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OPRL1 gene associated with more PTSD

June 11, 2013 Leave a comment

 

English: Cases of PTSD and Severe Depression A...

English: Cases of PTSD and Severe Depression Among U.S. Veterans Deployed to Iraq and Afghanistan Between Oct 2001 and Oct 2007 (Photo credit: Wikipedia)

It’s nice information to know if a certain gene can be associated with PTSD, if you have the gene you and your family could take extra steps in compensating for stressful events rather than expecting people to “buck up”.

This article shows that the use of a particular undisclosed drug kept people from having PTSD like symptoms in mice.  The drug works by activating the OPRL1 receptor for a brain chemical called nociceptin.   When the receptor was activated the mice learned not to feel fear.

In humans the presence of a particular SNP of that same gene had more pronounced PTSD symptoms.

So one version of the gene can protect you while another version may not.  And it seems that morphine  acts on a receptor that’s related, by that I assume close to, OPRL1.

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Targetted Probiotics

This is a great video by Kurt Woeller about the several kinds of probiotics.  While we all know that probiotics are good for you, I didn’t quite absorb which ones target what kinds of conditions.

Kurt references the following:

  • Culturelle used for Clostridia
  • VSl3 breaks down Oxalates
  • Threelac attacks yeast
  • Saccharomyces boulardii (yeast)  attacks candida (yeast) and clostridia.
Categories: Autism

Chronic Fatigue and Exercise Intolerance

Sleeping when studying - Nakhon Sawan, Thailand

Sleeping when studying – Nakhon Sawan, Thailand (Photo credit: Wikipedia)

Exercise Intolerance is exactly the thing that people blame themselves (and others for).  Stop being lazy, push yourself harder, nauseous?  here have a half a stick of gum, now don’t give up!

Maybe all these things are valid at one level to get one out of a rut, or complacency, but when you have chronic fatigue these behaviors maybe fairly dangerous.  One young man who pushed himself despite his Exercise Intolerance, died from his efforts.

The Test

Using the same stress tests as used by doctors and sports professionals 8 minutes on an exercise bike, add in a mask to test for oxygen levels, the system tests several systems, cardiac, pulmonary, and metabolic.  Normal people after having this type of stress should recover and have the same performance the next day.   CFS people do not. If you have CFS you know that it takes several days to recover.

The test can give you your “anaerobic threshhold”.  This is the activity level where CFS patients now lose strenth and stamina in a way that is difficult to recover from.  Less than your threshhold you can still “bounce back” from your activities.  That threshold can be referred by heart rate, so theoretically you can exercise as long as you remain below that threshhold.

Disability

Unfortunately some people meet this threshhold while taking a shower, or other daily activities.  Luckily Social Security has been accepting the results from this test as an independent marker of disability.

Categories: Bodywork, Fatigue, POTS, Stress

General Insurance Authorization info for ABA

January 30, 2013 Leave a comment

ABATrumpet Behavioral Health (TBA) and TACA (Talking about Curing Autism)  recently held a webinar about gaining insurance coverage for ABA (Applied Behavioral Analysis). ABA has typically been a 40 hr/week program at home aimed and infants and toddlers to train children in correct behavior.   It is not based on deep cognition.  Nonetheless it is one of the few things studied that have been shown to help autism, and what’s new is that insurance companies are beginning to cover it!    You can imagine  that any intervention  of 40 hrs/week with trained individuals can get quite expensive.

Important General Insurance Info

Regulating Health Plans in CA

TBA is based in California so there will be a California-centric view. In CA these are the organizations which regulate health plans: DMHC (Department of Managed Health Care) and CDI (California Division of Insurance).  If you have been denied healthcare these agencies can review the determination and may overturn insurance decisions.  They cannot change any benefits in the plan, but if the benefits are already in the plan they may be able to help you get them.

In your state, you might be able to go to the analogous agency in your state.  To find out who regulated insurance in your state you can simply ask the insurance company, and of course look it up on the web.

Type of Insurance Plan

  • Fully Insured – large group plans, regulated by the government, owned by insurance companies, regulated by state agencies.
  • Self Funded – employers money funds the plan so government mandates do not apply.  They may still hhave 3rd party administrators that look like insurance companies like the Fully Insured but employers decide final benefits. Several self insured plans cover ABA, such as Microsfot Home Depot etc

A Summary Plan Description- has the details of your plan, research this for benefit  actual benefit determination

Authorization

ABA falls under Mental Health benefit, therefore use mental health phone number when contacting the insurance company/administrator.  Your plan may have Autism Unit/Care Manager.  The best way to get authorization is to get a precise list of what documents are needed for authorization.

Assessment

ABA or any therapy requires an assessment.  You will want to find out what details are required to gain coverage.  Question can be:

  1. Who can do assesment?  Masters Level clincian? Licensed? How many hours after their masters are required i any?
  2. How long is the assessment? # of hours?  Are there different coverages for the assessment and the writeup for the assessments?  Is there a maximum timeperiod during which the report can be submitted?
  3. When is reassessment required?
  4. What code will you bill under?
  5. What assessemnt tools used by provider are approved?

Supervision

  1. Who can provide supervision? Masters? BCBA Licensed?
  2. Can Supervision be billed on same day as direct ABA Service?
  3. How many hours of supervision is approved?
  4. Does supervision have to be in presence of client?

Direct Services

  1. How many hours of direct therapy are covered?
  2. Who can provide direct therapy?
  3. Where can services be provided (historically it was at home), if clinic setting is there a different copay?
  4. What are approved dates of service?

Treatment Plan Requirements

  1. What forms should be used for authorization? Are they found online?
  2. Resend treatment plan before authorization expires?
  3. What to include in the treatment plan to be covered?
    • goals
    • objecives
    • target dates
    • baseline
    • transition plan
    • discharge criteria
    • Parent Involvement

How TBA can Help

Members of this organization fight for coverage under your exsiting coverage, they have several years of experience with  insurance companies, and state organizations.  They can help with the following to get coverage:

  • coding,
  • copay/ # of sessions
  • authorizations and
  • billing
Categories: Autism, Tools Tags:

ADHD and Executive Function

January 27, 2013 Leave a comment
Human Eye with different lines. The line of si...

Human Eye with different lines of sights.

We know that ADHD exists, so I’m not going to go into proofs that the child is not “raised irresponsibily”.  On the other hand, having a child with any disability does require you to be a more sophisticated parent and more sympathetic.

Executive Function (EF)

Executive Functions or EF are the skills used to filter, organize, and prioritize stimulus and cognition to perform a function.  Kids with ADHD  “exhibited significant impairment on neuropsychological
measures of response inhibition, vigilance, working memory, and planning”.   

Tests

From the neuropsych perspective, the Wisconsin Card Sort,  the Rey–Osterreith, and the Tower of Hanoi have been used to test EF.  You may have seen these tests on the Neuropsych Report when you had your child tested at the psychologists office.

EF part of ADHD or IS ADHD?

The International Journal of Disability, Development and Education, published a paper about how ADHD can be looked at with respect to EF with two perspectives: 1) Executive Function is part of the ADHD diagnosis or 2) Executive Function is the reason you have ADHD in the first place. 

Many meta studies have shown that while there is weakness of executive functioning in a part of the ADHD population it is not a singular representation of ADHD behaviors and outcomes.  Some studies show that only 30% of those diagnosed with ADHD have executive functioning problems.  And  people with autism, oppositional defiant, traumatic brain injury and other disorders also show EF problems.

Others like Denckla, Barkley, T.E. Brown and others show that there is significant cognitive impact, especially the ability to inhibit.  Brown has modeled the areas where this cognitive deficit can be seen:

  1. Activation: Organising, prioritising and activating to work.
  2. Focus: Focusing, sustaining, and shifting attention to tasks.
  3. Effort: Regulating alertness, sustaining effort, and processing speed.
  4. Emotion: Managing frustration and regulating emotions.
  5. Memory: Utilising working memory and accessing recall.
  6. Action: Monitoring and self-regulating action.

Brown argues that tests traditionally used in a neuropsych report are insufficient indicators of EF strengths.  The reason for this is that dissecting a problem into constituent parts is reductionist and does not reflect the whole.  While you can put body parts together and add electricity, you will not get a whole functioning human from it.  Rather a test of normal daily functions is a better indicator of EF ability.

Stealth Dyslexia

Sometimes EF problems can result from Stealth Dyslexia.  Have you or child made “stupid mistakes”?  You know that 3+12=15, but on a test you may multiply the left hand side and come up with an answer of 36, and not know you made the mistake.  Even if you go back and check.  Dyslexia originally thought to be a reading disorder may manifest in several ways not currently recognized as dyslexia.  What if the dyslexia manifested cognitively outside of just reading?  Eides and Eides have determined that Stealth Dyslexia have these in common:

  • Characteristic dyslexic difficulties with word processing and written output.  This is sometimes found as high IQ and verbal comprehension but trouble with output: terseness, spelling mistakes etc.
  • Findings on neurological and neuropsychological testing consistent with the visual language, auditory, and motor processing deficits characteristic of dyslexia.  Visual Percepetion issues and not attention could be the cause of coding/tracking problems.  Visual Problems can often be addressed by seeing a Developmental Optometrist.  Central Auditory Processing Disorder (CAPD) is found in many kids (and adults) where one cannot manage and filter background sounds from primary communication.
  • Reading skills that appear to fall within the normal or even superior range for children their age, at least on silent reading comprehension.  But writing and listening may be problematic.  Sometimes one can tape the lecture knowing that ideas will be recorded for later recall, several times if needed.   That way one can listen to the lecture and absorb the concepts.

Processing Speed

Yes slow processing speed is a recognized condition and can contribute to the impulsivity of ADHD.  People with SPS (I just made that up), cannot participate in dynamic conversations because just as they’ve figured out the pace, direction and tone, it has moved on.  They also have trouble “getting” things that are taught.  You might find very intelligent people teaching themselves, and rather than get behind they teach themselves ahead of everyone else. If you cannot keep up, you might just  forget it and decide to go for things.  And this may become a habit, that manifest as EF.  Some studies show that processing speed normalizes around 27 years of age, but if you can’t wait that long…or have regressed because of TBI, you can consider neurofeedback or SimplySmarter which works on sequential processing  and therefore could help processing speed in general. 

Medications have not been known to help with any of these things that interfere with clear EF, but knowledge of these aspects may allow you to have the sympathy to support your child (spouse?) better.

Categories: Affect/Emotion, Anxiety, Autism

Chronic Fatigue as a Response to Organ Failure

January 23, 2013 12 comments

 In 2004 a patient of Dr. Cheney, Carol Silverling wrote down her interpretations of the cardiac dynamics of CFS.  Her article was based on interviews with Dr. Cheney and her own knowledge.CS

The premise is that because of mercury poisoning or viruses we are creating too much peroxynitrite which causes oxidation and aging Reduced microcirculation as a result of the mercury  begins to cause organ failure.  In “normal” people this may result in a fast path to organ transplant (or death), but for others (those who have CFS)  it results in organ failure in a progressive slower fashion.  This means you have time to address the problems! 

Heart Failure

Dr. Cheney’s premise is that every CFS individual is in the process of heart failure, this is termed Idiopathic Cardiomyopathy (ICM). The difference between CFS and heart failure is that the body is trying to compensate for the lack of microcirculation  by symptoms found in CFS. 

 Dr. Natelson applied for an NIH grant to find physiological parameters that may independently be a measure for the degree of disability. The purpose of this was to find a quantifiable way to designate those that are disabled from those that are not.  But also a measure of the degree of disability…how disabled are you? This could be significant in a “two-sides-of-the-same-coin” kind of way.  With an objective marker you could not fool anyone into providing disability services that were not needed.

And on the other side, you could get disability services even though you “don’t look sick”. The measure they looked at was “Q”, which stand for cardiac output in liters per minute.  CFS individuals have the largest variation of Q when they stand up.  This lowered Q could result in organ failure due to low cardiac output.  In this measure the higher the score the greater the disability.  Using an FDA approved algorithm to measure impedance of blood,  they determined this Q measure.  The idea was that the Q value would be adjusted for size of the individuals so that the it was a true measure of disability across the population and body types.

There is a another statistic that correlates with Q, and that is post extertional fatigue (PEF).  This is not the “no pain, no gain” kind of pain you want while building muscle. This is a breakdown and can’t repair kind of muscle ache.  As it turns out all disabled CFS patients have PEF. 

At the same time you may be aware of POTS (Postural Orthostatic Tachycardia Syndrome). There are several kinds of POTS, but one is when one stands up and  the drop in blood pressure is large enough that the heart must compensate by beating faster.  The reason for the drop is that the end arteriole or resistance vessel was not doing its job of moving  blood up against gravity from your feet.  When this is not working your body also tries to compensate by increasing the pressure to get it moving.  When this occurs the main line (to the heart)  improves but peripheral blood is not moving optimally and microcirculation is decreased.    These compensations by the heart are just that — compensations.

Organ Failure Progession

Peripheral organs fail first without enough Q, but they are sacrified in priority.  Here is that priority in normal circumstances. See if this lines up with the progession of illnesses in yourself or family/friend:

  • Skin and hypothyroidism. The skin and nails are at the extreme “end” of your body and therefore will suffer the most from loss of microcirculation. Now you can’t regulate your temperature from your skin so your body turns down your thyroid ON PURPOSE.  Your skin which is one way to detox is now unable to do this and so detox through sauna is often recommended.
  • Muscles.  Not only do you get pain when you exercise, you get NO GAIN.  The more capillaries (like male athletes have) the less likely this is going to happen, and if you are a sedentary female…well you can guess. This is because women have fewer capillaries then men on average and based on the  lack of activity do not grow (or maintain the ones you have).  This could explain how with intense exercise you are still unable to gain muscle.
  • Gut.  Since your gut needs microcirculation to function, you won’t be able to digest, and will develop food allergies, and be unable to detoxify.  You could get flatulence, constipation and all sorts of overgrowths.  Less digestion also means less absorption. 
  • Brain.  As the master controller of your bodily functions if this doesn’t work, neither does anything else really.  You could get autonomic problems to hypothalamus regulation of hormones, decreased processing speed, memory and cognition.  The combination of thinking and being sedentary (office work anyone?) is the worst possible combination.  Meditation might help those who are sedentary, but even slow deliberate exercise would be good.  In the worst cased you could get a rebounder, a small trampline and just bounce on it.
  • Heart.  Now your heart struggles with even the smallest amount of exertion, if the microcirculation problems get worse your hearty heart cells begin to die.  If  this in turn causes more microcirulation problems you have begun a feedback loop of cardiac failure. 
  • Kidneys and Lungs are the last to go and are considered the cause of death.  The only thing that can save you is a transplant.  In CFS though it’s different. You may have most of the early steps, but you don’t end up with extreme pulmonary edema and renal failure.

Causes

ICM can often caused by infectious diseases; Dr. Cheney thinks there might be a link to some viruses.  The other contributing factor could be heavy metal poisoning.  An Italian study found that ICM hearts had 23K times more mercury than control and 18K more mercury than other types of heart disease.

Peroxynitrite

Dr. Pall has another angle on CFS and that is Peroxinitrite.

NO + Super Oxide = Peroxinitrite

Peroxynitrite is deadly and this is the celluar cause of “old age” and death.  However it is made from two compounds that are essential for life, Nitrous Oxide (NO) and Superoxide (SO). Peroxynitrite participates in oxidation with free radical formation. Dr. Pall studied these dynamics in CFS which can be explained as follows:

Nitrous Oxide  (NO)

 There are three kinds of Nitrous Oxide, iNOS, eNOS and nNOS. iNOS is created to fend off bugs and allergies.  eNOS is for microcirculation, and nNOS is for memory and learning, but also makes you sensitive to (Electro Magnetic Radiation) EMR and noise. The NMDA receptor makes NO when activated; some practitioners use GABA to downregulate NMDA.

Superoxide (SO)

is made while manufacturing energy, in the mitichondria. NO is found outside the mitochondria, thus NO and SO have no way of interacting with each other to create peroxynitrite. Until SO starts to leak out.  Within the mitochondria, SO should be broken down by SOD before leaking out, but this assumes that glutathione is present.  If you have the CBS mutation you may not be making enough glutathione.  If you are very toxic, the glutathione you make might be attending to other problems and not be around to help.

Mercury can block the binding site of selenium on a cell and therefore not allow the SO to be broken down, now it begins to leak out of the cell. The more energy you generate the more SO begins to leak in the presence of mercury. Eventually having not enough glutathione will result in injury to the mitochondria membrane.

CoQ10 in the mitochondria and ALA in the cytoplasma bind to SO to prevent leaking out and unable to form peroxinitrite in the when it does.  CoQ10 is tricky in that there is an optimum amount and taking more than that you may generate more SO than you wanted. (It appears that Idebenone may be better than CoQ10 in that case) 

Without CoQ10 and ALA to help, your body stops making energy in order to reduce the creation of peroxynitrite.  Provigil is often used to create energy by activating the NMDA receptor, but this is creating more NO, which can contribute  to peroxynitrite in the presence of SO. 

So what gets rid of peroxynitrite once it is created?  CO2.  CO2 is a peroxynitrite scavenger and is created when ATP is made. Normally this would work great, but as ATP is reduced (because peroxinytrite is not being scavenged) so is CO2 and thus the scavenging of Peroxynitrite gets reduced further.

You can increase CO2 by rebreathing your own breath. This will also improve microcirculation.  Have you notice you or family member sleeping comfortably entirely under the covers?  Could this be the mechanism going on?

How do you reduce NO and SO?

    1. Klonopin gets rid of the enzyme that creates NO.
    2. You could live at or below sea level to increase CO2. POTSIES often feel better at these elevations.
    3. Uric acid is a scavenger of peroxynitrite and is found to be low in CFS.  It is made from RNA and DNA metabolism, and fasting!  So those religious folks had it right. 
    4. Sushi is very high in digestible RNA and DNA. Microwaving kills RNA and DNA efficiently.   You can also eat “young food” such as eggs and raw milk. If you can’t get raw milk consider raw milk cheeses.  Nuts and seeds and baby lettuces and spinach as well.
    5. B12 injections (if you have the MTHFR mutation this means Methyl B12 injections)
    6. Magnesium Sulfate blocks NO production. Finally you can take Zinc and Selenium to block and/or chelate mercury.  

I really found this topic very interesting.  It explains a progression of symptoms that are familiar and for me points back to mercury being the culprit.  Luckily we have ways to remove the mercury even if is a complex process.  Other ways to help with microcirculation in the meantime are L-Arginine and Black Pepper Essential Oils.  

In summary, instead of running headlong into heart failure, PWCFS are going through the same progression just much slower…giving us time to maybe address the problem.

EMDR for PTSD

January 21, 2013 1 comment
EMDR

EMDR

EMDR stands for Eye Movement Desensitization and Reprocessing, originally coined by Dr. Francine Shapiro Ph.D.  She had been recalling  her own traumatic event while taking a walk, and realized that when her eye movements went from side-to-side that the  feelings and “pull” of that event lessened noticeably.   She then decided to investigate the dynamics further and  developed an 8 stage approach to EMDR.   To summarize the patient is creates a safe place in their imagination for retreat if any trauma is found to be overwhelming during the session.  Once this has been established the patient is brought back to the negative memories while they watch a light move from side to side.  After each movement session, the client reevaluates to see if the positive cognition (a preferred alternate to the same situation) is true.  When the client is satisfied that the positive cognition is true and the negative is not, the session is “installed” in the body through the client scanning their body and attend to any physical discomfort.

Does EMDR Work?

This processes then was studied several times by Dr. Shapiro and several  other researchers.  Even critics of the method still agree that there is a positive response, it is more a matter of whether eye movements are central to the therapeutic effects.  The evidence for the work is handily summarized  in a Q&A with Dr. Shapiro and the New York Times readers.   Some believe that desensitization was the key dynamic, while others claim that the eye movements are analogous to R.E.M. sleep eye movements  and this is how trauma is processed.  These studies have been supported by the American Psychiatric Association  (for example for rape) as well as the Department of Defense for soldiers returning from war.

Personal Response

Having done a lot of work on myself,  medically, psychologically and with nutrition, I felt that whatever was slowing down my progress must be subsconscious.  I asked my therapist if she knew anyone trained in other types of techniques such as hypnosis and found she was trained by Dr. Shapiro.  So we did our own sessions,  I ended up needing only 5 sessions for me to process what I was consciously aware of.   It was highly successful, and as a result I was able to move onto another level of self discovery entirely positive.

Variations

More than Eyes

Since the original discovery of EMDR, it has been found that the same effect can be had by using sound or touch on both sides of the body.  So while advancement is not dependent on eyes, it seems that the bilaterality is the key.  It appears that the bilaterality is a method of creating new flows that bypass the “stuck feeling” in the psyche and allow resolutions

Brainspotting

Brainspotting

Brainspotting

Brainspotting, a book by David Grand is a technique that extends that found in  EMDR .  The author used EMDR to address most of his trauma, but could not find a way to resolve it completely.  He realized that there was a location in an individual’s visual field that could be identified by patterns in eye movement when the patient looked in that direction and rested there.  These signify unresolved processes that are held in the brain, very much like one can hold trauma in the body.  The patient is guided to attend to this location and be with the trauma, then observe and watch the dynamics change as one follows the changes.  The brain is now able to process the trauma so it loses its hold and now becomes a memory.

Worth Trying

Bothe EMDR and Brainspotting are thought to be efficient ways to address trauma that is held in the brain.  They each require a lot less time that talk therapy and seem to have evidence to back up their efficacy.   If you decide to try it, please let us know how you did!

Categories: Affect/Emotion, Trauma
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