol (paracetamol), ibuprofen or aspirin (patient must be over 16 years of age for aspirin) will help relieve symptoms. Newborns may need to stay in hospital until their organ functions return to normal. Adults with weakened immune systems may also have to be hospitalized if there is extensive organ damage.

Alternative Medicine

• Minerals are important especially Zinc, Magnesium and Selenium. However taking Colloidal minerals is highly recommended as they generally supply good amounts of all necessary minerals.
• Lysine can help stop viruses replicating and is an excellent defense.
• Vitamin C is useful but needs to be taken in large amounts to be effective against a herpes type infection.
• All B vitamins are necessary to support the immune system as is Vitamin A and should be taken daily. Vitamin A often also needs reasonably high amounts to be effective against viruses. Often extra Vitamin B12 is necessary.
• Supplements containing Paris polyphylla, Dandelion, Woad, and Licorice appears safe and effective in reducing cytomegalovirus infection activity in pregnant women.
• Garlic extract has potent antiviral activity against human cytomegalovirus. Garlic contains a compound known as allitridin which has therapeutic activity comparable to the antiviral drug ganiciclovir in a mouse model of cytomegalovirus hepatitis.
• Supplements containing Jinye Baidu granule significantly increase the negative conversion rate of HCMV-IgM.
• Ascorbic acid reduces the infectivity of herpesviruses and paramyxoviruses.
• Astragalus may have a therapeutic role in combating cytomegalovirus infection.
• Geum japonicum, Syzygium aromaticum (Clove), and Terminalia chebula inhibit Cytomegalovirus infection.
• The brown seaweed known as Leathesia difformis contains fucoidan fractions with antiviral activity against cytomegalovirus and herpes simplex virus type 1 and 2.
• Various extracts of ginger inhibit Cytomegalovirus, HSV-1, and HIV virus.
• Artemisinin, a compound found within the herb wormwood, inhibits a broad range of viruses.
• Bamboo compounds have anti-cytomegalovirus activity.
• Calcium spirulan, an inhibitor of enveloped virus replication, from a blue-green alga Spirulina, exhibits activity against a variety of viruses.
• Flavonoids belonging to the kaempferol series exhibit antiviral activity against cytomegalovirus.
• Other very useful herbs for any viral infection are Echinacea, Astragalus, Phyllanthus and Reishi mushroom.

Refernence –

http://www.ncbi.nlm.nih.gov/pubmed/10611727

http://www.greenmedinfo.com/disease/cytomegalovirus-infections

http://www.aidsmeds.com/articles/CMV_6771.shtml

http://www.thebody.com/content/art6017.html

http://www.medicinenet.com/cytomegalovirus_cmv/page5.htm

http://kidshealth.org/parent/infections/bacterial_viral/cytomegalovirus.html#

http://www.mayoclinic.org/diseases-conditions/cmv/basics/treatment/con-20029514

http://www.nhs.uk/Conditions/Cytomegalovirus/Pages/Treatment.aspx

Cryoglobulins are proteins found in the blood that precipitate (clump together) in the cold and cause inflammation and organ damage. However, these proteins can occasionally be present in low levels in the blood without any symptoms. When there are symptoms due to the cryoglobulins, the disease is called “cryoglobulinemia.”

Immunoglobulins are the class of proteins that make antibodies in response to foreign substances – antigens introduced into the body. In the case of cryoglobulinaemia, the abnormal immunoglobulins form complexes – cryoglobulins and precipitate (leach) out of the blood at cold temperatures. This causes restricted tissue blood flow and systemic inflammation, which leads to many clinical signs and symptoms including skin lesions, arthralgia (joint pain), arthritis, vascular purpura (purple skin marks), livedo (marbling pattern), and bleeding conditions.

Types of Cryoglobulinemia –

Cryoglobulinemia may be classified based on cryoglobulin composition with the Brouet classification, which is as follows –

Cryoglobulinemia is basically classified into three types, Type-I, Type-II, and Type-III.

• Type I Cryoglobulinemia – This is caused by monoclonal immunoglobulin. This type is usually related to cancerous conditions of the blood or the immune systems.
• Types II Cryoglobulinemia – This is caused by IgM, IgG and IgA monoclonal immunoglobulin. These types of Cryoglobulinemia are most commonly found in people who have chronic inflammatory conditions like hepatitis C.
• Types III Cryoglobulinemia – This disease is caused by IgM and IgG polyclonal immunoglobulin.

Cryoglobulinaemia is thought to be rare. Essential mixed cryoglobulinaemia occurs in about 1 in 100,000 people. Most cases of cryoglobulinaemia have an underlying cause. The type of cryoglobulinaemia found in patients is roughly 25% with type I, 25% with type II and 50% with type III.

Each type is associated with different diseases and disorders, which may include cancer involving white blood cells, infections, autoimmune disorders, rheumatic diseases, vasculitis, kidney disease, hepatitis C virus infection, and peripheral neuropathy. More than 90% of people with cryoglobulinemia also have a hepatitis C infection. Hepatitis C virus infection is primarily acquired by needle sharing and tainted blood products, and only rarely transmitted sexually. Treatment of the underlying hepatitis C virus infection may be an effective therapy for an associated peripheral neuropathy

Causes

• Hyper-Viscosity– Cryoglobulins circulates in blood and become thick and precipitate at low body temperature. The cause of change in physical characteristics at low temperature is not known.
• Antibodies– Cryoglobulins are proteins that function as antibodies. Cryoglobulin increases in autoimmune disease.
• Infection- Cryoglobulin is found in higher concentration in hepatitis C infection.
• Blood Cancers– Cryoglobulin is abnormally increased in patient suffering with lymphoma and multiple myeloma
• Connective Tissue Disease– Concentration of Cryoglobulin is at higher level in patients suffering with connective tissue disorder like lupus.

Risk Factors –

Infections associated with cryoglobulinemia include the following:

• Viral – Hepatitis A, B, and C (see Differentials); HIV; Epstein-Barr virus (EBV); cytomegalovirus (CMV); adenovirus; chikungunya
• Bacterial – Endocarditis, streptococcal infections, syphilis, Lyme disease, leprosy, Q fever, brucellosis
• Fungal – Coccidioidomycosis
• Parasitic – Malaria, toxoplasmosis, others

Symptoms         

Most people with cryoglobulins have no symptoms other than elevated levels on lab tests. When symptoms are present, they are most commonly fatigue, joint pain, numbness or weakness, and a rash that looks like red spots or purple bruises, usually over the lower legs.

Other symptoms and signs may include –

• Change of the color of hands and/or feet (from normal to white to a purplish-blue color) with cold, called “Raynaud’s Phenomenon”
• Weight loss
• High blood pressure
• Swelling of ankles and legs
• Skin ulcers and gangrene
• Enlarged liver or spleen
• Numbness, tingling or weakness
• Kidney damage

Specific Symptoms of Cryoglobulinemia –

• Skin- Purple bruises, rash and skin ulcer
• Skeletal System- Joint pain, muscle ache, ankle swelling (edema feet) and Raynaud’s phenomenon
• Nervous System- Peripheral neuropathy, numbness and weakness
• Respiratory System- Dyspnea or short of breath
• Kidney- Glomerulonephritis causes hematuria, proteinuria and kidney failure
• Cardiovascular System- Hypertension
• Gastrointestinal System- Enlarged liver and spleen

Complications

Complications include –

• Bleeding in the digestive tract (rare)
• Heart disease (rare)
• Infections of ulcers
• Kidney failure
• Liver failure
• Skin death
• Death
• Ischemic Changes– Serum Cryoglobulin causes thick precipitation of serum at low temperatures. Increased blood viscosity eventually start slowing the blood flow or blocks the smaller vessels. The reduced blood supply to tissue and organs causes ischemia (lack of blood supply) and numerous complications including renal failure.
• Tissue and Organ Damage– Cryoglobulinemia is a disease, which damages the tissue secondary to ischemia. Blocking of blood supply to normal tissue and organ causes ischemia.

Treatment

Medications –

• Rituximab is an effective drug and has fewer risks than other medicines.
• Cyclophosphamide is used in life-threatening conditions where rituximab is not working or available. This medicine was used often in the past.
• A treatment called plasmaphereis is also used. In this his procedure, blood plasma is taken out of blood circulation and abnormal cryoglobulin antibody proteins are removed. The plasma is replaced by fluid, protein, or donated plasma.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used in patients with arthralgia and fatigue.

Alternative Treatment