Psychosocial Considerations and Quality of Life Issues in Peripheral Neuropathy

It's something your doctor may not have time to address but unless you have help from elsewhere, the psychological effects of neuropathy are easily underestimated, whilst contributing to making your life a misery. This article from Medifocus Health (see link below) shows what happens to many neuropathy patients, sometimes without them realising it themselves. It's very important to be aware of how quickly your mental state can change when you're continually under stress from ill health. If you're also HIV positive, these problems can become exaggerated and friends and family become more important than ever!

Psychosocial Considerations and Quality of Life Issues in Peripheral Neuropathy

"Quality of life" is a measure of how well patients adjust to their condition. It measures many factors related to living with a medical condition, including:
•Physical and material well-being
•Social relationships with other people (e.g., spouse, siblings, or friends)
•Social activities (e.g., helping others, getting together with other individuals or groups, community/religious involvement)
•Personal fulfillment (e.g., career, creativity, pursuit of intellectual interests)
•Recreational activities (e.g., sports or relaxation)
•Health status (perceived and actual)

A significant aspect of quality of life and ability to function daily is related to how individuals with peripheral neuropathy perceive themselves and regard their situation. Physical well-being has the greatest influence on a person's perceived health status and on most other measures evaluated in quality of life test scales.

Chronic neuropathic pain can be very debilitating and can affect several dimension of daily life as reflected in lower scores of quality of life scales including:
•Psychological health (e.g., depression, anxiety)
•Work-related problems (e.g., reduced levels of productivity, absenteeism)
•Sleep disturbances
•Feelings of isolation
•Sense of disappointment that expectations of recovery are not being met

Peripheral neuropathy affects a wide range of people and its impact on quality of life is closely related to the severity of this interference in daily life. In some people it is very debilitating and chronic, while others may be affected only intermittently with varying degrees of discomfort ranging from mild to severe. Pain management programs play an important role in teaching individuals how to live with their condition. These programs focus on pain control, as well as social and physical functioning, and emotional health. Another benefit of pain management programs is that they usually consist of several types of professionals, including psychologists or psychiatrists who can help monitor emotional status and try to prevent secondary conditions such as depression and withdrawal from society in individuals with peripheral neuropathy.

Depression is not uncommon in persons with peripheral neuropathy due to the chronic aspect of the pain, loss of function, emotional burden, and reduced quality of life. Some of the medications used to treat peripheral neuropathy are actually antidepressants and may help to control depression as well. However, it is very important that patients share feelings of depression with their health care providers so that they can be addressed appropriately. Support groups are helpful for many persons in coping with the pain and discomfort and its impact on daily life.

Response to medications is extremely variable and many patients try numerous types and doses of medications before finding one that brings some measure of relief. Some doctors and patients find that keeping a daily pain diary is a useful tool to monitor responses to medications and therapies so that changes or adjustments to patients' pain management programs can be implemented as needed. Response to monotherapy (one drug) is estimated to bring a 30-50% reduction in pain, at best. Multi-drug therapies that target different parts of the nerve pathways may be more effective. Although there are no clinical trials to date regarding multi-drug treatment of peripheral neuropathy, this strategy is often practiced by physicians.

http://www.medifocushealth.com/NR021/Understanding-Peripheral-Neuropathy_Psychosocial-Considerations-and-Quality-of-Life-Issues-in-Peripheral-Neuropathy.php

Cataract Clouds of the eye

Cataract

EYES - Cataract

Clouds of the eye

In olden days, aged people who suffered fromcataract led the rest of their life being blind. Now, in the anti-ageing era (?), everyone should thank scientific development in surgical manipulation for lighting up the vision and thus one’s life. Cataract is one of the most common complaints of vision problems of people over 50 years of age. Nowadays it is also the commonest surgery among aged persons with the maximum results.

Cataract is the disease of the lens in the eyes, where the clear lens loses its transparency and focusing quality due to ageing or disease or trauma. Cataract is a cloudy opaque area forming in the lens, involving the centre or periphery in one eye or both eyes. Cataract in aged persons is due to the ageing process and usually occurs in both eyes.

Lens – Lens is a form of skin (which is developed from skin ectoderm during embryological development) which is a colourless (not white), biconvex and crystalline material situated just behind the pupil of the eye. It is made up of protein and water which is arranged as a lot of fibres in dense layers. The central part of the lens is called nucleus and the peripheral part is called cortex. Its size is about 9 mm in diameter and 4 mm in thickness. Even though it is a type of skin, it has no blood supply. Its nourishment and oxygen come from aqueous humour (optically transparent watery suspension behind the lens) and auto oxidation of lens protein (glutathione is oxidised by beta crystalline) which help in metabolism.

The lens help in convergence of the light rays which pass through them for forming the image in the retina. The lens is also very important for focusing on the object. The coagulation of the proteins in the lens due to the ageing process (loss of oxidation process) or diseases may cause cataract.

Occurrence and incidence – It occurs irrespective of race and sex, after the age of 50. Incidence is more in people with diabetes.

Types of cataract – Cataract can be classified as

Nuclear cataract – Also termed as hard cataract where opacity is in the centre of the lens i.e. it is sclerosis of the nucleus. The periphery part remains transparent. It is sometimes visualised as brown or black due to melanin deposition. This type takes a very long time to get matured.

Cortical cataract – Also termed as soft cataract where the glare is the very first complaint. This form of cataract easily gets matured in about 6 months to one year.

Triggers of cataract: Even though there are lots of thoughts about the triggers of cataract, the ultimate reason or exact cause remains unknown. Researchers have not succeeded yet in knowing the cause of cataract and mechanism of its formation. But correlation shows ageing and deficiency of vitamins and minerals can cause cloudy and opaque cataract. Cataracts tend to grow slowly, so vision gets lessened gradually which finally leads to complete loss of vision when it gets fully matured.

The main triggers are:

A) Internal factors

• Senile cataract or age-related cataract are developed due to coagulation of lens protein and defective oxidation process of lens
• Cataract due to deficiency of glutathione, beta crystalline, riboflavin and vitamin C
• Congenital cataract : In this case, cataract forms either due to infection of German measles or vitamin deficiencies during pregnancy.
• Systemic illness – Cataract incidence rate shows drastic increase in diabetic patients, due to metabolic disturbances.

B) External factors

• Trauma – Cataract can develop immediately after an eye injury or later on slowly.
• Irritants- Smoke, acid fumes, etc.
• Radiation
• Drugs – Steroidal drugs may cause cataract.

C) Infections of the eyes spreading inside involving the lens due to delayed treatment or maltreatment will also cause cataract formation

D) Genetic – It is also found to run in families.

Symptoms of cataract

• Cloudy vision – as if seeing through a fog or vision will be like washout images
• Glaring of sunlight, lamps and it is mostly noticed at the time of crossing the road and night driving
• Rainbow colours or haziness or circular ring can be seen surrounding the light.
• Needs more light for better vision, in initial period of cataract

Effects of cataract

• Losing self-confidence – depression may develop.
• Losing independent movement – achievements and self work will get disturbed.

Diagnosis can be made easily by an eye check-up. You yourself can diagnose it when you see the opaque white or grayish white thing in the pupa. Ophthalmologist diagnoses it clearly with its type and management, with the help of ophthalmoscope and slit lamp examination after dilating pupils with atropine. With Refraction Chart Test and Tonometer (which helps in analysis of eye pressure) diagnosis and its complications can be made very clear.

Regular check-up of eye, blood pressure and sugar is mostly enough for ruling out its risk factors and sometimes culture of conjunctiva discharges may be done to rule out bacterial infection.

Prevention of cataract: Since we don’t know the exact cause, prevention also seems to be difficult for us. But it is better to avoid and manage the triggering factors. So
Avoid

• Steroidal drugs which cause cataract and glaucoma
• Smoking and smoke
• Watching TV for a long time
• Working for a long time on computers.
• Long and continuous study
• Direct sunlight or high beam lights

Take

• Nutritious diet for a healthy life, especially food rich in vitamins A, B and C.
• Rest with closed eyes for a while, when you are straining more at the computer or reading.
• Plenty of fluids – water, juices to avoid dehydration and sclerosis.
• Care of the eye and protect it from infection, dust, UV lights, radiation and injury by wearing sunglasses.

Complications – Infections, glaucoma, blindness and inability to view retina for any retinal diseases especially in case of diabetic retinopathy.

Treatment – There is no specific medicine available for cataract. Recently, most doctors prescribe antioxidants only as a general drug for old age problems, including cataract. The main four antioxidants are beta carotene, vitamins C and E, and the mineral selenium. Antioxidants are present naturally and mostly in grape seeds, corns, turmeric, garlic, sesame seeds, ginger, plums, ginseng, holy basil, olive oil, etc. Antioxidants have proved in scientific research that they can retard or postpone many aspects of the ageing process. But it is only a general drug and not a cure giving drug.

So allopathic treatment mainly depends on surgical manipulations or extraction of the opaque lens and replacing it with a new clear artificial lens i.e. an intraocular lens (IOL). Cataract surgery with IOL is the permanent solution for opaque lens and refraction errors. There is no hard and fast rule for operation so you can take your own relaxed time for operation.

There are different types of surgeries like:

• Intra capsular cataract surgery – here the lens with capsule is removed – rarely done
• Extra capsular cataract surgery with implantation of rigid intraocular lens – here the back part of the capsule is left undisturbed.
• Phaco-emulsification i.e. Micro incisional surgery has the advantages of shorter hospital stay and fewer complications. Phaco-surgery is the most common procedure in developed countries. Here lens is emulsified using laser and a foldable silicon lens is inserted through the minute incision.

Now cataract surgery is very safe and effective, when performed without any risk factors like hypertension, diabetes, glaucoma and eye disorders. Rarely complications occur with pain, redness, swelling due to infection or pressure in eyeballs.

Homoeopathic approach – Betterment is important and not the system or the doctor. In case of cataract diagnosed early, surgeons usually wait till the cataract matures, so that it can be removed easily. Until then, the patient has to suffer with the complaint and its effects and complications.

But in Homeopathy, if you are diagnosed earlier itself as having cataract, you can get started with Homeopathic Cineraria Maritima Succus eye drops, so that you will never go to the surgeon’s table for cataract surgery. Prevention is better than cure – Homeopathy is advantageous over other systems of medicine with this saying in the case of cataract since it proves the ability to prevent and control the progress of cataract.

The earlier you treat, the better your chance of complete recovery or otherwise stopping the progress of the maturation of cataract. Cataract is a structural damage, so reversing cataracts is tough, yet it can be done over time with patience.

If later, when the cataract gets mature, the best way out is surgery and not drops or any medications. If the patient’s health is not fit for surgery, then they can be somewhat (10-20 per cent) benefited with this Cineraria Maritima Succus eye drops. Also, cataract needs to be removed only if it affects the vision so much that it interferes with your day-to-day activities. You can postpone it for any vacation period or your leisure period.

Recent treatment proves no other eye drops can treat or cure cataract other than CMS eye drops. Cataract can be treated in the early stages itself with this eye drops. Early treatment gives the best results. Cineraria Eye Drops – Cineraria Maritima Succus is the only most effective Homeopathic remedy which can increase eye vitality power. It has been used for a long time and proved its efficacy in treating all types of cataracts.

Recently, the Central Council of Research in Homeopathy – CCRH – Government of India, has claimed that Cineraria Maritima Succus surely prevents cataract formation. So, any patient diagnosed with cataract in the early stages by an ophthalmologist, can simply use Cineraria Maritima Succus eye drops twice daily for 6 months to 1 year. They will never let their eyes to be touched by a surgeon’s knife.

Homeopathic Medicines should be taken under the advice and diagnosis of a qualified Homeopath.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)

Laxmi Homeo Clinic

24 E. New Mahalipatti Road

Madurai, TN 625 001

India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)

Fax: +91-452-233-0196

E-mail:  drcheena@yahoo.com

www.drcheena.com / www.drcheena.in

(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)

The Simple Pleasures of the Pine Family January Newsletter

~ Pine Family Treasures ~

Side Effects of HIV Meds

This is more a general post explaining why HIV medication sometimes causes side effects and what they might be. Of course, neuropathy features strongly amongst those. It's from a U.K. site called 'Positive Gay Guide' (see link below)and is useful background information for any HIV patient.

Side effects of anti-HIV drugs

Side effects from anti-HIV drugs occur either because of an allergic reaction to the drugs, or because of the action of the drugs themselves. HIV enzymes that anti-HIV drugs target are similar to the enzymes your body needs to function normally. When you take anti-HIV drugs they don’t only inhibit the enzymes in HIV, they can also start to affect your body’s own enzymes causing unwanted side effects.

Anti-HIV drugs are very powerful, and so it takes time for your body to adapt to them. There are ways to cope with side effects when they happen. The most common side effects such as nausea or diarrhoea can be managed with anti-nausea or anti-diarrhoea medication. Another common side effect in the short term is a body rash, and this can often be managed with antihistamines. However, a rash can also be a sign of a more serious allergic reaction which we talk more about later on this page. For this reason, if you do get a rash you should go to see your doctor straight away.

Your doctor will use your regular blood tests to monitor you for a wide range of problems that anti-HIV drugs can cause, such as anaemia (which is a deficiency of red blood cells) and kidney or liver toxicity. If the drugs were causing any of these problems then they would be spotted during your routine appointments and blood tests.

Since most side effects disappear after a while many people decide to push through the first month or so, as long as the side effects are not too severe. Make sure you always tell your doctor about any side effects you experience since he or she will need to check that nothing serious is going on.

Obviously, if the side effects are too severe then you and your doctor would want to think about changing one or more of the anti-HIV drugs you are taking to a combination that you would find easier to tolerate.

We talk more about this in the section on changing treatment.

It’s important to note here that you should never just stop taking your anti-HIV drugs, even if the side effects are really bad, without the advice of your HIV doctor. He or she will be able to tell you how to change to a different combination with minimal risk of developing drug resistance to your anti-HIV drugs.

Drinking alcohol or taking certain recreational drugs can make side effects more severe. For instance, ecstasy can increase the levels of the protease inhibitors in your blood. This would increase the chance that you would experience severe side effects.

You can read more about alcohol and recreational drugs and how they can affect HIV and HIV treatment in the section on looking after yourself.

Severe allergic reactions

More serious side effects of anti-HIV drugs can be caused by allergic reactions to certain drugs. One of these is caused by abacavir in 4% to 8% of people who take it, and is known as a hypersensitivity reaction. There is now a genetic test which shows whether you are likely to get this reaction, although the test may not be available everywhere. If you are thinking of taking abacavir, ask your doctor about this test.

Abacavir hypersensitivity reaction usually occurs within the first 6 weeks of treatment, however it can occur at any time and so people taking abacavir are advised to carry a warning card in their wallets. All boxes of abacavir, Kivexa or Trizivir (which both contain abacavir) have a pull out warning card which you should carry with you.

The symptoms of hypersensitivity reaction get steadily worse over a few days and can include a rash, fever, gastrointestinal problems, nausea and vomiting. If you develop these symptoms after starting abacavir you should go to see your doctor immediately. If you were diagnosed with a hypersensitivity reaction then your doctor would ask you to stop taking abacavir. Once you have stopped taking abacavir you must never take it again. Taking abacavir again after you had a hypersensitivity reaction the first time can lead to a very quick and severe allergic reaction which can be fatal.

Metabolic changes

Metabolic changes refer to changes to certain chemical or physical processes used by your body, such as the way it converts fat into energy. Your doctor will keep an eye on certain indicators of metabolic changes each time you have your regular blood tests, such as your cholesterol levels.

It’s unclear why some people experience metabolic changes when taking anti-HIV drugs, however those that have been seen in people with HIV include high cholesterol, diabetes and insulin resistance, high blood sugar and high blood fats (which can be related to body fat changes, and we talk about these later on this page).

If your blood tests indicate that you are experiencing problems with metabolic changes, your doctor may recommend changing the combination of drugs you are taking to one that your body will be better able to cope with. Your doctor may also recommend that you alter your diet to help with problems such as high cholesterol or he may even suggest that you exercise more often.

You can read more about your diet and exercise in the section on looking after yourself.

Body fat changes

A long-term side effect that has been associated with certain anti-HIV drugs is lipodystrophy and lipoatrophy. Lipodystrophy is fat redistribution around the body, usually fat gain around the abdomen. Lipoatrophy is fat loss from parts of the body, often seen as facial wasting or wasting from the arms and legs. These side effects can often be managed with appropriate anti-HIV drug choices, however if you have resistance to some anti-HIV drugs your options may be limited and you may not be able to avoid the drugs that could cause lipodystrophy and lipoatrophy. Protease inhibitors have more commonly been associated with fat redistribution around the abdomen, whereas the NRTIs such as d4T, ddI and AZT have been associated with fat loss. However, other factors are also likely to contribute to lipodystrophy and lipoatrophy, including HIV infection itself.1

If you are having problems with lipodystrophy or lipoatrophy then you and your doctor could think about changing the combination of anti-HIV drugs you are taking. For example, it has been shown that men who have lost fat from their face because of taking the NRTI d4T can actually start to regain some of the lost fat when switching from d4T to abacavir, another NRTI.2

There are also reconstructive treatments for people with facial wasting. One of these is polylactic acid, also known as New Fill or Sculptra. This is given as injections into the areas on the face where fat has been lost, and it helps to stimulate collagen growth and increase the skin thickness. This is a very safe treatment, and has been shown to greatly improve the quality of life of men in a number of studies.3 However it’s not available everywhere on the NHS, and even where it is there could be a long waiting list. Speak to your doctor if you think you may be interested in finding out more.

Peripheral neuropathy

Another long term side effect of certain anti-HIV drugs is peripheral neuropathy. This is a painful condition caused by damage to the peripheral nerves, usually in the feet, legs and hands. It’s often described as feeling like burning pins and needles, and can range from mild tingling and numbness to very intense pain.

The drugs that have been associated with peripheral neuropathy are the NRTIs d4T, ddI and to a lesser extent 3TC, however peripheral neuropathy can also be caused by HIV itself. Alcohol and some recreational drugs are neurotoxins, meaning that they are toxic to the nervous system. Taking recreational drugs, such as amphetamines or cocaine, or drinking too much can make peripheral neuropathy worse.

If you do develop peripheral neuropathy from your anti-HIV drugs you and your doctor would want to change the combination of drugs you are taking if possible.

If you aren’t taking any of the drugs that are associated with peripheral neuropathy or the condition continues after stopping the drugs which could cause it, it may be that there’s another cause. Your doctor would probably do a blood test to check your vitamin B12 levels, as a B12 deficiency can cause neuropathy. It could also be HIV itself that’s the cause.

There are some treatment options available for peripheral neuropathy. The anti-convulsant drug gabapentin has been shown to improve the condition in some people, but not all. Other treatments include a low dose of amitriptyline, a drug normally used to treat depression, and acetyl-l-carnitine, an amino acid which may actually reverse the nerve damage seen in people with peripheral neuropathy. However, medical opinion is divided about how effective these and other treatments for neuropathy are. If you are experiencing pain from peripheral neuropathy that isn’t caused by any anti-HIV drugs you are taking, you could ask your doctor to refer you to a specialist neurologist who can investigate the causes further.

If you are in quite a lot of pain then you could also ask to be referred to a specialist in pain management or palliative care who will explore with you different ways to manage the pain you are in. It may be worth asking about trying a Transcutaneous Electrical Nerve Stimulator, more commonly referred to as a TENS machine. This passes a small electric current through your nerves and has been shown to be beneficial to people experiencing neuropathic pain.

You can find more information about the side effects of the specific anti-HIV drugs you are taking, or thinking of taking, on NAM’s website, Aidsmap.

http://www.gmfa.org.uk/positive/hiv-treatment/side-effects