The Candida Expert

Archive for the ‘Family’ Category

Gut Microbes Benefit Pregnancy

More and more science points out how critical and essential the intestinal flora (microbiome) is for health in the body. We are “Super-organisms.” The current point of view is that we consist of host cells (human cells) and support cells (bacteria, parasites, viruses, yeasts, fungi, etc.). Over thousands of years, we have co-evolved into a cohesive and co-dependent unit, where the presence and health of all the parts (human and non-human alike) constitutes the health of the whole. This recent research article demonstrates how the intestinal flora, or gut microbiota, play a regulatory role in creating a healthy pregnancy.

The composition of microbes in the gut –http://candidaplan.com/blog/?p=336

 

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Candida, Fruit, and Dr. McCombs Candida Plan

When I developed the McCombs Plan about 20 years ago, I was fortunate enough NOT to be familiar with the anti-candida programs or books that were around. That meant that I could discover for myself what worked and what didn’t work for my patients. Three years later, I started getting questions from my patients about why this or why not that.

The Plan as it had been developed was very successful from the beginning and is still the original Plan as it is laid out today. One of the common questions that I received was why – http://candidaplan.com/blog/432/candida-fruit-and-dr-mccombs-candida-plan/

Can You Eat Too Many Healthy Fruits and Veggies?

Is it possible to overeat healthy foods? I guess that would depend on the context. The point of the article below is that it is possible to consume too many calories and gain weight, regardless of whether the food is healthy or not. Contrary to this type of logic however, when doing Dr. McCombs Candida Plan – http://candidaplan.com/, we find that eating plenty actually helps to increase weight loss. This is due to the fact that detoxifying the body takes lots of energy and you need to fuel this process. Many people comment that they “haven’t eaten this much in years and they’re still losing weight,” which brings us back to context. Here’s the short article anyway – http://www.sciencedaily.com/releases/2012/07/120724144423.htm

It may make you scratch your head, but in fact it is possible to overeat healthy foods, according to Loyola University Health System registered dietitian Brooke Schantz.

“While fruits are nutritious, too much of even a healthy food can lead to weight gain,” Schantz said. “The key is to remember to control the portion sizes of the foods you consume.”

Schantz reported that overeating healthy foods is easy to do, but the same rules apply to healthy food as junk food. Weight fluctuates based on a basic concept — energy in versus energy out. If your total caloric intake is higher than the energy you burn off in a day, you will gain weight. If it is lower, you will lose weight.

“I have had many patients tell me that they don’t know why they are not losing weight,” Schantz said. “Then they report that they eat fruit all day long. They are almost always shocked when I advise them to watch the quantity of food they eat even if it is healthy.”

Schantz said that one exception applies. Nonstarchy vegetables are difficult to overeat unless they are accompanied by unnecessary calories from sauces, cheeses and butter. This is due to the high water and fiber content of these vegetables coupled with the stretching capacity of the stomach. The vegetables she suggested limiting are those that are high in starch, such as peas, corn and potatoes. Foods that are labeled as fat-free or low-fat are another area of concern.

“People tend to give themselves the freedom to overeat ‘healthy’ foods,” Schantz said. “While the label might say that a food or beverage is low-fat or fat-free, watch the quantity you consume and refrain from eating an excessive amount. Foods that carry these health claims may be high in sugar and calories.”

Context, context, context!

More on Bacillus subtilis

Here’s a list of antibiotics that Bacillus subtilis is used with. It’s effects are against aerobic and non-aerobic bacteria. There is no differentiating between good and bad bacteria, as some people are lead to believe. That differentiation is something put out by the pharmaceuitical companies and MDs. The warrior model of destroying this and that as used in medicine, is antiquated and has been so many decades. The “holistic” approach used by many people is just a variation on the medical warriot model, whereby medications are substituted with something else to bring about destruction. The approach to destroying anything in the body, fails to consider that in doing so, we are destroying ourselves in the process. It’s okay if you want to support those groups, it’s just that the information is misleading.

All bacteria in a balanced system benefit the system. Create the balance and you also create the safeguards against anything that shouldn’t be there. Destroy that balance and you’ll see health start to slip away as the ecosystem starts to collapse into chaos.

As you’ll see below, Bacillus subtilis has been associated with food poisoning, disease conditions, and has been tested for biological applications as a biolgical agent.

Bacillus subtilis is the basis for many antibiotics due to its strong antibacterial function. This antibacterial function will create imbalance within the body by destroying bacteria. It also has a strong antifungal effect and is the basis for antifungal medications, but these, as we know, create other imbalances.

You’ll see below this list of B. subtilis-based antibiotics some more information on B. subtilis. It’s not a risk-free choice. Whatever your decision, make it an informed choice.


B. subtilis
does produce an extracellular toxin known as subtilisin. Although subtilisin has very low toxigenic properties (Gill, 1982), this proteinaceous compound is capable of causing allergic reactions in individuals who are repeatedly exposed to it (Edberg, 1991). Sensitization of workers to subtilisin may be a problem in fermentation facilities where exposure to high concentration of this compound may occur. Exposure limits to subtilisin are regulated by Occupational Safety and Health Administration (OSHA) (29 CFR 1900, et seq.)Biotechnology Program Under Toxic Substances Control Act (TSCA)

Bacillus subtilis Final Risk Assessment

III. HAZARD ASSESSMENT

A. Human Health Hazards

1. Colonization

B. subtilis is widely distributed throughout the environment, particularly in soil, air, and decomposing plant residue. It has shown a capacity to grow over a wide range of temperatures including that of the human body (Claus and Berkeley, 1986). However, B. subtilis does not appear to have any specialized attachment mechanisms typically found in organisms capable of colonizing humans (Edberg, 1991). Given its ubiquity in nature and the environmental conditions under which it is capable of surviving, B. subtilis could be expected to temporarily inhabit the skin and gastrointestinal tract of humans, but it is doubtful that this organism would colonize other sites in the human body (Edberg, 1991).

2. Gene Transfer

The transfer of gene sequences between strains of B. subtilis has been demonstrated when the strains were grown together in soil (Graham and Istock, 1979). In addition, Klier et al. (1983) demonstrated the ability of B. subtilis and B. thuringiensis to exchange high frequency transfer plasmids. Other studies have shown that B. subtilis has the ability to express and secrete toxins or components of the toxins that were acquired from other microorganisms through such transfers of genetic material. B. subtilis expressed subunits of toxins from Bordatella pertussis (Saris et al., 1990a, 1990b), as well as subunits of diphtheria toxin (Hemila et al., 1989) and pneumolysin A pneumococcal toxin (Taira et al., 1989). Although B. subtilis does not appear to possess indigenous virulence factor genes, it is theoretically possible that it may acquire such genes from other bacteria, particularly from closely related bacteria within the genus.

3. Toxin Production

A review of the literature by Edberg (1991) failed to reveal the production of toxins by B. subtilis. Although it has been associated with outbreaks of food poisoning (Gilbert et al., 1981 and Kramer et al., 1982 as cited by Logan, 1988), the exact nature of its involvement has not been established. B. subtilis, like other closely related species in the genus, B. licheniformis, B. pumulis, and B. megaterium, have been shown to be capable of producing lecithinase, an enzyme which disrupts membranes of mammalian cells. However, there has not been any correlation between lecithinase production and human disease in B. subtilis.

4. Measure of the Degree of Virulence

B. subtilis appears to have a low degree of virulence to humans. It does not produce significant quantities of extracellular enzymes or possess other virulence factors that would predispose it to cause infection (Edberg, 1991). There are a number of reports where B. subtilis has been isolated from human infections. Earlier literature contains references to infections caused by B. subtilis. However, as previously stated,the term B. subtilis was synonymous for any aerobic sporeforming bacilli, and quite possibly, many of these infections were associated with B. cereus. In a recent British review article, Logan (1988) cites more recent cases of B. subtilis infections in which identification of the bacterium appeared reliable. Infections include a case of endocarditis in a drug abuse patient; fatal pneumonia and bacteremia in three leukemic patients; septicemia in a patient with breast cancer; and infection of a necrotic axillary tumor in another breast cancer patient. Isolation of B. subtilis was also made from surgical wound-drainage sites, from a subphrenic abscess from a breast prosthesis, and from two ventriculo-atrial shunt infections (as cited by Logan, 1988).

Reviews of Bacillus infections from several major hospitals suggest that B. subtilis is an organism with low virulence. Idhe and Armstrong (1973) reported that Bacillus infections were encountered only twelve times over a 6-1/2 year period. Species identification of these Bacillus infections was not made. In another hospital study over a 6-yr. period, only two of the 24 cases of bacteremia caused by Bacillus (of a total of 1,038 cases) were due to B. subtilis (as cited by Edberg, 1991). Many of these patients were immunocompromised or had long term indwelling foreign bodies such as a Hickman catheter.

B. subtilis has also been implicated in several cases of food poisoning (Gilbert et al., 1981 and Kramer et al., 1982 as cited by Logan, 1988).

As previously mentioned, B. subtilis produces a number of enzymes, including subtilisin, for use in laundry detergent products. There have been a number of cases of allergic or hypersensitivity reactions, including dermatitis and respiratory distress after the use of these laundry products (Norris et al., 1981).

5. Conclusions

B. subtilis is not a human pathogen, nor is it toxigenic like some other members of the genus. The virulence characteristics of the microorganism are low. According to Edberg (1991) either the number of microorganisms challenging the individual must be very high or the immune status of the individual very low in order for infection with B. subtilis to occur.

B. Environmental Hazards

3. Hazards to Other Microorganisms

B. subtilis has been shown to produce a wide variety of antibacterial and antifungal compounds (Katz and Demain, 1977; Korzybski et al., 1978). It produces novel antibiotics such as difficidin and oxydifficidin that have activity against a wide spectrum of aerobic and anaerobic bacteria (Zimmerman et al., 1987) as well as more common antibiotics such as bacitracin, bacillin, and bacillomycin B (Parry et al., 1983). The use of B. subtilis as a biocontrol agent of fungal plant pathogens is being investigated because of the effects of antifungal compounds on Monilinia fructicola (McKeen et al., 1986), Aspergillus flavus and A. parasiticus (Kimura and Hirano, 1988), and Rhizoctonia (Loeffler et al., 1986).

Although B. subtilis produces a variety of antibiotic compounds in culture media, the importance of antibiotic production in the environment is unknown (Alexander, 1977).

B. subtilisis not a frank human pathogen, but has on several occasions been isolated from human infections. Infections attributed to B. subtilis include bacteremia, endocarditis, pneumonia, and septicemia. However, these infections were found in patients in compromised immune states. There must be immunosuppression of the host followed by inoculation in high numbers before infection with B. subtilis canoccur. There also have been several reported cases of food poisoning attributed to large numbers of B. subtilis contaminated food. B. subtilis does not produce significant quantities of extracellular enzymes or other factors that would predispose it to cause infection. Unlike several other species in the genus, B. subtilis is not consider toxigenic. B. subtilis does produce the extracellular enzyme subtilisin that has been reported to cause allergic or hypersensitivity reactions in individuals repeatedly exposed to it.

In conclusion, the use of B. subtilis in fermentation facilities for the production of enzymes or specialty chemicals has low risk. Although not completely innocuous, the industrial use of B. subtilis presents low risk of adverse effects to human health or the environment.

Candida and Inflammation in the Athlete

There’s a certain sense of loss in realizing that the best of each us is being eroded away, or lies wasting away, as hidden potential within the cells of our bodies. The gradual erosion of potential is often found in cases where there is an underlying imbalance in the body that creates chronic inflammation and the inability to absorb nutrients for normal function and repair. When chronic inflammation and nutritional imbalances are combined, degeneration of tissues advances at a far faster rate than it normally would. I have found this to repeatedly be the case in people who have been exposed to antibiotics and as a result suffer from the system-wide imbalances that are created from their usage.

In many people, this may look like a normal aging process. In the athlete, it usually is associated with excessive wear and tear on joints and failure of the muscles and the body to respond and perform as they once did. Athletic careers and pursuits can end prematurely, and the hopes and dreams of what could have been, remain forever as hopes and dreams.

Under these types of constant inflammatory conditions, the serious athlete or weekend warrior who pushes the limits of his body’s ability in pursuit of personal records and goals, will end up driving the inflammatory machinery that will eventually rob them of their potential for excellence. Exercise produces pro-inflammatory immune system responses and oxidative stress that play a role in repair and remodeling of muscle tissues. Intense exercise carries this response further, and over the long-run can produce immune system suppression and autoimmune-type responses. The following excerpt from Journal of the International Society of Sports Nutrition helps to explain a little more on this topic:

“DOMS (Delayed Onset Muscle Soreness) typically occurs after unaccustomed or high-intensity exercise, most commonly anaerobic. Soreness is usually noted at 24 hours post-exercise and can last as long as 5 to 7 days post-exercise. Although several models of DOMS have been suggested, researchers generally agree that muscle damage initiates a cascade of events leading to DOMS. The muscle damage and oxidative stress response following anaerobic exercise have been deemed necessary to promote skeletal muscle remodeling to gain benefit from the exercise, but enhanced recovery may be advantageous for more rapidly promoting an anabolic environment.

Exercise elicits mechanical and hormonal reactions from the body. The resulting muscle damage from these reactions elicits inflammatory and oxidative responses that may exacerbate muscle injury and prolong the time to regeneration. The hormonal contributor to muscle damage during exercise is derived through basic neuroendocrine responses to exercise demands. High intensity exercise triggers the activation of the hypothalamic-pituitary-adrenal (HPA) axis leading to the release of cortisol and other catabolic hormones. These hormones function to meet increased energy needs by recruiting substrates for gluconeogenesis via the breakdown of lipids and proteins. Through their catabolic nature, these hormones also indirectly lead to muscle cell damage.

Inflammation following anaerobic exercise functions to clear debris in preparation for muscle regeneration. The magnitude of the increase in inflammatory cytokines (such as IL-6) varies proportionately to the intensity and duration of the exercise. However, a prolonged inflammatory response can increase muscle damage and delay recovery by exacerbating oxidative stress and increasing production of reactive oxygen species (ROS). The increased ROS production seen with high intensity training can lead to oxidative stress such as lipid peroxidation (1).”

While intense exercise is usually associated with greater degrees of DOMS, inflammation, immune system suppression, and oxidative stress, mild-to-moderate exercise is typically associated with boosting the immune system and supporting greater health in the body. If however, there is an underlying state of chronic inflammation due to an infectious agent, then even mild-to-moderate exercise may result in many of the symptoms commonly found with intense exercise, as fuel is added to an already burning fire. Over a period of months and years, this can lead to shortened productivity and limited excellence in today’s athletes. In one sense, it is the equivalent of driving with the brakes on.

The most frequent infectious agent that fits this model is Candida albicans. C. albicans commonly exists as a yeast organism in the human body and is considered a normal part of healthy tissue flora. Due primarily to the effect of antibiotics, this yeast organism transforms into a pathogenic, problematic fungal form that has been associated with a multitude of conditions and diseases in the body.

Since the introduction of antibiotics in the late 1940s following WWII, there has been a remarkable increase in the research of candida-related conditions and diseases (2) with over 24,000 research articles being published since 1949. On average, that is enough for one research article per day in the last 51 years, with enough left over to fill another 6 years of daily research publications. With a one-to-one association between antibiotic use and the development of systemic fungal infections, implications exist for society as whole being afflicted with a post-antibiotic syndrome of fungal candida and immune system dysregulation.

In systemic fungal candida infections, ongoing pro-inflammatory reactions from both systemic and localized immune system responses combine with the virulence mechanisms of fungal candida to create a constant state of oxidative stress, pro-inflammatory hormonal imbalances, chronic tissue inflammation, and tissue degeneration. This type of smoldering, nonresolving inflammation becomes a constant component of the microenvironment within and is implicated in many diseases and conditions.

Joint restriction, pain, swelling and inflammation, weight gain, fatigue, blood sugar imbalances, nutrient deficiencies, slower post-exercise recovery periods and other symptoms are commonly associated with this underlying condition in today’s athletes and others.

In response to patients who had these problems, I developed a well laid out plan to counteract this post-antibiotic syndrome and subsequent systemic imbalances. Athletes who have followed the McCombs Plan have seen a decrease in the degree and amount of inflammation experienced during exercise, as well as pre- and post-exercise inflammatory responses with faster recovery times. Many of the conditions associated with fungal candida that impact human performance have been diminished and resolved. Marathon runners and Tri-atheletes found themselves competing without “hitting the wall.” Wrestlers, weight lifters and others found that their joint pains and restrictions decreased and disappeared. Increased energy and vitality that is sustained throughout the day has been a common response.

If we are to achieve the best that we can be, we must rid ourselves of these types of physiological limitations, or settle for less and be happy with what could have been.

1. The effects of theaflavin-enriched black tea extract on muscle soreness, oxidative stress, inflammation, and endocrine responses to acute anaerobic interval training: a randomized, double-blind, crossover study

Shawn M Arent, Meghan Senso, Devon L Golem and Kenneth H McKeever

Journal of the International Society of Sports Nutrition 2010, 7:11doi:10.1186/1550-2783-7-11

http://www.jissn.com/content/7/1/11

2. SciTrends of Biomedical Sciences

http://rzhetskylab.cu-genome.org/cgi-bin/trendshow?MeSHID=1191

Adventures of a Preterm Daddy: Part IV – The NICU at Cedars-Sinai

Immediately following the birth of our 25 week-old twins, I was whisked away to the 4th floor of Cedars, while my wife was wheeled to a 3rd floor recovery room following her c-section. In a somewhat numbed state, I entered the Neonatal Intensive Care Unit.

Like Alice, or perhaps more appropriately Alex in Wonderland, I had fallen down a rabbit hole into a very strange world of giraffes, jets, and isolettes. Cedars’ NICU has a capacity for 45 babies spread out over 6 bays and a couple of extra rooms for isolation purposes. Although its NICU is continually unranked in national polls, it is nonetheless an impressive display of the best that technology has to offer. It is equipped with the latest in climate controlled incubators called Giraffes and their smaller cousins, the isolettes. Surrounding each Giraffe, you’ll find monitors, ventilators, screens, and an assortment of tubes and wires leading to each of its inhabitants. Bays 1 through 4 are for more intensive care, while bays 5 and 6 are for those babies preparing to graduate and begin their lives amongst the rest of us. As fate would have it, we wound up in Bay 4, nicknamed “The crazy bay.” Two weeks prior to our arrival, business was so slow that two of the NICU bays had been shut down. The weekend of our arrival must have been High Holy days for preemies and other assorted special needs babies as the house was full. Amidst the flurry of activity and a chorus of various alarm bells and flashing lights, I was given forms to read and sign and instructions on what to do and expect. Through a haze of adrenaline, worry, and concern, I was introduced to Joan, the nurse charged with watching over our little girl. Joan’s presence was calming and reassuring, something gained from 28 years as a NICU nurse.

Cedars-Sinai’s NICU has a battalion of some 130 nurses that rotate on 12 hour shifts. As our midwife had pointed out to us, NICU nurses don’t work in the NICU just because they need a job. These are very special individuals filling a very special need. Some of the nurses, whom we liked to call our Super-nurses, filled that need extremely well. Our super-nurses were Joan, Gilda, Debra, Dalys, Vanji, Tysson, Pam, Kathy, Wendy, Yvonne, Anne, Monica, Macy, Lorna, Adrienne, Judy, Meera, and others. The nurses are the workhorses of patient care in every hospital and no less so at Cedars. Styles vary tremendously and while some embrace the parents in their rightful role as the primary caregivers, others treat them as the enemies. Many of the nurses that I spoke with talked of having dreams about the alarms going off. In this world, babies come and go, and live and die frequently. According to Cedars-Sinai, 27% of the NICU babies don’t make it. Nationwide, the average is much higher at 45% (http://www.csmc.edu/8921.html). For caring hearts, being a NICU nurse can be a very stressful way of life.

My wife’s entrance into the NICU wasn’t until the next day. Following surgery, mothers are first required to have a bowel movement prior to leaving their rooms. By the next day, she had two of them (sorry honey, but its part of the story). This became the hot topic amongst the maternity floor nurses. Nurse after nurse came into her room to inquire how this miracle of God had took place, as most mothers take several days to a week to accomplish this task. Like most medical centers, Cedars has very little knowledge about functional nutrition. Functional nutrients are proven to be more readily absorbed, transported, and utilized than most synthetic and inorganic nutrients. Cedars-Sinai relies heavily on synthetic nutrients to address the real-life needs of their patients. In the case of post-partum mothers, they use ferrous sulfate as an iron supplement to compensate for any blood loss during birth. Ferrous sulfate is a form of iron that causes constipation, bloating, and other symptoms. To compensate for the constipation, patients are given laxatives that work by irritating the bowel wall. Neither product works very well, leaving the mothers feeling miserable and longing to see their newborn babies. We used a natural food and herb-based product called Floradix to address her iron needs and trace minerals to assist with moving the bowels without causing irritation. In less than 24 hours, a mother and her babies were together once again.

To its credit, Cedars-Sinai has a unique philosophy toward the parent’s involvement in the NICU. Their philosophy states that the parent is the most essential and constant member of the infant’s health care team and promotes parents as active and equal participants in order to instill confidence and empower them in their role as the primary caregivers. Well, at least that’s what it says on the plaque on the wall outside the NICU. Inside the doors of the NICU however, it’s doctor’s egos, nurse’s preferences, hospital policies, standards of care, and defensive medicine that take precedence over the care, comfort, and individual needs of each child. If there’s room left over, then the parents might have a voice. This “voice” was something that my wife likened to hostage negotiations. Although they may be willing to listen to what you have to say, they proceed with their own agenda.

As the week began to creep along, my wife was discharged from the hospital and we began our daily treks back and forth between home and the hospital. Everyone told us that our lives would change once we had our babies, but this wasn’t the change we had been expecting. Both doctors and nurses told us to plan on bringing our babies home around their original delivery date, August 16th, some 100+ days later. With cell phones permanently on in case the hospital needed to call us for an emergency, our previous lives faded away and we waited nervously for what was yet to come.

The Adventures of a Preterm Daddy: Part III

As the second day of our stay at Cedars rolled around, my wife’s symptoms had slowly subsided. Our substitute OB doctor, Dr. M, made another appearance early on and brought along another colleague, Dr. X, whom he introduced as a specialist in ultrasounds and neonatal care. Yet another ultrasound later, our specialist had determined that the cervix had once again shortened overnight. At this stage, Dr. M recommended a round of steroids. Steroids are typically given during pregnancy to help a babies lungs develop at an accelerated pace when there is a risk of a premature birth. A baby’s lungs aren’t designed to begin the work of breathing until 36-40 weeks, depending on the new math versus the old math approach to what is considered a full term baby. Steroids can speed up the maturation of the lungs and give a preterm baby a better chance of survival with fewer complications. When I asked about the effect of steroids suppressing the immune system, Dr. M denied it, while Dr. X stated that it was true. We had observed that Dr. M was so quick to deny that medications ever had any side-effects, that he was now denying the opinion of his proclaimed specialist and colleague. They went back and forth briefly with Dr. X citing several studies and winning out. When I asked which steroid would be used, Dr M mentioned that it would be dexamethasone or betamethasone. When I asked about studies where dexamethasone had been implicated in brain damage and developmental delays, Dr. M once again stated that it never happens, while Dr. X stated that it was a possibility. Dr. X pointed out however that previous studies had been done with multiple doses of dexamethasone and he would only advocate one dose, which he believed to be much safer. After listening to the facts and the fiction, we decided to hold off on the steroids until our regular doctors were back and I could do a little more research. A note to Dr. M: Don’t challenge your proclaimed expert. Either way, you lose. You either demonstrate that they’re not an expert, or you demonstrate your ignorance by challenging and losing to the person that you’ve just introduced as an expert. Both results don’t instill any confidence in your patients.

By Tuesday, both of my wife’s doctors were back in town and made their appearances at Cedars. Her sonogram doctor, Dr. S, appeared and told us that he expected to be sending us home after the ultrasound. He mentioned that it was better not to stay at the hospital because they tend to look for things to treat. This resonated with the words of a nurse whom I had spoken to earlier that day. She had been at the hospital for its 33 years of existence and stated that she avoids doctors at all costs and would rather do anything than end up at the hospital. Such words coming from a nurse seemed to speak of the mismanagement that she had seen over the years. The message that I took away from both conversations was, “time to go home.” Unfortunately, the ultrasound didn’t bring us the good news that would signal a rapid retreat. Instead, the cervix length had shortened instead of stabilizing. What had been 3.5cm on Friday was now 1.6cm. This meant that it was time for the steroids, as we didn’t want to run the risk of preterm babies with the added burden of more lung complications. We opted for the betamethasone which has been demonstrated to be safer. Dr. S told us to rest and hold tight and he’d be back for a follow-up ultrasound on Sunday and hopefully send us home.

The rest of the week was very much like the beginning of any roller-coaster ride, where you go through a few minor ups and downs until you reach that gradual climb that leads to a final jaw-dropping descent. My wife’s cramping and bleeding episodes would come and go, and for the most part seemed to be on their way out. It was starting to feel more like a car trip through a hilly countryside than a roller-coaster ride at Six Flags. We ventured out a little bit more in our take-out habits and discovered Jerry’s Deli around the corner from Cedars.

By Saturday, we were looking forward to Dr. S’s return on Sunday and an ultrasound result that gave us our return ticket home. The baby’s heart monitors strapped to my wife’s belly gave us the reassuring sounds of two hearts peacefully enjoying their time in the womb. As Saturday night rolled around, the winds changed and we found ourselves once again riding the ups and downs of cramping and spotting. Although I managed a couple of hours of sleep, half hoping that these symptoms would fade away as the others before them had, my wife was unable to sleep. The cramping intensified and mild muscle relaxants and pain killers were having no effect. By morning, with the symptoms increasing, we anxiously awaited Dr. S’s return. He was called in earlier than planned and the ultrasound revealed that the cervix was now .5cm, and my wife was dilated 3.5cm. Now 3.5cm is not very large for a full term baby, but for a 25 week old baby, it was an open barn door. Dr. S made the call and preparations were under way for a C-Section delivery. The tension became magnified as a flurry of nurses went into action. Within 45 minutes, we found ourselves in the operating room.

Our initial hopes for an intimate home water birth had now been officially replaced by a 20-person production in a hospital operating room complete with surgeons, nurses, anesthesiologists, and assorted neonatal assistants. Sitting next to my wife’s head, I watched the entire surgery via an overhead mirror above and behind us on the ceiling. It was only two weeks earlier that I had been watching the same surgical procedure on the Discovery channel, unaware of what was to come. On Sunday, May 3rd, my wife delivered a baby boy, Ethan Kai at 1 pound, 10 ounces and a baby girl, Ana Sophia at 1 pound, 9 ounces. With these twin miracles, our ticket was punched for admission to the Cedar-Sinai’s Neonatal Intensive Care Unit, hereafter know as the NICU.

The Adventures of a Preterm Daddy: Part II

There’s an old spiritual saying that goes something like, “God will never give you more than you can handle,” to which Mother Teresa was quoted responding, “I just wish that he didn’t trust me so much.” These statements will soon become a core part of our life during this pregnancy.  

As the last week of April approached, all of our plans for a long pregnancy seemed to be in place. I left town for a neurology seminar and my wife attended a birthday party for another set of twins while I was gone. An April heat wave left her feeling faint, dehydrated, and thirsty at the party. After cooling off a bit she left the party early and went home to rest and relax. By the time that I returned home that Sunday night she was experiencing some cramping which gradually increased over the next 2 days. We made a quick trip to her OB doctor to check things out. Yet another ultrasound (http://www.huffingtonpost.com/dr-jeffrey-mccombs/the-adventures-of-a-prete_b_215874.html) revealed the possibility of a slight detachment of the placental sac that keeps the babies safe and nourished in the womb during pregnancy. She recommended rest and no exercise and informed us that she’d be out of town that coming weekend but there would be another doctor covering for her while she’s gone, if needed. She also recommended going to the Sonogram Doctor for a more detailed ultrasound if things didn’t improve, and noted that he would also be out of town with another doctor covering for him. That weekend also happened to be the weekend that our midwife was going to be out of town. Somewhere in the back of my mind, I remember an old marine saying about rats leaving a sinking ship, so as the last weekend of April approached, we had the setting for a perfect storm. 

Friday morning came with more cramping and spotting. We quickly made our way to the sonogram doctor’s office where we were greeted by an admittedly neurotic doctor. As can be expected, neurotic doctors and worried expectant mothers don’t make a good combination. Another more detailed ultrasound revealed the same results of a possible slight placenta detachment. The sonogram also indicated that the length of the cervix was long. The length of the cervix is one of the deciding factors as to when the delivery process will commence. A long cervix indicates that there is a ways to go before it’s time to deliver, and in our case this was a very good sign. Fetal heart monitors showed that the twins were doing fine, seemingly oblivious to the events shaping the world around them. We were given a reprieve and sent home with instructions for complete bed rest and if the symptoms didn’t stop, we were to go to the hospital. 

That Friday night, the symptoms continued to worsen and by Saturday morning we had called the substitute OB doctor (Dr. M) and we were on our way to Cedars-Sinai Medical Center in Los Angeles. Cedars-Sinai was founded at its current location in 1976. With some 10,000 employees and over 75,000+ patients being served each year, Cedars ranks as one of the top hospitals in the country. Its proximity to Beverly Hills is underscored by the names of celebrities found adorning the many rooms, centers, and buildings, as well as the streets surrounding the hospital. We were quickly ushered to one of the Labor-Delivery rooms on the 3rd floor, where yet two more ultrasounds and some IV fluids later, my wife was stabilized. The ultrasounds revealed that the cervix had shortened overnight, so we were wheeled down the hall and admitted to the Maternal-Fetal Care Unit. The nurses and doctors told us that our stay there would last until the cervix had stabilized and the other symptoms had diminished or disappeared. As a side note, one of the nurses mentioned that the previous occupant of the room had been there 7 weeks under similar circumstances, but had gone home stabilized and pregnant. We kept our hopes high and our fingers crossed, as I became familiar with the art of shallow breathing 

Over the course of the day, we were subjected to an ongoing parade of doctors, interns, and residents who were pushing for my wife to take the Rhogam vaccine. Rhogam is a human blood-derived vaccine that is typically given to Rh- mothers (my wife) who give birth to Rh+ babies. Since I’m Rh+, this was a possibility, but not necessarily likely. When Rh incompatibility occurs, the mother could become sensitized and in subsequent pregnancies, the baby could develop a serious blood disease. There are approximately 400,000 pregnancies in Rh- women every year. Of these, some 10,000 deaths in babies used to occur due to Rh incompatibility before the vaccine was developed. With the vaccine, these deaths have been averted by giving the vaccine to babies who are Rh incompatible within 72 hours after birth. This allows time for simple blood tests to be performed to determine if there is any incompatibility in the first place. When use of the vaccine is not necessary, it avoids other risks, such as blood-borne diseases, that are minimal but inherent in the vaccine. It has now become a practice in the US to give the vaccine at 28 weeks of pregnancy and then again at birth. The vaccine at 28 weeks is more of a prophylactic choice by physicians, which translates to preventative and usually unnecessary. Through some online research, I was able to find a non-invasive test to determine Rh compatibility that has been done for years on pregnant women in England, but not here in the US. After some email correspondence with the National Blood Bank of England, I was directed to a lab here in the US that has recently started doing this testing – www.lenetix.com. Lenetix Labs also has some other unique genetic tests that can avoid the use of routine invasive diagnostic tests like amniocentesis and CVS sampling that are frequently done during pregnancy and are known to cause miscarriages.  

With the parade over and some carry out food from my new favorite restaurant, Barefoot, to sustain us, we settled into our new Beverly Hills digs. Exhausted from the day’s events, my wife managed to get some sleep and I crawled into a hospital cot which folded up around me like a human taco. And as dreams of going home danced in our heads,…

The Adventures of a Preterm Daddy: Part I

As we sat with my family at Thanksgiving last year, my wife announced that we were going try to get pregnant. This was happy news for my mother who has been waiting for her 50 year old son to contribute to the family line like my two sisters and brother have done previously some 20-30 years earlier. Little did we know that as we sat there, she was already 1-2 weeks along in her pregnancy. Three store-bought, do-it-yourself pregnancy tests later in the first half of December, and we find out that she’s pregnant. This celebrated news was followed up a couple of weeks later with new information that we were having twins, courtesy of a diagnostic ultrasound scan due to some concerns of her doctor at that time. 

A diagnostic ultrasound in our family is not a choice taken lightly. I’m a 3rd generation Doctor of Chiropractic, never vaccinated as a child, grew up on vitamins with each meal and weekly if not daily adjustments. Ultrasound is a type of radiation that can be used therapeutically or diagnostically. My educational and clinical experience with ultrasound has been as a therapy. Ultrasound produces sound waves (a type of radiation) that pass through the tissues. The tissue’s resistance to and absorption of these waves causes heating of the tissues and some other metabolic effects that can be desirable in promoting healing. Therapeutic ultrasound is not recommended during pregnancy, over tissues such as the eyes, heart, spinal column, growing bones, testes, epiphyseal plates, carotid sinuses, cervical stellate ganglion, and vagus nerve. Although you may not be familiar with these anatomical tissues, they are all found in developing babies and everyone else. Given my clinical experience, I naturally questioned its use as a diagnostic tool. This philosophy of questioning comes from a statement found in the Hippocratic Oath that I took upon graduation from school that states, “First do no harm.” It’s the responsibility of a doctor to always assess the methods being used to determine that there is no harm being done to the patient as a result of medications or procedures.  

Diagnostic ultrasound uses a similar frequency range, much like sonar on a submarine, to produce images. It is used to screen for abnormalities of the developing fetus. For more information on the benefits and risks of ultrasound, visit – http://www.ob-ultrasound.net/. Like therapeutic ultrasound, the resistance to and absorption of the sound waves, plays a role in the creation of the images. To me, this indicates some degree of heating of the tissues in a developing baby. Is this enough to create some type of damage to the baby? Currently, the risks are not considered to be relevant but the US National Institute of Health recommends against its use in routine scanning of the fetus and developing embryo and ‘although its use doesn’t appear to be associated with any known hazards, investigators should continue to evaluate risks.’ Hmmm.  

Additionally, some research points to correlations between diagnostic ultrasound and the Autism/Aspergers spectrum of developmental disorders. The bottom line on ultrasound is that it should be used based on a ‘benefit vs. risk’ assessment, a term that I’ll talk more about later. Most doctors and sonogram technicians oppose its use by moms who want to have periodic pictures to show everyone. To me, its use is a big question mark that may or may not have complications years later. 

Okay, well we had one ultrasound that seemed to be necessary, but we decide that we probably won’t elect to have any others unless absolutely necessary. There is a saying that goes something like this, “Man plans, God laughs.” During the course of our journey through this pregnancy, we will seem to keep God amused.

 

My wife’s 1st obstetrics doctor recommended a list of questionable procedures (amniocentesis, CVS, Rhogam vaccine) and handed us a couple of boxes of prenatal vitamins. Medical doctors get about 5 hours of training in nutrition during medical school. This was very apparent by the box of vitamins that we were handed. The prenatal vitamin’s list of nutrients and additional ingredients consisting of synthetic dyes, synthetic nutrients, chemical fillers, and toxic fats were quickly donated to the trash can in his waiting room on our way out of his office. It was time to ask around for references and interview a few OB doctors.  

Obstetrics (OB) is surgical specialty dealing with the care of women and their children during pregnancy. Although our intention is to have a natural home birth attended by a midwife, we will still need an OB doctor and a hospital as a back-up. This is common practice in California for parents who choose homebirths. Unfortunately, twin homebirths in California is against the law and a midwife who attends one can end up in jail. This was interesting since other states allow this practice which dates back to the beginning of man. Concerns about the possible complications associated with mothers carrying multiple babies however, means that this is left to the hospitals and obstetrics doctors in California. I’m not sure if this is a policy based on previous experience or a philosophy of better safe than sorry. 

We consider traveling out of state to Tennessee where the midwife of midwives, Ina May Gaskin, holds court when she’s not teaching midwives and doctors across the country. They inform us that they like to have couples come 6 weeks before the due date and if our babies don’t make it to 34 weeks gestation and decide to come out early, we would end up going to a hospital in Tennessee. Since twins seem to have a habit of coming early, this option doesn’t sound too inviting. Given the logistics and hassles of travel and the possibility of an early delivery, we opt for a natural delivery at an LA hospital attended by an OB doctor, a midwife, and 2 or 3 other people. It’s not home, but we want to make it as intimate as possible. I thought I heard God laughing? 

We selected our OB doctor, Jessica Schneider, MD and our midwife was Elizabeth Bachner. Dr. Schneider wants an ultrasound every month once we hit 20 weeks, but we decide on one detailed anatomical ultrasound at 20 weeks and then one just before birth to determine positioning of the babies. This approach was also recommended by an assistant to Ina May Gaskins and it sounds good to us. The ultrasound comes back normal and we begin to make all of the necessary arrangements. 

We have a doctor and a midwife, and my wife has become a walking encyclopedia on pregnancy, twins, and birth. She’s exercising every day, eating well, taking her vitamins, and spending quiet time with herself and the babies. Her due date is mid-August and so in late April we settle into what we expect to be a nice long pregnancy…and God giggles.

Antibiotics and Candida

I often get asked about antibiotics and systemic candida. Antibiotics are definitely the best way to create systemic fungal infections and lifelong intestinal flora imbalances in the body, as well as an unlimited number of other problems. Although the medical profession doesn’t even acknowledge this, scientists and researchers state this obvious fact over and over again.

 

Antibiotics kill good and bad bacteria. Killing these bacteria causes a massive hemorrhaging of the internal components of all bacteria. This is particularly problematic because our bodies respond to these internal components by producing acute and eventually chronic long-term inflammation that can affect all tissues and cells throughout the body. This massive inflammatory cascade can breakdown tissues and interfere with cellular function. One of these internal substances, Lipopolysaccaharide (LPS) is common in gram-negative bacteria and is a substance that most researchers use in laboratory testing due to the overwhelming reliable strong immune response that it causes.

 

Some of these intracellular bacterial components, like Peptidoglycans (PGN) also act directly on the cellular membrane of the yeast Candida Albicans causing it to transform into its pathogenic fungal form. This is in addition to antibiotics eliminating millions of beneficial bacteria that help to keep the Candida Albicans yeast within ratios that benefit the overall health of the intestinal tract and therefore the rest of the body.

 

Antibiotics can also suppress the immune system response. This primarily affects the macrophages which go around cleaning up pathogenic organisms that would otherwise harm us. By suppressing macrophages, antibiotics can reduce the pro-inflammatory cascade which macrophages play a big role in initiating. While this may seem beneficial, it actually aids in the spread of the pathogenic fungal form of C. Albicans. First, with antibiotic-induced suppression of the immune system, the fungal candida now can spread more rapidly without macrophages to inhibit it. Secondly, by suppressing the macrophages and the inflammatory response, the liver does not release positive acute-phase proteins which are necessary for preventing the spread of pathogenic organisms throughout the body. Three of these acute-phase proteins (Ferritin, Ceruloplasmin, & Haptoglobin) function by binding iron and making it unavailable to pathogenic fungal candida. Without these 3 proteins, fungal candida can now attach itself to our blood cells and feed on an unlimited source of iron in the form of hemoglobin to help it spread throughout the body. This also goes for other pathogenic microbes that will be spreading as a result of the effect of antibiotics in the body. 

 

By killing off the beneficial bacteria that inhabit and help to regulate the normal healthy intestinal flora, we lose the beneficial enzymes and acids that these organisms produce. This causes the pH of the intestinal tract to become more alkaline. An alkaline intestinal pH also promotes the conversion of C. Albicans into its pathogenic fungal form. When the intestinal pH is acidic, candida remains in its normal yeast form. 

 

The above examples are just some of the ways that antibiotics promote and maintain the ongoing growth and spread of fungal candida throughout the body.

 

Killing off the beneficial bacteria also leads to decreased absorption of nutrients that our cells and tissues need to function in a healthy state. Certain strains of acidophilus help to synthesize B vitamins. A deficiency of these alone would create innumerable problems within the body.

 

There are an estimated 100 trillion micro-organisms within the intestinal tract. For many years, researchers were able to identify some 300-500 species of micro-organisms that were responsible for making up the 100 trillion cells. Recent advances in the use of technology have now identified close to 6,000 species in the large intestine alone. Most of what these organisms do and how they interact is unknown. As long as there is a sufficient amount of beneficial bacteria to keep everything in balance, then we have a better chance at staying healthy. Research now tells us that some these species are permanently eliminated from the body by the use of antibiotics – http://www.sciencedaily.com/releases/2008/11/081118121941.htm.

 

Apart from the use of antibiotics being responsible for thousands of deaths and over 144,000 visits to emergency rooms each year in the U.S. alone, the incidence of antibiotic resistance continues to escalate worldwide to the point that we are rapidly approaching a new era where antibiotics won’t be useful for most people – http://www.sciencedaily.com/releases/2009/01/090128183925.htm.

As this continues to happen, we will see an increase in the use of natural methods that help restore balance without creating additional problems. This is the goal of the McCombs Plan for Health, Vitality, and Transformation – http://mccombsplan.com/.

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