Blacklegged Tick © by fairfaxcounty

Could an effective and safe Lyme Disease Vaccine be one step closer to a reality?

Lyme disease is a brutal illness and anyone that suffers from it wouldn’t wish it on their worst enemy.  Many patients have to go through multiple Doctors and years of medical run-around to finally be correctly diagnosed with Lyme Disease.  Could a vaccine help spare others the same fate?

A research paper published in The Lancet Infectious Diseases reported promising phase 1/2 clinical trial results on an investigational Lyme Disease vaccine.  The study, run by scientists from Stony Brook University, Brookhaven National Laboratory, and Baxter International Inc. analyzed the safety and immune response potential of the vaccine.  The 300 volunteers received three primary immunizations and then one booster.  All types and doses of the vaccine, some of which had an adjuvent (an additive that triggers an immune response to the vaccine) resulted in significant antibodies against all species of Borrelia.

“The results of a clinical trial conducted by Baxter are promising because the vaccine generated a potent human immune reaction, covered the complete range of Borrelia active in the entire Northern hemisphere, and produced no major side effects (researchers reported only mild adverse reactions were seen).”  Dr. Luft

This all sounds really exciting… and it could be.  But this is not the first attempt at a Lyme Disease vaccine, which makes some patients who have seen researchers go down this road before, very wary.

The first and only licensed Lyme Disease vaccine approved by the FDA was called LYMErix and was developed by SmithKline Beecham (now GlaxoSmithKline).  It was given in a three dose series and had a unique way of acting: it stimulated antibodies that attacked the Lyme bacteria in the tick’s gut as it fed on the human host, before the bacteria were ever able to enter the body. 

Vaccinated individuals showed a 76% reduction in Lyme disease in the year following vaccination, with no significant side-effects noted. Based on these promising findings, the U.S. Food and Drug Administration (FDA) approved LYMErix™ on 21 December 1998. Source

The vaccine was not without issues even as it hit the market.  First: after you received the initial injection you needed it again 1 month and 12 months later, while possibly needing booster shots every year since it was unknown how long immunity might last.  Secondly with less than 80% efficacy it still left 20% of people unprotected and an unknown number of people that wouldn’t be as careful in tick infested areas if they thought the vaccine was magically protecting them completely, but weren’t receiving the boosters.

What happened next depends on who you ask (like most things in the medical world).  Reports began to surface of people developing an autoimmune arthritis, of having it trigger their then dormant Lyme disease, and maybe worst of all – some people reported they actually contracted Lyme disease from the vaccine itself. 

 A lawsuit was filed in Dec. 1999 claiming 30 percent of the population has a predisposition to a degenerative autoimmune syndrome which can be triggered by contents of the vaccine.  They stated SmithKline Beecham used high concentrations of OspA (outer surface protein A of Borrelia burgdorferi) as the foundation for the vaccine. The amount of OspA entering the bloodstream at any point in the three dose LYMErix vaccine placed patients who are HLA-DR4+ at risk of developing “treatment resistant Lyme arthritis”.

By 2001, with over 1·4 million Lyme vaccine doses distributed in the United States the vaccine side effects database included 905 reports of mild self-limited reactions and 59 reports of arthritis associated with vaccination.   Many believe the reporting process broke down and many reactions were never reported.  The FDA investigated and found no suggestion that the Lyme vaccine caused harm to its recipients, in part because they believed the arthritis incidence in the patients receiving LYMErix occurred at the same rate as the background in un-vaccinated individuals. Many patients that feel they were severely harmed by the vaccine, disagree. In 2002, with mounting pressure from Doctors and the community, SmithKline Beecham withdrew LYMErix from the market citing financial issues.

What now?

Dr. Luft said one of the main challenges of developing a Lyme disease vaccine is for it to be effective, it will need to work on more than one protein like the previous vaccine.  A vaccine needs to be designed to protect against a variety of Borrelia species that spread Lyme disease worldwide.  He believes this new vaccine could do just that.

Drs. Luft and Dunn focused vaccine development on the most abundant Borrelia outer surface protein found when the spirochete bacteria reside in ticks.  Using the scaffold of this protein, called OspA, they, in collaboration with researchers at Baxter, bioengineered a set of unique OspA proteins not found in nature.” These new OspAs share different parts from different species of Borelia.

“After a series of experiments and refinements, formulations consisting of these new OspA proteins were shown to protect against a broad spectrum of Lyme disease spirochetes. We hope that a larger-scale, Phase 3 trial will demonstrate not only a strong immune response but true efficacy in a large population that illustrates protection against Lyme disease” said Dr. Luft.

Only time and more clinical trials will show how truly safe and effective this vaccine will be for Lyme Disease.  For right now, Lyme patients can only try to spread the word of prevention to try to save others from walking a mile in their shoes.

—————————————————————————————————
Sources:

[1]  Steere AC. et al. Vaccination against Lyme disease with recombinantBorrelia burgdorferi outer-surface lipoprotein A with adjuvant. Lyme Disease Vaccine Study Group. New England Journal of Medicine. 1998;339:209–215.[PubMed]

[2]  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870557/#ref020

[3]  http://arthritis.about.com/od/lyme/a/lymevaccinesuit.htm

[4] http://www.sciencedaily.com/releases/2013/05/130510075337.htm

The post Lyme Disease Vaccine Shows Great Promise appeared first on Putting Experiences of Patients First.

Dr. Seuss Art © by mrsdkrebs

I would not see you here or there,
I would not see you anywhere.
I would not, could not, in the rain,
Not in the dark. not on a train.
Not in a room. not in a tree.
I don’t like Doctors, as you see.

  << You do not like Doctors of any kind? of any type? of any mind? >> 

That is correct, just so you know,
There are no Doctors to whom I’ll go.
I’m all burnt out, fed up and such,
So I’ll not see them, nor stay in touch.
They are no help, this much I know
I see no need, so on I go!

One day I went in for a general med check with my Dr and she instantly began to lecture me before she even sat down about how she would no longer order my pain meds.  As of that moment, she would no longer refill the prescription she fully agreed I needed because she didn’t want to fill out the paperwork.  She was sending me to a pain specialist.  I instantly felt my heart start to pound, my brain start to race and my palms go sweaty.  I had no choice, I had to head to yet another new Doctor, the biggest of fears (and for pain meds no less, the hardest prescriptions to get!)Yup, even Seuss wasn’t making me see a Doctor.  The mere thought of having to see one started to cause anxiety the likes of which I couldn’t describe without sounding crazy.  Year after year of horrible experiences leaves a mark.  I never knew how a Doctor would react.  Even my GP who understood my case on some basic level,  seemed relatively supportive of the treatment path one visit and often drastically unsupportive the next.  You need them for the medications, tests, disability letters, help when something goes wrong.  It feels like you are completely at their mercy.

I decided ahead of time, I would take no crap from this Doctor.  I was determined I would feel in charge.  I walked into the Doctors appointment with a whole different attitude. Here’s how I helped treat my Dr Burnout Syndrome (DBS):

Anxiety comes from an intense fear of something we can’t control.  Rarely do we keep asking ourselves, after the first few bad thoughts: “And then what?”  We hear the first bad answer in our head and we stop and feel completely overwhelmed.
Ex:  I will see this new Doctor and it won’t go well.  And?  He won’t believe I’m really in pain.  And?  Then I’ll try to calmly explain my situation in another way.  He’ll say awful things to me.  And?  I won’t allow him to belittle me.  I will show up with printouts that medically support my case.  He won’t give me the pain meds I need.  And?  If he simply won’t help me, I have to find another Doctor.  And?  Then I have to get to another appointment and start again.  And if the next Doctor (or the next one) is fantastic and will genuinely help me and make my life easier, is it worth that effort?  Yes!  (( Rinse and repeat as needed )). 
I literally did that dialogue in my brain every single time my mind started to runaway with bad DBS thoughts.  After awhile, I could feel myself become calmer as the bad thoughts started and I started down the “and?” path.

You’re the Boss:  We begin to feel like we should be grateful a Doctor will help us to any degree.  That’s not true!  You are deciding about the Doctor as much as they are deciding about you.  You don’t deserve to be treated poorly.  You can stand your ground nicely and attempt to win over a Doctor that isn’t doing exactly what you need.  If it doesn’t work out, then you’ll move on.  It’s easy to forget, caring Doctors are out there.

Try, try again:  The thought of having to go see yet another Doctor when you are already fed up to begin with is anxiety inducing in itself.  But having a good Doctor, someone who is on your side and is willing to really help you, is worth all the hassle.  I found one, trust me it’s worth it.

Paging Dr. Seuss:  Try to find the name of just one person in the Doctor’s office you think would be helpful to you and write it down.  When you have a question or issue, having a contact is key.  Remember not to get frustrated if they don’t call back in 2 days.  They are juggling a lot of patients every day.  Never say you need an answer immediately unless that’s true, it just makes them think you say that about everything.  A good contact might take a few phone calls to the office to find, but when you do, it saves a lot of frustration especially when your Doctor tank is already on empty.

Take a Vakay:  If you are completely burnt out & need a break away from it all, give yourself one.  This was one of the best things I did.  I gave myself a time line in which I wouldn’t talk about Doctors or think about the next appointment or what I needed to convince them to do for me.  It’s tricky if you need meds refilled often, but even then give yourself whatever length break you can and try to enjoy it if only mentally.  Somehow just knowing I had 6 weeks to not worry about this topic, helped erase it from my mind.  This really helped me regroup and when the vakay was over, I was ready to tackle Drs all over again because I hadn’t been semi-tackling them mentally for the whole 6wks.

In the end, that pain doctor I would have done anything not to see, ended up being the best doctor I’ve probably ever had.  He not only changed my life with the way he controls my pain but he showed me that unicorns do exist: it is possible to find a great Doctor that will do anything to help me, is brilliant and will give me his cell phone number “just in case you ever have a question”.  Now that’s worth a Dr Seuss rhyme!

The post Dealing with Dr Burnout – Paging Dr Seuss appeared first on Putting Experiences of Patients First.

Below, we have provided tips and advice that you may find helpful during the application process:

1. Understand the difference between the two disability programs. 

The Social Security Administration offers disability benefits through two separate programs. It is important to understand the difference between these programs so that you can determine which you may be eligible for.

The first program is called Social Security Disability Insurance (SSDI). SSDI eligibility is based on an applicant’s work history. It is typically required that the applicant has worked five of the past ten years in a job (or multiple jobs) where Social Security taxes were withheld. The SSA assigns “Work Credits” to each year an individual pays into the Social Security Disability program. To qualify for SSDI you must meet the SSA’s specific work credit requirements. You can learn more here: SSDI

The second program is called Supplemental Security Income (SSI). SSI is a needs-based program offered to disabled or elderly individuals who have very little income and financial resources. SSI is a good option for disabled children or adults who do not have enough work credits to qualify for SSDI. Learn about the financial requirements for SSI here: qualify for SSI

2. Find a doctor willing to help you document your condition.

To qualify for Social Security Disability, applicants must provide thorough medical documentation of their illness or condition. This is extremely important because the SSA will use this documentation to decide if a claim is accurate and if an applicant’s symptoms are severe enough to keep him or her from working.

Before you apply for disability benefits, be sure that your doctor is willing to help you thoroughly document your illness. Schedule an appointment to sit down and talk with your doctor about your plans to apply for disability benefits. Be sure to request copies of all test results and medical records. You should also ask about any additional testing that may be done to support your claim. Explain to your doctor that you will need him or her to make observations and formal statements regarding your physical and mental limitations as well as your ability to work.

If you feel like your doctor is not willing to support you throughout the process, don’t be afraid to search for a new one.

3. Hire a legal professional.

For individuals dealing with a serious illness or condition, the disability application process may be overwhelming and stressful. Although having an attorney is not required to apply for disability benefits, many applicants find it extremely helpful to have the assistance of a legal professional.

An attorney will have a thorough knowledge of the application process and will be able to help you collect all the necessary documentation that you need to be approved. Applicants who have an attorney are less likely to make mistakes on their application and therefore more likely to be approved. Remember, a Social Security Disability attorney is typically only paid if you are awarded Social Security Disability benefits.

4. Don’t panic if your initial claim is denied.

Nearly 60% of initial applications are denied. If this happens to you, don’t panic. You are allowed to appeal the decision. It is important to note that many applications are denied because they are incomplete or lack necessary medical evidence. You can avoid this by working closely with a medical or legal professional to ensure that you have provided thorough medical documentation and that you have filled out all necessary application paperwork.

Once you decide that you are ready to begin the application process, you can do so on the SSA’s website or in person at your local Social Security office. Although applying for disability benefits can seem overwhelming, doing the correct research can improve your chances and relieve any stress you may be feeling.

If you find yourself getting discouraged, remember that disability benefits exist to help individuals who cannot work due to illness. Those affected by invisible illness are no exception, it is important that you don’t give up on getting the financial assistance you need. You can learn more about applying for disability benefits here: Social Security Disability Help

We would like to thank guest author Molly Clarke for writing this to help anyone battling an invisible illness figure out how to navigate Social Security disability a little easier.

The post Tips on Applying for Disability Benefits with an Invisible Illness appeared first on Putting Experiences of Patients First.

When I was a kid, the bane of my existence was thank you notes.  I hated them with an 8 year old’s passion usually reserved for spiders or other creepy crawlies.  Every birthday or holiday when the last shred of wrapping paper had been hauled off to recycling, my mom would inform me it was “time for thank you notes”.  We were to write Aunt S thanking her for the  weird contraption that only showed a kernel of corn up close. (Yes, that’s a real gift I received & wasn’t nearly as cool as I just made it sound).  I hated the notes & always wrote the exact same thing to everyone:

Dear (fill in name),  Thank you so much for the (fill in gift name). Love, (fill in my name)

My Mom caught on & informed me how important it was to find something you are grateful for, even in a gift you might not like.  Hmm… okay.  I got the gift out of the trashcan & actually tried it this time with the intent of finding something I could honestly say I liked about it.
Attempt #2:  Dear Aunt S, Thank you for the gift. I looked at the corn with that thingy you sent & was shocked how cool it actually looks up close like that.  It looks like a weird little planet! Love: Cari

My Mom made me practice gratitude like I practiced ballet & softball & school work. Then I got really sick & much of what I had always been grateful for in my life, was gone & I didn’t know how to find happiness in the midst of the new reality.

Then one day I was watching tv & the host of the show was talking about how this author changed her life.  She had written a book about one simple thing that forces you to see the world around you differently & be a happier person.  She had 100 stories & loads of “scientific proof” on why it worked but the basic concept was simple:  Write down 5 things you were grateful for every day.  It could be anything, everything: ice cubes making a drink cold, clean sheets on your bed, fuzzy socks warming up your cold toes, a migraine finally passing.  The woman said if all you can think to write in the beginning are things like: you survived today, good – now you only have 4 to go.  I joked to my mom the journal sounded like 1 big thank you note!  My Mom didn’t get the sarcasm & ever one to love a thank you note (& desperate to help me cope any way possible) she raced to the store & bought 2 journals for us to do this together.

The concept seemed overly simple for the severity of what I was dealing with.  95% bedridden vs a gratitude journal.  How is that a fair fight?

My super villain would surely kick gratitude’s ass.

Every day I begrudgingly wrote down 5 things I was grateful for like I wrote the thank you notes as an 8yr old.  I wrote almost the exact same thing day after day.  But after a few weeks I noticed I was actually going through the day looking for things to be grateful for, new things to write down.  It became a challenge to see how creative I could be, how deeply I could find beauty in… anything.  A few weeks later my Mom’s journal was on the shelf collecting dust, mine was slowly becoming the change I desperately needed.

Why it worked:

I didn’t even realize the degree to which my brain had been silently going through the day, looking at everything around me as a painful reminder of the life I didn’t have, until I forced it to go through the day looking for something to be truly grateful for.  It’s easy to be grateful for the big things in life: your dream job, falling in love, traveling the world, having a baby.  But when I got sick, my life got smaller.  Those big things weren’t the big picture anymore.  When I had to go through the day looking for the good side of the exact same situation, same life, same illness I had a few weeks earlier, it changed how my brain had to see things.  It changed everything. 

Practice Gratitude: How to keep a Grateful Journal

• Get a pen only for that journal or notepad so you never have to go searching for one (make sure it doesn’t bleed through journal paper, that’s a pain)
• Keep pen & journal where you will use it (I do this before bed so I fall asleep so I end the day on a positive bote but it doesn’t matter when you do it)
• If writing “I am grateful for…” 5x every day is too exhausting, keep it simple & only list the rest of that sentence. Nothing wrong with short hand! (Now I just fill one page in the journal, something I can do easily now that my brain is wired to look for things all day long).
• Cut yourself some slack: if you haven’t done it in a month or are only up to writing 1 word for each item, that’s fine. Do what you can. The intention is the important thing, not how it looks.
• What doesn’t happen is as important as what does! Writing you are happy you didn’t break your ankle when you tripped over the dog toy, counts!
• If writing in a journal isn’t your thing, type it on your laptop or iphone.  Use something like Evernote & you’ll have access to it anywhere, any time

What doesn’t work:

• Repetition: After only a few weeks, I noticed I kept writing the same few things over & over.  I challenged myself that a nap or a soft pillow couldn’t be written down more than say once a week.  I was bedridden at the time, so this made me dig deep & really look at the little things around me & not just the obvious ones.
• Thinking:  for me at least, just thinking what you are grateful for didn’t have the same effect.  There’s something about the action of also writing it out that seems to be the key.

I have been keeping a Grateful Journal for the most part since I was about 20.  Every time I stop doing it for whatever reason, I am mad at myself later when I realize yet again just how much this helps.  This one simple task  has done more to help me find happiness on the worst days than anything else I’ve tried.  Some of the biggest changes it’s made for me are intangible,  I don’t know how to fully describe it other than to say, keep one for 2 months & see if it helps release you from the quicksand too!

The post Chronically Grateful – How I found chronic gratitude in chronic illness appeared first on Putting Experiences of Patients First.

Apparently, autoimmune illnesses are cheaper by the dozen and once you get one, you have a good chance of getting another.

© by Tambako the Jaguar

Disorders of an autoimmune nature are known to occur with increased frequency in patients with another autoimmune disease. About 25 percent of patients with autoimmune diseases have a tendency to develop additional autoimmune disorders. source

I personally think that estimate is extremely low.  I have trouble thinking of more than a few friends that don’t have more than 1 autoimmune syndrome, condition or diagnosis.  There is an actual term for having more than one autoimmune diagnosis:  Multiple Autoimmune Syndrome (MAS).  I (shockingly) had never heard of it before.  But if you have at least three distinct autoimmune conditions, you too may be joining me in MAS Land.

Apparently they decided to try to clasify MAS based on prevelance of illnesses that went together.  Here’s what they came up with: Classification of Multiple AutoImmune Syndrome  (MAS):

• Type 1:
  Myasthenia gravis
  Thymoma
  Polymyositis
  Giant cell myocarditis
• Type 2:
  Sjogren’s syndrome
  Rheumatoid arthritis
  Primary biliary cirrhosis
  Scleroderma
  Autoimmune thyroid disease
• Type 3
  Autoimmune thyroid disease
  Lupus erythematosus (SLE)
  Sjogren’s syndrome
  Multiple Sclerosis
  Rheumatoid Arthritis
  Myasthenia gravis and /or thymoma
  Pernicious anemia
  Idiopathic thrombocytopenic purpura
  Addison’s disease
  Type 1 Diabetes mellitus
  Autoimmune hemolytic anemia
  Dermatitis herpetiformis
  Chronic active hepatitis
  Ulcerative colitis
  Scleroderma

Criteria: at least three conditions must be present in the same patient & often one of those is a dermatological condition: psoriasis, vitiligo, scleroderma, etc. Note: It didn’t say you had to have one, just that people often did.  It was unclear if skin issues from Lupus (for example) counted.

Additions:  I think ME/CFS & Fibromyalgia will someday be added to the MAS Type 3 list, but that’s purely based on observation of the number of co-conditions I’ve seen patients also battle.

This system of classification could be a great benefit to patients.

First:  it should make research and analysis of these co-morbid conditions easier.  Does one cause the others?  I saw one Doctor ask: Do the meds to help autoimmune illnesses actually trigger other autoimmune illnesses to show up?  Or is purely a domino effect once the first one is knocked over?
Second:  it offers the possibility of foreseeing and detecting a new condition liable to appear in a patient who already has other diseases in that category.  The Dr can be monitoring specifically for related co-conditions & if they begin to have symptoms, have an idea of where to start to diagnosis it.

One underlying reason for hitting this autoimmune windfall could be genetic susceptibility.  Studies have shown many patients with an autoimmune illness, have a close relative with one as well.

HLA antigens that predispose people to autoimmune diseases cause an increased risk for several different autoimmune disorders. source

Once you’ve been diagnosed with one autoimmune illness, your Dr should monitor you for signs of another.  But where do you draw the line?  When are rashes from the sun just a severe ME/CFS reaction & when are they a sign of potential developing Lupus?  That’s the tricky question & the answer might be “Overlap Syndrome” (no, I am not making that up).

Overlap Syndrome:

A true definition on OS is a little murky but that actually fits our illness pretty well.  Essentially it’s when you have one “primary” condition and you develop other accompanying or overlapping symptoms of other conditions that are all autoimmune in nature.  So the ME/CFS “rash” example, the question would be is it a sign they might be developing Lupus or are their autoimmune symptoms just overlapping into symptoms of another autoimmune condition?

“Two types of overlap syndromes have been observed: the crossover, in which the diagnosis of one disorder is fairly typical but the patient also has some features of a second disorder; and the true overlap, in which the patient has features of two distinct autoimmune disorders as well…” source

In overlap syndrome, features of the following diseases are most often found (only most common diseases are listed):

• Systemic Lupus erythematosus (SLE), Sjögren’s syndrome, Rheumatoid arthritis (RA), Polymyositis, Churg–Strauss      syndrome, Autoimmune   thyroiditis,  Antiphospholipid antibody syndrome, Systemic sclerosis

Overlap Syndrome makes it possible to have Lupus & show strong symptoms of Sjogrens without testing positive for it.  I know I have had this happen myself with different autoimmune symptoms, suddenly I have symptoms mostly connected to another autoimmune condition.  Knowing these symptoms can overlap without always leading to the full blown illness is helpful.

The biggest hope in all of this is it’s proof yet again that when they understand how to fully treat & eradicate one autoimmune illness, it will help us all!

The post Multiple Autoimmune Syndrome – Could you have this? appeared first on Putting Experiences of Patients First.

Suddenly there she was: standing on the beach smiling at me, all happy with a baby in her arms, her handsome husband smiling with a toddler in his arms.  One of those “everyone randomly wore white to the beach tonight” impromptu looking photos. I saw it & thought:  How do you now have that life & I am not part of it?  I don’t get to see you happy?  I am the one you called at 2am when the biker guy broke your heart.  I am the one who was on the other end of that sofa eating the entire bag of Doritos with you when you were upset you had to break up with the emo guy because he cried in front of you (& now you didn’t love him anymore).  I am the one that talked with you over & over again if children would ever be possible with your medical condition & would any guy be okay with that.  I was there for you… & she was there for me… Until suddenly… she wasn’t.

We ironically became friends while I was really sick, so she knew what my life was.  When she came to town to visit her sister, she would convince the sister they should come see me.  She & I always hit it off & when her sister bailed bc she couldn’t take my life, she befriended me.  She said she would visit & when she actually showed up, she laughed at how shocked I looked every single time.  No one had ever followed through like that.  (I got sick at 11, what 14 year olds are good on the follow-through?)  We were best friends.

In 10yrs we never had a single fight or argument (literally).  Suddenly 3 sentences of an email erased 10yrs.  It’s not math I understand.

I tried to repair it, several times actually.  When I called & left a really emotional message saying how sad & sorry I was if there was any misunderstanding between us, let’s talk it out, I received an email (days later): ”I’ll call you when I want to talk about it”.  A few wks later when she hadn’t called I knew I had to decide which way to go.  I had no real friends at the time so deciding whether I should grovel to get the friendship back was an actual thought.  It’s easy to say don’t do that if you are out in the world & you can make new friends but I wasn’t.  Letting her go meant I had no one, no real friend, no one I talked to or really told my life to – but at what personal cost?  Do you try to keep a friend that obviously doesn’t want to be around your life anymore? So I took a deep breath & did something really scary:  I bungee jumped off the friendship cliff not knowing if I had any safety rope around my ankles or not.   I’d rather have no friends than one that would treat me like that .
I’d rather jump. 

As painful as it was at the time, jumping ended up being the best decision I ever made. Suddenly I wasn’t using so much of my energy to keep a friend that really didn’t want to be there anyway. I felt proud of myself for knowing I could do it without her.  And because of that decision, amazing things changed in my life. I met my new (real) best friend, I met a whole community of patients online that I can tell my life to, I started acknowledging my illness in a way that was honest. I jumped and then a few years later I realized I needed to jump again. *sigh*

My best childhood friend suddenly died & it knocked the wind out of me.  Growing up, she lived at our house & my sister & I lived at hers.  You can’t find 10 childhood pics of me that she won’t be in 4.  When I got sick, she didn’t step up as a huge support for me, she was occasionally there off & on.  I sent her a note when I heard she had cancer & we began to keep in touch as best both of us could with the treatments we were going through.  As I sat at her funeral it struck me, technically she & I probably kept in contact as much as I did with another “friend” I had.  But I knew she wrote me back because she loved me & other people only ever did it because I wrote first & they felt they had to.

After her funeral I looked around & asked myself, who am I desperately hanging on to that isn’t really my friend?  It’s funny how painfully obvious the answer was.  Two names immediately popped in my head.  I had actually tried to walk away from the 1 friend before but chickened out hoping the last 6yrs were a fluke & they would return to being a real friend any day now.  This time I jumped & never looked back!  It’s amazing how much better I felt about myself.  I no longer felt kind of desperate for them to show any sign they were a friend.  My life isn’t any different without them, well actually – it’s better.

Tips for dealing with friendships while sick:

“I would be there for them”
I think most of us have thought this at one time or another.  Too many of us have lost really close friends while we’ve been sick for it to be a coincidence.  It isn’t easy to watch us be sick & suffer & lose chunks of our life & hear us talk about it & never be able to make plans with us or rely on us physically.  It’s easy to feel their side pales in comparison to ours & maybe it does, but it doesn’t mean their side is easy either.

Slow your roll
Go slow.  Don’t give a lot of detailed medical information.  Remember it’s nothing to us to talk about this stuff but for most people, it’s overwhelming & scary & they don’t want to hear all the gorey details.  Give a general update on your life & see how they respond.

It’s not me, it’s you:
Keep the attention on them.  This has worked for me over & over again.  People like to talk about themselves.  Ask them about their life.  If they ask you about yours, give a short answer & shift the attention back to them.  If they are really interested they will either ask you again or ask another question for more detail.  This way you follow their lead.

Assess the risk:
I had this friend, he literally couldn’t take any of the medical details of my life ironically because he cared about me (& he was a wuss!)  It quickly became obvious that everytime I emailed him about random stuff, he wrote back right away.  Every time I said anything about my illness, even if it was just a funny story, he wouldn’t email again for 3wks.  It actually became really comical.  Every so often I just wanted to say some very minor detail about my life so I did.  But I did it knowing the consequence.

Nice to make your acquantence:
Not everyone is going to stick around & be a real friend.  Some start that way & shift to what I call “Facebook friends”, those people that will wish you happy birthday on your FB wall once a year or send you a random email near Christmas.  It can be painful if you used to be real friends & now you’re the only one putting in effort.  If you can switch over too & be happy, they are another layer of support, which is always a good thing!

The post Bungee Jumping Off the Friendship Cliff appeared first on Putting Experiences of Patients First.

The reason behind this?  No one appears to be right.  PCRs only detect the infection 6% to 15% of the time (5.) The fatally inaccurate ELISA was the lightning rod for this whole lyme controversy since the CDC said it’s the gold standard.  For awhile it seemed like the Western Blot, especially by Igenex, might fill the void, but there is controversy both about its false-positive rate (specificity) and its ability to correctly detect the infection (sensitivity.)   Then we woke up from the dream and saw estimates for Western Blot false-positives range from 23% to 30% (4) which is high as a kite if true, and estimates of 50% to 70% sensitivity (2.)   Both of those estimates show a test that produces equally many false-negatives as false-negatives.  [Note: Igenex says their false-positive rate is closer to 4% (6.) ]

© by fredcamino

Just for today, let’s quit arguing about which test is least bad.  There’s no question we need more accurate testing.  Luckily a lot of innovation has happened in the last year and we’re getting closer.  Here are 3 tests that are each flawed, but when combined might provide a clear answer to the big question: Lyme or Not?

1. C6-Peptide ELISA

is more accurate than the old ELISA, but it still only detects lyme correctly in 60% of cases.  Uhhh so why is it on this list?  It has an extremely low 1% rate of false positives (3.)

In English Please: If you test positive, there’s only a 1% chance that’s wrong.  If you test negative, you might wanna consider getting one or both of the next 2 tests.

Price: Varies by company, available at Quest Diagnostics.

2. Borrelia Culture by Advanced Laboratory Services

was introduced in 2011, largely by Dr. Joe Burrascano, as the first commercial test that actually grows the lyme bacteria from your blood.  There was a roar of approval in the lyme community, followed by a predictable uproar from the medical community due to the test’s lack of validation.  Dr. Burrascano says the test has 94% sensitivity (2.)  That’s 94% accuracy with 0% chance of false-positive since the test identifies the actual pathogen and not the immune response.

In English Please: If/when this test is validated…..If you test positive, you’re the big winner: you got lyme for sure.  If you test negative, then there’s only a 6% chance it might be wrong.

Price: $595 (from Advanced Laboratory Services)

3. iSpot Lyme assay by Pharmasan Labs

was just introduced this month.  This test uses the Elispot LTT technology to identify t-cells specific to lyme antigens.  The Head of Immunology at Pharmasan says it has 94% specificity and 84% sensitivity (1.)  That means it avoids false positives in 94% of cases, and detects it correctly in 84%.

In English Please: If you test positive, there’s a 6% chance that’s wrong.  If you test negative, there’s still a 16% chance you actually have lyme.

Price: $375 or $499 including western blot (from Lab Testing Direct.)  The European equivalent is the LTT Elispot Test by InfectoLab

Conclusion:

My personal opinion: Given that the iSpot Lyme assay has been validated using Clinical Laboratory Improvement Amendments (CLIA) program (4), an 84% chance it detects lyme correctly the first time makes it my choice for first-line diagnostic test.  But due to the 6% chance of false positives, if it came up positive I would consider getting either the culture or C6 ELISA to confirm an infection.  If either of those say you have lyme, you might as well go home and start a lyme treatment blog.  Unless you shower in waterfalls made of of Cristal, it might be difficult to spring on the $595 culture test when the C6 is offered by Quest and might be covered by insurance.

Keep in mind that Dr. Burrascano says 2 outside labs will soon validate the culture’s 94% sensitivity rate, which would just be incredible for a test with no chance of false-positives.   That would bring a whole new level of clarity to a community in dire need of it.

Disclaimer: The information in this blog is not advice, and should not be treated as such. You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider.

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Sources:

1. https://www.gtcbio.com/component/conference/inflammatory-and-immunological-biomarkers-agenda

2. http://www.publichealthalert.org/pdf/2013/2013_1.pdf

3. http://www.prweb.com/releases/2010/02/prweb3542194.htm

4. https://www.neurorelief.com/index.php?p=cms&cid=486&pid=149

5. http://www.betterhealthguy.com/joomla/lyme-disease/testing

6. http://www.ldsg.org/index.php?id=11&no_cache=1&tx_ttnews%5Btt_news%5D=57&tx_ttnews%5BbackPid%5D=4&cHash=ab5f39f8e9 

The post New Solutions for Inaccurate Lyme Testing appeared first on Putting Experiences of Patients First.

IMG_1855 © by kibbles_bits

Fluge and Mella of the Rituximab clinical trials are now recruiting for a trial on Enbrel (Etanercept), a TNF-alpha inhibitor, for ME/CFS patients that didn’t respond to b-cell depletion therapy: http://clinicaltrials.gov/show/NCT01730495

In the big picture, I like where Fluge and Mella are going.  They seem to me like men on a mission that won’t be stopped.  I will now shove my face with crow for positing earlier that their choice of medication was ego and theory-driven.  They’re clearly not stopping with their B-cell theory, and this bodes well for all of us.

TNF-alpha is one of the main pro-inflammatory cytokines, and its dysregulation is being implicated in a wide variety of illnesses.  It’s also associated with just about any type of stressor whether infectious, injury, or psychological (1.)

Let’s Look at TNF-Alpha in ME/CFS

ME/CFS Studies:

TNF-alpha has been known to factor in ME/CFS for at least 14 years (2.)  Recently, a 2011 australian study showed CFS/ME patients had significantly higher levels of TNF-alpha along with Interleukin-10 and gamma interferon (3.)  Interesting note: IL-10 is associated with b-cell production.  Another study showed that TNF-alpha may have something to do with ME/CFS patients’ inability to exercise (4.)

But the most relevant study was also unpublished: “Kristin Lambrecht, a physician assistant with the University of Minnesota, presented a study of six CFIDS patients using the drug etanercept (Enbrel)…. Patients receiving the drug reported reduced fatigue and pain and improved exercise tolerance.”  (5)

Dr. Johnathan Kerr, the researcher that identified multiple subsets in ME/CFS, was hoping to get funding for a trial on Enbrel but his proposal was denied and he was unceremoniously fired.  Fortunately, Mella and Fluge have taken up on the baton for one of our fave protagonists.

ME/CFS Patient Reports:

Dr. Enlander has actually been using Enbrel off-label with some patients, but the reports I’ve gotten haven’t been remarkable.

A Phoenix Rising member Kristin says the following about Enbrel: “I was in a “pre-study” with Enbrel back in 2000. I have CFS-moderate. For the first weeks-nothing. Week 5-8 I felt wonderful. Not completely normal, but SO much better. I cried when I had to stop at 8 weeks and found out the cost of Enbrel.” - http://forums.phoenixrising.me/index.php?threads/mabthera-rituximab-from-india-israel.18648/page-2#post-296813

TNF-Alpha Also Plays Role in Fibromyalgia

Fibro Studies

A 2007 study found elevated TNF-alpha, Interleukin-10, and Interleukin-8 in FM patients (7.)  Another study measuring TNF-alpha levels over 6 months of multidisciplinary pain therapy showed elevated Interleukin-8 and TNF-alpha (8.)

Overall however, results are mixed, and a good summary could be found here: http://www.fibromyalgia.com/articles/item/42-cytokines-and-fibromyalgia-syndrome

Fibro Patient Reports

Because fibromyalgia is frequently diagnosed with other pain-related autoimmune diseases, we have a huge spate of anecdotal reports to draw from.   Brace yourself for a murky picture:

“I am on my 5th week of enbrel injections and it has really helped my fibromyalgia. I don’t know if it is supposed to help but it does.” - http://forums.spondylitis.org/ubbthreads.php?ubb=showflat&Number=64018

Our friend and fellow patient Kim did well on Simponi, responded horribly to Humira, and then her pain improve dramatically within 24 hours of Enbrel.

“At this time, my RA is fairly well controlled with the Enbrel. However, I unfortunately can’t say the same for my fibromyalgia. It has been running rampant for at least the past 8 months.”  - http://www.drugtalk.com/diclofenac/drugthread.php/t-627553.html

“I have been using Enbrel for my problems with rheumatoid arthritis and it really helped. Unfortunately, it seems that enbrel brought my fibromyalgia….Lene Anderson (HealthCentral) remarked that Enbrel had made her FM much worse.” - http://www.steadyhealth.com/enbrel_brought_my_fibromyalgia_t146263.html

“Although I had initially been diagnosed with FM before the real RA diagnosis (a couple months between the positive test and the first major swelling showed RA clinically), it was nothing compared to the RA. Now it’s a real problem – when I’m on full schedule of Enbrel, the Fm is much worse.” - http://www.steadyhealth.com/enbrel_brought_my_fibromyalgia_t146263.html

Another Immune Suppressor, Another Achilles Heel

As with the other immune suppressing drugs we’ve been discussing lately, TNF-alpha inhibitors are not without severe risks.  Enbrel’s company website states that it can leave you vulnerable to new infections or reactivate Hepatitis B (6).  A tricky proposition for ME/CFS, a disease often characterized by low natural killer cells.  These issues have resulted in 45 patients Humira, Enbrel, Remicade, and Cimzia dying from fungal diseases.  In 2012 the FDA warned that the drugs can cause “a rare cancer of white blood cells” in young people. (13)

Let’s Lower TNF-Alpha Without Axing Immunity

There are however a few approaches that are generally considered safe and might suppress TNF-alpha with minimal immune suppression:

1. Ketotifen, which stabilizes mast cells but also suppresses the release of TNF-alpha in HIV-infected patients (9).

2. Vasointestinal Peptide (VIP), an anti-inflammatory nasal spray: “Well-established immunomodulatory actions of these peptides are to inhibit macrophage and microglia production and release of inflammatory mediators such as TNF-α and IFN-γ” (10.)

3. Minocycline, a tetracycline antibiotic used for mild RA.  Dr. Cheney prescribes it as an anti-inflammatory for ME/CFS, rotating it with artesunate.  The Marshall Protocol suggests using it at much lower dosages to minimize dose-dependent immunosuppressive effects (12.)

4. Dominant-negative TNF inhibitors (DN-TNFs): Might be the future.  These specifically ”blocked solTNF activity in human and mouse cells, a human blood cytokine release assay, and two mouse arthritis models” without suppressing innate immunity (11.)

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 Sources:

1. http://ajp.psychiatryonline.org/article.aspx?articleID=176404&RelatedWidgetArticles=true

2. http://www.ncbi.nlm.nih.gov/pubmed/10535608

3. http://www.masscfids.org/resource-library/3-research/327-new-research-on-immune-abnormalities-in-cfscfidsme

4.  http://cfids-cab.org/cfs-inform/Cytokines/white.etal05.pdf

5. http://www.cfids.org/archives/2001/2001-2-article01.asp?view=print

6. http://www.enbrel.com/prescribing-information.jspx

7. http://www.ncbi.nlm.nih.gov/pubmed/17543146

8. http://www.fibromyalgia.com/articles/item/42-cytokines-and-fibromyalgia-syndrome

9. http://www.ncbi.nlm.nih.gov/pubmed/8737754

10. http://www.ncbi.nlm.nih.gov/pubmed/23517078

11. http://www.ncbi.nlm.nih.gov/pubmed/17641054

12. http://mpkb.org/home/mp/minocycline

13. http://www.theepochtimes.com/n2/health/seven-diseases-big-pharma-hopes-you-get-in-2012-part-2-of-3-188630.html

The post ME/CFS Researchers Go From B-Cell Depletion Therapy to Enbrel appeared first on Putting Experiences of Patients First.

Prostaglandins are hormone-like substances that affect the body in variety of ways, also regulating inflammatory mediation. An anti-flammatory diet includes less foods that create inflammation-causing prostaglandins (PGE2) in the body, and more foods that create anti-flammatory prostaglandins (PGE1 and PGE3). 

Inflammation plagues auto & neuro immune patients in many forms & food is one of them.  Eating the wrong foods or too much food in one sitting can trigger inflammation.  Tip: Try eating smaller amounts of food, more often throughout the day & adding more anti-inflammatory foods to your diet.

Note: always consult your Doctor first, even foods / spices can be dangerous if it’s contraindicated for your case, your medications and especially your gut if it’s not a food you can tolerate.

Anti Inflammatory Foods:

by Public Domain

Celery/Celery Seeds: James Duke, Ph.D. found more than 20 anti-inflammatory compounds in celery & celery seeds in his research, including a substance called apigenin, which is powerful in its anti-inflammatory action.  Use celery seeds as a salt substitute or add to soups, etc.

Cocoa:  Studies have shown over & over, cocoa reduces levels of inflammatory markers in blood & possibly even increases blood flow.  Cocoa has a rich concentration of flavanols, which reduce inflammation and blood clotting.

by D H Wright

Cherries: have have been shown to have significant pain reduction & anti-inflammatory effects.  Muraleedharan Nair, PhD found that tart cherry extract is ten times more effective than aspirin at relieving inflammation!

Parsley: You know the little leafy twig they stuck on your plate at restaurants to make the food look more appealing? (but it always arrived wilted & sad & the first thing you always did was flick it off the plate?)  Yeah, that little twig is actually pretty amazing. It helps our bodies in a long list of ways, not the least of which is reducing inflammation, joint pain & stiffness.

by brx0

Blueberries: an excellent anti-inflammatory food. They increase the amounts of compounds called heat-shock proteins that decrease as people age.  When heat-shock proteins are in short supply, inflammation, pain and tissue damage results.

Raspberries, Blackberries & Strawberries: Dr. Muraleedharan Nair’s later research discovered these berries have similar anti-inflammatory effects as cherries.

Sweet Potato’s:  biggest anti-inflammatory benefits that come from sweet potato’s are their high amounts of antioxidants (mainly beta-carotene, alpha-tocopherol & ascorbic acid).

Spinach © by desegura89

Kale / Spinach: has anti-inflammatory properties but what’s even more fascinating is spinach contains naturally occurring plant-based steroids called phytoecdysteroids.

Fish (such as salmon) or Fish Oil: According to Dr. Alfred D. Steinberg, an arthritis expert at the National Institute of Health, fish oil acts directly on the immune system by suppressing 40 to 55 percent of the release of cytokines (the compounds known to destroy joints and cause inflammation).

Green tea at Samovar. © by sjsharktank

Green Tea: we hear a lot about green tea being so good for us. It does have anti-inflammation properties. But what many people might not know, you probably have to drink 3-4 cups a day to reach that potential.

Flax seeds and Flax Oil: Flax seeds are high in natural oils that convert into hormone-like substances in the body to reduce inflammatory substances. An easy way to eat them is to add ground flax seeds to smoothies, yogurt, anything you already eat!  (Note: do not heat them)

by ECohen

Pineapple: contains bromelainan an enzyme that aids in the healing of indigestion &amp; reducing inflammation. Extracts of bromelain have proven to be as effective as some non-steroidal anti-inflammatory drugs and are used in a number of natural anti-inflammatory supplements for arthritis.

Spice it UP!

spice_1 © by srqpix

All chili peppers / spices (like cayenne pepper):  include capsaicin (the hotter the pepper, the more capsaicin it has), which is a potent inhibitor of substance P, a neuropeptide associated with the inflammatory processes.

Tumeric: Research shows this Indian spice (commonly used in curries / pre-mixed curry powder) contains a powerful, non-toxic compound called curcumin. Studies found turmeric’s anti-inflammatory effects are on par with potent drugs such as hydrocortisone and Motrin, but have none of their side effects!

ginger-segway

Cinnamon: is not only tasty it’s amazing stuff! Cinnamon’s ability to lower the release of arachidonic acid from cell membranes puts it in the category of an “anti-inflammatory” food that can be helpful in lessening inflammation.  But beyond that there are some reports its also an anti-bacterial, anti-fungal & anti-parasitic! (and… it smells wonderful!)

Ginger: (a relative to Tumeric) Dr. Srivastava at Odense University found that ginger was superior to non-steroidal anti-inflammatory drugs (NSAIDs) like Tylenol or Advil at alleviating inflammation.

(I don’t know why ginger is riding a segway, I just know the photo was too funny not to use!)

They say food is medicine, these studies continue to prove it’s true!

The post Anti-Inflammatory Foods – Some proven as effective as drugs! appeared first on Putting Experiences of Patients First.

balanced rocks © by Marie Loughin

For years we’ve been hearing that TH1/TH2 balance is a big key (if not the key) to disorders such as lyme disease, ME/CFS, fibromyalgia.  But treatments aimed at restoring TH1/TH2 balance have largely produced mixed results.  Studies on Crohn’s disease suggest that overexpressed TH1, often thought to be deficient in our illnesses,  might actually be responsible for some inflammatory diseases, suggesting that broadly raising TH1 may not be the answer to our prayers.

These diseases have begun to look more to autoimmune research for clues, and TH17, which is distinct from TH1 and TH2, might be the biggest clue yet in the quest to treat autoimmune diseases without broad immune suppression.  Now we’ve stumbled upon an equally impressive finding: Tregs (T-regulatory cells) might be the anti-inflammatory yin to TH17′s autoimmune yang.

Depletion and Infusion with Tregs Both Show Stunning Results

A few studies clearly illustrate the potential impact Tregs can have on autoimmunity. The first was a mouse model where transferring  Foxp3⁺ TRegs prevented autoimmunity.  Conversely, removing them caused death from multi-organ autoimmunity within 10 days (6.)

Then came humans: those with a genetic mutation to the Foxp3+ gene “develop insulin-dependent diabetes, thyroiditis, eczema, haemolytic anaemia and inflammatory bowel disease, and without bone marrow transplantation they die at an early age” (6.)   In a human clinical trial,  depletion of CD4⁺CD25⁺ Tregs from healthy individuals caused enhanced allergic responses to milk, nickel, grass (6.)

Shoemaker Discusses Tregs

Dr. Ritchie Shoemaker, now fully focused on research, lasered in on Tregs at a recent lecture summarized by Scott Forsgren here: www.betterhealthguy.com/joomla/blog/264-physicians-round-table-2012.  He confirms CD4+CD25+, a specific type of Treg, is low in many of the lyme and biotoxin patients tested.

Interestingly, “it was found that in those with HLA-susceptibilities, Treg cells dropped with antibiotic treatment.  They increased after biotoxin treatment and increased even further with the incorporation of VIP,” presenting an interesting paradigm where focusing solely on infections can potentially make patients worse, which is indeed what we see in a lot of chronic lyme disease, ME/CFS, and related illnesses that get blasted with bug killers.  Patients often attribute this to “herxing.”

As TGF-Beta 1 Goes, So Goes TH17

Shoemaker says that low Tregs go hand-in-hand with high TGF-Beta 1, which is commonly elevated in our patient population.  In a nutshell, he says “TGF-b1 and C4a are the best tests to show a patient has an actual condition.”  But what does TGF Beta-1 have to do with TH17?  Apparently muchos:

* TGF-Beta 1 promotes TH17 development (1)

* High TGF-beta 1 can lead T cells to differentiate into TH17 (2)

* TGF beta-1 correlates with both auto-immunity and Th-17 inflammation (3)

*  The combination of high IL6 and IL23 induce Th17 differentiation, and TGF-beta-1 further enhances it (4)

The evidence shows TGF beta-1 raises TH17, so if TH17 is the key to autoimmune disease development….

What To Do About It?

As he often does, Shoemaker lays it out clearly for us.  According to him, the following treatments raise CD4+CD25+ Tregs (desirable):

* Methotrexate 

* Beta-interferon drugs like Copaxone

* VIP (Vasoactive Intestinal Peptide)

* EPO (Procrit)

while the following lower CD4+CD25+ Tregs (undesirable):

* Prednisone

* IVIG

* Antibiotics (in those with HLA susceptibilities)

Note: Shoemaker didn’t mention anti-TNF-α but it’s another candidate for raising Tregs.  In a study on RA patients, those that received this corrected a defect in Treg function and showed increase in peripheral Treg numbers (5.)  He does however mention that VIP helps sarcoid patients in part by lowering TNF (7.)

Let’s Look A Little Closer

Looking at this list of treatments that raise Tregs, it basically looks like a list of the most effective Rheumatoid Arthritis treatments (methotrexate, anti-TNF-α) and Shoemaker’s tried-and-true anti-inflammatory therapies.  The biggest takeaway?  VIP is a 3-tool star: raises Tregs, lowers TGF Beta-1, and regulates TH17 (7.)

A closer look at corticosteroids, methotrexate, and anti-TNF in Rheumatoid Arthriitis shows the following:

“no associations were detected between the frequency of CD4⁺CD25⁺ T cells in the peripheral blood and the use of methotrexate, corticosteroids or tumor necrosis factor (TNF)-neutralizing agents.  However, in a subsequent study a significant increase in the number of CD4⁺CD25^high T cells was observed after anti-TNF treatment in patients with RA who responded to therapy, but not in those patients who failed to respond to therapy” (9.)

A study on anti-TNF therapy in juvenile arthritis showed that Etanercept and Adalimumab (two anti-TNF drugs) had a modulating effect on Th17 and Treg cells (10.)

I’d like to know where Shoemaker is basing his opinion that methotrexate raises Tregs and prednisone lowers it.

Welcome to the VIP

I just got a Rx for VIP nasal spray.  Note: Shoemaker says certain conditions must be met for VIP to work: “VCS is negative, ERMI is < 2, and MARCoNS is negative.  It won’t work if you have not addressed these factor first.”  

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Sources:

1. http://www.ncbi.nlm.nih.gov/pubmed/19535626

2. http://www.survivingmold.com/docs/Ackerley_Discuss_the_Shoemaker_Treatment_Protocolv1.pdf

3. http://www.survivingmold.com/docs/Resources/Shoemaker%20Papers/213v1.pdf

4. http://www.copewithcytokines.de/cope.cgi?key=Th17%20cells

5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1782265/

6. http://www.nature.com/nrd/journal/v12/n1/full/nrd3683.html

7. http://www.survivingmold.com/docs/VIP_published_3_2013.pdf

8. http://www.docstoc.com/docs/34185452/Treatment-of-CFS-patients-with-elevated-C4a-using-low-dose-erythropoietin-corrects-abnormalities-in-central-nervous-system-metabolites-and-restores-executive-cognitive-functioning-Ritchie-C-Sho

9. http://arthritis-research.com/content/7/3/93

10. http://www.blackwellpublishing.com/acrmeeting/abstract.asp?MeetingID=761&id=80935

11. http://www.jleukbio.org/content/78/6/1327.short

The post Fixing Treg / TH17 Balance: The Key To Fixing Autoimmunity? appeared first on Putting Experiences of Patients First.