Monday, June 29, 2009

Improving the Quality of Life -- One Physician's Experiences in Treating the Symptoms of an Illness that has No Effective Treatments

Written by Anthony Hardie, 91outcomes

(Boston, Mass. - June 29, 2009) Dr. Meryl Nass, a practicing physician at the Mt. Desert Island Hospital, in Bar Harbor, Maine has learned through practice that since there is no recognized treatment or set of treatments for her Gulf War Illness patients, she has sought to find what works, focusing on treating the symptoms and trying treatments that treat similar illnesses known to work. Her goal is simple: improve the patient's quality of life.

In a study presented today in Boston before the federal Research Advisory Committee on Gulf War Veterans' Illnesses involving a records review of 20 of her Gulf War patients, 15 male and five female, Dr. Nass noted her findings included a host of diseases, illnesses, conditions, symptoms, and difficulty communicating.

Many other conditions were noted, including tinnitus, recurrent oral ulcers, and other firmly diagnosed conditions, rather than self-reported conditions.

She noted that the group of ill Gulf War veterans had an average of 13 diagnoses each, "which you don't see in other parts of the world," said Dr. Nass.

One-fourth had Type 2 diabetes, and many of them had hypertension. What struck Dr. Nass as unusual, however, was that those patients were mostly male, mostly non-obese, and were diagnosed with these conditions in their 30s -- all highly unusual for the conditions.

She found that central sleep apnea was common among her study group of ill Gulf War veterans.

Severe nausea, vomiting, or diarrhea was common in forty percent of her patients.

Dr. Nass noted that many of these veterans have Multiple Chemical Sensitivity, including to detergents, solvents, paints, glues, and many others. She has frequently seen food sensitivities in her patients with Multiple Chemical Sensitivities, which requires an elimination diet to determine what foods are impacting negatively on the patient.

Dr. Nass has found in her clinical practice that no one pharmaceutical or single group of pharmaceuticals has proved to be particularly useful for fibromyalgia, which she called, "a surrogate" for Gulf War Illness. However, while she said that treating fibromyalgia patients through a multi-system approach is often quite successful, she candidly noted that success in treating Gulf War Illness patients has been only about "30 to 40 percent" for whom quality of life was improved, though not enough so that they could go back to work.

Treating the Symptoms

In the absence of proven treatments for the underlying Gulf War Illness condition, Dr. Nass has seen "countless" Gulf War veterans suffering from Gulf War Illness. In seeking to improve their quality of life, Dr. Nass has combined a variety of approaches, using "patient-centered care", which she says is necessary because so many Gulf War Illness patients have difficulty remembering, particularly complex instructions.

She tries a comprehensive approach, including treating pain, sleep, nutrition, gastointestinal complaints, saying, "treat everything you can." Those treatmens include treating the symptoms of debilitating fatigue, cognitive issues, chronic pain, and respiratory, gastro-intestinal, and immunological problems among others.

Her methods also include having appointments that last longer than usual, providing handouts and writing exactly what care is needed, which is often complex -- necessary because of Gulf War Illness patient's significant cognitive issues.

She also uses a pain questionaire developed by the manufacturer of Oxycontin in order to assess the level of pain, which is a primary symptom for many veterans suffering from Gulf War Illness. She also creates a complete problem list that is used as a continuing guide to treatment.

And, Dr. Nass explains that it's important to test for conditions with similar symptoms, like Lyme Disease, Vitamin B-12 deficiency, thryoid function issues, and other problems unique to each patient.

"Every veteran is also emotionally wounded," says Dr. Nass, which requires especially compassionate care, a thorough review of the veteran's often extensive medical records, and geting a "good feel" for the patient and family.

She noted that she was surprised that while thyroid function appears normal in Gulf War Illness patients, prescribing thryoid hormone at about one-third the level normally produced by the thyroid has significantly reduced pain and some other symptoms in a number of her Gulf War Illness patients. She says it remains unclear why the veterans' thyroid hormones simply don't stop functioning.

During questions following her presentation, it was noted that the high levels of GERD (Gastro-esophageal Reflux Disease) in Gulf War Illness patients lead to the common prescription of proton pump inhibitors (PPIs), which can then result in a Vitamin B deficiency in Gulf War Illness patients. The Vitamin B deficiency then must also be treated.. Examples of PPIs include Prilosec, Prevacid, Aciphex, and Protonix.

She noted that sexual dysfunction in males with fibromyalgia has been successfully treated with biweekly testosterone injections. She has prescribed narcotic pain medications and ritalin -- usually used primarily for attention deficit -- with success in Gulf War Illness. She notes that she always addresses the psychological aspects of having a chronic multi-symptom illness like Gulf War Illness.

Dr. Nass stresses that she must write everything down for Gulf War Illness patients (but not fibromylagia patients) due to the memory loss and cognitive issues, and she retains a copy as the treating physician.

Limited but Important Successes

One Gulf War Illness patient Dr. Nass described from her Mt. Desert Island Hospital practice was still working, would overdo it, then stay several days in bed, then repeat the cycle.

While he's not able to return to the workforce, several of his symptoms have improved, he is now able to work physically two to four hours per day, he now has a good self-image, and his family life has improved -- in short, true to Dr. Nass's goal as a physician, his quality of life has improved.

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