Vascular growth and brain protection

“A nourishing protein that promotes the growth of neurons and blood vessels appears to stop the progression of a genetic disease that causes degeneration of the cerebellum, according to new preclinical research. The disease, spinocerebellar ataxia type 1, typically strikes people in the 30s and 40s and eventually causes death.”

The key protein is called Vascular Endothelial Growth Factor, VEGF. It is known to stimulate the growth of healthy blood-vessel linings. We know for a fact that healthy blood vessels are important to maintaining healthy brains! Without them, we get strokes, not to mention this type of ataxia.

The funding-hungry researcher’s first thought is, “How do we turn this into a drug?”

The smart clinician’s first thought is, “How do we improve vasculation, oxygenation and circulation in safe, endogenous, sustainable ways from youth onwards?”

Don’t need FDA approval for that. Just takes fresh food, fresh air, clean water, and safe activity.

Clinicians, if you’re puzzled about how to get all that for your patients, call your legislators (use the link on the right to find them) and share your concerns. Those letters after your name are worth more than you might think.

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SSRI can improve cognition after a stroke

This came out 2/2010, right in the middle of my being horribly overdosed on SSRI and SNRI medications:

http://www.sciencedaily.com/releases/2010/02/100201171523.htm

(This is where I give myself points for not being violently and irrationally opposed to the class of drugs that did me, personally, so much harm. It’s important not to throw the baby out with the bathwater.)

129 patients were divided into roughly 3 groups, one of which got 5-10 mg Lexapro daily, another got placebo, and the third were assigned to “a problem-solving therapy program developed for treating patients with depression.” (No idea what program that is and they weren’t specific about it.)

The Lexapro group had the best neurocognitive scores after 12 weeks, though the author doesn’t say by how much, or how they processed the data. These are both important issues in scientific studies, since some differences are significant and others are just curious, and how you arrived at those figures can have a considerable effect on how seriously your readers should take them.

“…reported changes in neuropsychological performance resulted in an improvement in related activities of daily living” — which makes perfect sense. When all is said and done, healing of any kind is about what more you can DO afterwards! Doctors, patients, and significant others tend to lose sight of that, getting lost in the compelling drama of symptomatology, misery, and pain. It’s not that that isn’t important, but being able to take care of yourself — or making it so your patient can do so — is absolutely primal.

This study used low doses, which I suspect is key to unimpaired cognitive function — not to mention avoiding the usual side effects of this class of drugs, as they did.

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Warning: Starvation and alcoholism don’t mix

The latest candidate for Dept. of the Blitheringly Obv.: Young people eating too little and drinking too much is worse than doing either alone. No, really??

Lasting damage to memory and thinking, more bad choices, and increased likelihood of developing chronic conditions later in life, are far more likely because the damage from each form of fashionable self-abuse compounds the other.

This idea is certainly high on the head-desk quotient, but the article is mostly clear and sensible:

http://www.sciencedaily.com/releases/2011/10/111017171506.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

They mention that the risks to women are higher ounce per ounce, but don’t say why; that vagueness is annoying and wrong, and science is far enough along to know better.

The idea that real food might be good for you is kind of a shocking idea, to some. Encourage them to get used to it. Fresh salad, berries, roast chicken, apples, baked potatoes, butternut squash … There are worse things. Like brain damage, cirrhosis, kidney failure, strokes, chronic fatigue, and HIV.

And looking really bad by 30.

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Assessing live myelination — and dead CRPS!

Fortunately, I’m bright enough to evaluate this extraordinary new method:

http://www.sciencedaily.com/releases/2011/09/110913103211.htm#.TnDL-iVvIQs.mailto

There are vague mentions in the literature of myelination in CRPS, but researchers are so busy trying to figure out how to pill CRPS — a highly pillable disease — that such mechanistic issues get surprisingly little play.

Myelin is the protective sheath of fat that keeps your neurons safe and warm, so they can do their work. Without myelin, your nerves can’t fire properly — or else they can’t stop firing. They need the myelin sheath. Little kids need to take in a certain amount of cholesterol so their growing bodies can build good myelination. Demyelination, that is, the loss of that sheath, is most famously known for its role in Lou Gherig’s disease.

I’ve long suspected that demyelination is both an important sign of disease progress and a powerful contributing factor to further degeneration of the peripheral, if not the central, nervous system in CRPS. However, there’s not much in the literature, probably because it’s a useless treatment marker in someone who’s beyond treatment.

This brings us to the particularly delightful issue of finding corpses to study, since until now we could only check myelination after autopsy, and those who donate their bodies to science are filed under what took their lives.

People with CRPS develop heart disease, cardiovascular disease, bleeding disorders, organ failure, vision impairment, and staggering depression as a direct consequence of CRPS. However, when they drop dead, get struck by a bus they couldn’t see, or take their own lives, we don’t say “They died of CRPS.” We say, “They died of heart disease, organ failure etc., traffic accident, or suicide” (– if we’re feeling kindly, “or depression.”)

Thus, there’s no way to identify the actual mortality rate of CRPS, although there unquestionably is one.

Diabetes, cancer, and AIDS get more dignity than this. I’d like to see our mortality rate properly attributed, not swept under the enormous rug of opportunistic conditions. This would contribute hugely to better medicine.

Doctors hate seeing patients hurt, but after awhile they can turn away from that, in order to drag themselves back to the office; they hate to see them die on their watch, and it makes them apply upward pressure on the reimbursement and legislative aspects of the care system.

There’s nothing like a mortality rate among those in their “productive years” to make legislators sit up and take notice.

I started nursing within a decade of the first AIDS diagnosis; my first job was on an AIDS unit. I’ve seen it work.

Let’s get our deaths properly attributed. It’s one last gift we can give our compatriots as we head out the door. I’m going to put it in my will.

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Chronic pain in homeless people not managed well

Today’s very promising applicant for the Dept. of the Blitheringly Obvious: “Chronic pain in homeless people not managed well”:
> http://www.sciencedaily.com/releases/2011/07/110721112613.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29
My cynical side is just delighted that people got paid to write that down in black and white. Smacken zie forehead.

For a change, I’m going to ignore the disingenuous and smug language putting inappropriate blame on the patient, because there’s so much basic information missing.

As anyone who has been homeless or worked with the homeless knows, indigence involves the following facts of life:

– Assuming you can even get to treatment sites …
– Doctors won’t take you.
– Hospitals don’t want you.
– Clinics can rarely fit you in.
– Pharmacies hate to see you — a gaping well of need — coming through the door.

And that’s just the medical side. In regular life,

– There’s no decent surface to lie down on.
– There’s rarely a good way to get clean.
– The concept of “good food” is irrelevant. You have to eat what you can get, regardless of whether it triggers a flare or messes with your brain, and are expected to be grateful.
– If you’re a woman or a kid alone, you’re going to wake up with some guy on top of you. This is very bad for back and hip pain, among other things.

Facts you should know:

– Being homeless is a perfect recipe for mental ill-health.
– Disabled people are over 10x more likely to be homeless than their equally-educated & -skilled cohorts.
– Chronic pain is part of most disabling conditions.
– Because of the economy, and despite the masses of money floating around in the stratosphere, disability and indigence are hitting historic highs.

Clinical take-aways:

– Take note of the link on the right to contact your political representatives. Let them know how you’d like the situation to change.
– ALWAYS ask indigents about pain: what, where, when, exacerbates, what they do about it, & most importantly, what they’d like to be able to do about it. Answers to the last will surprise you, because most of these people aren’t stupid. (Just weird.)
– Provide freebies, including toothbrushes and emesis basins. What they can’t use, they can barter with.
– When prescribing, be as generous with free samples as your drug reps’ handoffs permit. Your insured patients only need enough to get started; your impoverished patients need to get so used to feeling better that they’ll prioritize accordingly (beg, borrow & steal for their scrip instead of their booze? It happens.)

Keep in mind that a few days’ relief is just a break, but a few weeks’ relief lets them start to function for a change. Some will abuse your kindness, but big deal.

The rest will take the opportunity of having their burden lifted a little, to move forward in a way they couldn’t do before. And thus a good deed goes onward, invisible to you but not to those ahead.

Make it a habit. Eventually, you’ll see it come back to you. The feeling when it does is indescribable.

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Hemingway: How courage and depression go together

This article is well-intended, but egregiously judgmental and woefully ignorant:

http://www.npr.org/2011/07/02/137540700/after-50-years-remembering-hemingways-farewell

If it weren’t for the inane babble puzzling over why Hemingway lived so intensely, this line would be the Winner of The Most Fatuous Statement award: 
“…in January 1961 he told his wife, Mary, that he could no longer write a single good sentence. And Hemingway would only settle for great ones.”
It wasn’t a question of settling for less than great, it was a question of how important it is to fulfill your purpose and dig some meaning out of life, even amid the unbearable. That purpose and meaning was taken from him, under the mistaken guise of treatment. 
Hemingway got electroshock therapy for his depression; a common side effect is to knock out your language abilities and cognition, sometimes for months and sometimes forever. The one thing that made his life endurable — writing like himself — was taken from him. 
Depressed people have more courage and determination than their non-depressed cohorts. Studies are finally being funded that verify this (which I’ll dig up later. Feel free to nudge me with a comment.) 
Think about that next time you curl your lip over suicide. It’s not about courage. It’s about unbearable pain and a degree of mental crippling that puts a valid life out of reach. 

Waiting and working at it until things improve is a reasonable thing to do: Hemingway waited and worked at it for  40 years, though with so little real hope for treatment. Talk about courage! It’s unthinkable how much courage he brought to bear on his life. His intensity and wild behavior were directly related to making his life bearable — and his work more compelling. Check his quoted remarks on that subject. What’s between the lines is breathtaking. 


The article’s remark about suicidal lineage is true, but poorly understood. A suicide in the family has the powerful effect of making suicide less unthinkable. There is often a genetic tweak associated with it, but that’s not all there is. The thing to know now is, we are not our predecessors; we can do more. Far more. 

Hemingway died before we developed SSRIs, SNRIs, and a tremendously improved understanding of neurochemistry, behavior, nutrition and psychodynamics. We have more options now. Lots more. Waiting and working at it is a real success path now. 
Be good to your depressed friends. You probably have no idea what they’re capable of, when they can be well again. Help them persist. 
It’s the most important thing to do: persist. A valid and bearable life is a reasonable thing to hold out for. Only death bars the door to healing. Things will change. 
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The key to growing old gracefully

Another candidate for the overpopular Department of the Blitheringly Obvious:

“Social life and mobility are keys to quality of life in old age”
http://www.sciencedaily.com/releases/2011/05/110528191542.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

The article goes on to say that old people go to great lengths to stay active and connected, and use their well-seasoned brains to problem-solve issues of daily living at a rate that makes most younger people look like pikers.

In this article, they actually used the term “extreme lengths” — obviously they haven’t considered what it’s like to be old. You simply have to cope, in order to have a life worth living, and your friends help you figure it out. Doesn’t that seem pretty self-explanatory?

Nurses could have told them all that, plus a bunch of gruesome stuff about skin care, but study scientists pay even less attention to nurses than they do to patients. I’m just glad someone FINALLY thought of asking the only people whose opinion on “quality of life for the elderly” really counts.

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Numeric literacy, mental integrity, and fun with ferrets

Most people get confused when faced with an article about medicine, or any kind of complex science. Because people with extremely expensive educations wrote that stuff, then other people figure (at some level below common sense) that the study’s authors must be fundamentally superior.

Education is not the same as intelligence.
Intelligence is not the same as sense.
Sense is not the same as integrity.

I come from a highly educated family. (‘Nuff said.) Growing up in the context of good education really made it clear that people are people, regardless of the letters after their names. Degrees simply mean that someone can work hard on their own behalf; they’re no guarantee of logic or brilliance. It’s never wise to subvert common sense in favor of education.

So, if you’re one of the majority who doesn’t have alphabet soup after your name, give yourself some credit as you read these things.

There are a few simple principles that can help you dissect a study with reasonable confidence:

  • Question assumptions (& listen to your eyebrows.)
  • When the question makes no sense, you don’t have to accept the answer.
  • If it seems stupid, it probably is.
  • Don’t ignore the man behind the curtain.

A Furry Example of Fuzzy Logic
The article cited below is precious … A delicious exercise in mental pretzel-ry designed to reduce the average brain to cottage cheese. It’s easy to unravel if you hang onto your common sense and don’t let go, because your brain is not average.
Ready? Here it is.

  1. The title of the article linked below proclaims that researchers have proven that Topic A is bogus.
  2. The researchers’ summary says no such thing. It states that they’ve proven that your belief in Topic A should be much greater if you do believe in it or much less if you don’t; doesn’t matter which.
  3. Then the researchers state that that finding, itself, doesn’t matter, because they personally don’t believe in Topic A, can’t think of anything in its favor, and that you should agree with them — regardless of their own findings — simply because they said so.  (A fairly common conclusion.)

Let’s pause to regroup, since this is enough to make most people tear their hair and gnaw the furniture. That tends to kill the punchline.

Backing up the train of thought to the beginning…


Pick something that there’s some disagreement about. For the sake of clarity, choose something not too emotional, like, “Do ferrets make good pets?” Pretend that’s Topic A.

You’ve already thought of ideas that support this and ideas that don’t, and you probably already know whether you, personally, would like having a ferret as a pet.

Have you ever, in your most random moments, picked a percentage or a ratio to indicate how much you would, or wouldn’t, like to have a ferret as a pet, with nothing to compare it to? I mean, is there any value to the idea of doing so? How odd is it to assume that people would?

TIP: Question assumptions. If your brain — or the skin on your forehead — starts to squirm, it’s a good clue that there’s an unexamined assumption waiting to jump up and trip you. Stop and check. 

Liking pet ferrets is simple: you either like them (a little or a lot), you don’t like them (a little or a lot), or you decide you don’t know enough to have an opinion. That last option isn’t even available here, but it’s very common.

If you have an opinion about ferrets as pets, doesn’t its extent depend on external forces — whether you’ve known pet ferrets, whether their owners were responsible, whether it was a nice ferret or a real brat?

And wouldn’t the appeal of keeping/getting rid of a pet ferret depend on whether there’s a pet store stocking ferrets and ferret supplies, what your lease says about pets, whether or not your housemate can ferret-sit while you’re hiking the Camino de Santiago, whether your veterinarian can help you surrender an unwanted ferret? And don’t these circumstances themselves change, from place to place and time to time?

So how can you assign an absolute percentage to your opinion about whether ferrets make good pets? How surprised would you be if anyone asked you to do so?

And, really… Why would you? Do you assign a percentage to how much you dis/like strawberries, the color blue, or Sarah Palin? Or don’t you use value words instead — love, like, can’t stand?

Unless most (rather than very few) of you think of your preferences in numeric terms, then the very question the researchers are trying to answer is fantastical. Pure silliness.

TIP: You don’t have to accept an answer, if the question itself makes no sense. 

Moreover, the way they processed the data doesn’t change your answer; it indicates that your beliefs should be far stronger, whatever they are.

They’re saying that, if you would like a ferret as a pet, you should be on your knees at the pet shop, weeping with longing — or, if you already have one, should be emitting a constant stream of happy little noises as you snuggle your ferret at work, on the bus, everywhere, all the time.

If you would not like a pet ferret, you should be packing to move so you can stay as far away as possible from anything long and furry or even vaguely ferretlike — or just blow up all the ferret-friendly pet shops where you live.

TIP: Just because someone with a very expensive education says it, doesn’t necessarily make it so. If it seems stupid, it probably still is.

Contrary to the title of the article, the results tell you: don’t change  your position, just become more extreme about it. That’s their conclusion.

Isn’t that helpful? Just what we need: debates that are even more shrill, spittle-flecked and unreasoning.

TIP: Repeat prior tip… Really stupid.
In light of the decisions that led up to this conclusion and the anti-intellectual nature of the outcome, do you think this makes sense? 

And, clearly following their own advice, the scientists themselves pick a side and pronounce that they don’t like pet ferrets and that you shouldn’t like them either.

Why?

Because they don’t understand how anyone could like pet ferrets and BTW other scientists in vaguely pertinent fields don’t know enough to prove how pet ferrets can possibly be desirable.

Therefore (stretching the metaphor), given this massive ignorance on the part of so many highly-educated people, ferrets are obviously terrible pets and all of them should be gassed.



…WHAT??…

SUMMARY:

This is not a terrible study and it was not done by stupid people. They just left their mental integrity in their other jeans, and that happens a lot.

Why on earth…? Because we all have assumptions and agendas.

Science aims to clear that out, but it’s done by live humans with organs and mortgages, so their objectivity is pretty hit-and-miss.

When reading science articles, be open to hidden agendas while you look for the facts.  For better or worse, they go together. You might as well notice both.

Scientists are often very obvious about using big words to say silly things, and if you can step aside from feeling intimidated, it’s surprising how obvious they are.

The problems here are common problems:

  • Point 1. Article’s title misrepresents the outcome of the study.
    I usually read an article at least twice before making up my mind.
    I read it through, then start again at the title.  How accurate is it?
    If the title isn’t fairly accurate, I know someone’s got an intrusive agenda.
  • Point 2. Outcome doesn’t make sense.
    It says you should believe either more than you do, or less than you do, but it doesn’t matter which.  How to do so is not mentioned (for good reason.)
    I usually look over the details of an article three or four times, to give the facts time to sift together in my mind.
    When I feel my brow wiggling at something, I stop and look again. I trust my good sense more than I trust my education.
    Figuring out crappy data just requires you to assume you’re not an idiot, even if you don’t know the field. 
    Don’t think badly of the scientists, just assume they have their own sets of human flaws.  It’s a safe assumption!
  • Point 3. Conclusion goes against the findings.
    In any case, DON’T believe in Topic A, because the researchers have made up their minds on the basis of their ignorance, and screw their data anyway.
    Continue to assume you’re not an idiot, as you read the conclusion.  It’s that simple.
    Then compare it, again, to the title and to the facts.
    If something doesn’t add up, you know there’s agenda going on.

These particular scientists intended to prove that their statistical method was better than existing methods. Given all the logical problems surrounding their efforts, I think they blew it, but I’m not a statistician.
CLUE:
The topic of this study was ESP.

As my relentlessly rational, very prescient Dad once said when I asked him whether his use of ESP was irrational, “It would be irrational to ignore the evidence of my own experience. It’s highly consistent for me, even though most people can’t do it, or can’t do it very well. But just because they can’t use this valuable tool, does that mean I shouldn’t?  That wouldn’t be very clever!”

Dad was very clever. (…And for the record, he did foresee his own end.)

Let’s step over to another, less-emotional metaphor to think about studying this subject.
Imagine that most people are basically color blind, but a few can see some color.  Anyone who can see beyond the greyscale is not going to get much credit, but there are enough of them to make the rest wonder.

However, since the colorblind are looking for proof of color with instruments that see only luminance, but cannot see color even as tone or hue, they probably won’t have much luck proving something that they don’t understand, can’t use, and don’t believe in anyway. (…But they can sure get snarky, trying.)

TIP: Don’t ignore the man behind the curtain. Think for yourself … And try to remember, especially if you’re in a position of respect, that you don’t necessarily have the right to think for others. 

Today’s unbelievably fatuous truism, which everyone always forgets anyway:  Other people are not you. Only you are. Honor that, and things go better.

THE POINT IS:
In the end, everyone has to pursue their own logic, account for their own experiences, and come to their own conclusions.

What science is supposed to offer is a crystalline view of measurable and provable data. It doesn’t help if the scientists pick up a hammer and smash the crystal when presenting it to public view.

As I know all too well, education is not the same as intelligence; intelligence is not the same as sense; sense is not the same as integrity.

Read studies for yourself.  Practice makes perfect: the more you do it, the easier it gets, and the more accurate (and potentially shocking!) your understanding becomes.

Jump in here and comment on your own experiences. I’d love to hear from you about your adventures with this.

THE STUDY:

http://www.sciencedaily.com/releases/2011/05/110518080059.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

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Digestive problems early in life may increase risk for depression, study suggests

http://www.sciencedaily.com/releases/2011/05/110512171517.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

This article states that gut disturbance in early infancy/lifelong gut disturbance (the language is kinda sloppy) can trigger lifelong depression and anxiety.

This doesn’t surprise me, but most of the rest of the article does.

The rat-botherers who did the study presume it’s all about the vagus nerve. Recently, a deliciously expensive procedure which stimulates the vagus has been found to alleviate some depression. It’s good to know that.

It’s good to keep a couple other things firmly in mind first, though:

– Serotonin is produced in the small intestine, as well as the brain. It helps to digest protein. It also plays a role in immune signaling. Think that could possibly be related, either to depression or to inflamed gut syndromes? H’mmm…

– My first thought: get right on top of infant digestive problems. That means getting serious about both prevention and cure.

Oddly, that idea wasn’t even mentioned, even though prevention is infinitely better than trying to manage a lifelong downer like IBS or depression — let alone both!

Prevention is simple in concept, but inexcusably difficult in our current system. With babies, it’s easy: get dead-serious about breastfeeding. Where that’s not possible, put aside formulas at the first sign of allergy. Don’t switch between cow and soy milk, two of the most allergenic infant proteins on the planet; milk more goats and camels. Go to a breastmilk-bank. Find your local midwives because they are much better with the idea that birth is only the beginning of a much longer life, and they should know how to figure this out. If they don’t, they can tell you who else to call.

And punctual treatment for troublesome insides — with the least invasive meds. Interfere with their little regulatory systems as little as possible, but take care of the problem. For indigestion, chamomile and calcium carbonate are much better than h2-inhibitors (Zantac, Prilosec and the like.) Chamomile also soothes the mind and settles the emotions, so the kid can relax.

Try elimination diets to screen for allergies. Sadly, wheat, eggs, cow dairy, soy, and corn are common allergens which affect the developing gut — and the developing skin and brain, because their little bodies never got the memo that all of these systems are supposed to be separate from each other.

Google those terms, discuss them with your midwife/pediatrician/nurse practitioner, and take care of the problem at its source.

You don’t want more depressed people in the world. There are better things to do with infants than let their guts screw up a good life, handing them into the craps-shooting care of multiple pharmaceuticals and invasive procedures.

When I get on the CPU, I’ll set up more links for my factual statements. This is it from the iPhone.

Bon appetit!

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Doing what? Doing SOMETHING.

This links to an article that states the astounding — nay, earthshaking — news that people like to be productive; it’s good for their heads. Exactly what they do isn’t always the point.

I’ve been saying that for years. Being productive is good pain control and significantly helps depression.

Pity I never knew there was funding available to make a lot of other people say the same thing! Heh.

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