The Candida Expert

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75+ Candida Studies: The Candida Fact Sheet

Introduction

Many of the doctors who have consulted with me have asked for more information and references to better educate themselves, their patients and fellow doctors. To assist them, I gathered together a few of the references that we are including in our online Candida Library. In this article, you’ll find over 75 research references that provide information on how Candida goes from a harmless normal constituent of the gastrointestinal tract to a pathogenic systemic problem that can affect anyone and everyone.  I’m providing this information here for you to become better educated about Candida, like the many doctors with whom I’ve consulted. Pass it along to your family, friends, and doctors, if you feel that it can also assist them in learning and understanding more about a problem that affects virtually everyone. Please click here to download this Candida Fact Sheet as a PDF so you can email or print it out.

Candida Facts

The human digestive tract is said to contain some 100 trillion cells compared to about only 10 trillion human cells in the body. This particular arrangement has led to man being classified as a “super-organism,” whose health is directly related to the function of the thousands of species of micro-organisms that make up the 100 trillion cells in the intestinal tract. For years, research suggested that there were 400-500 species that made up this microbial population. Recent advances in research have now put that number at anywhere from 3,300 to 5,700 or more, (9) to upwards of 30,000 species. The intestinal tract houses what has been called “the densest ecosystem on the planet,” and is approximately 25-28 ft long. The surface area of the intestinal tract measures approximately 200 square meters, roughly the size of a tennis court.

Modern medicine states that systemic Candida exists only in immunocompromised individuals, as a result of AIDS, immunosuppressive therapy, such as in organ transplants, or chemotherapy. Science states otherwise, and extends that list to include: diabetes, premature infants, surgical patients; (7)(10)(66) hematological malignancies; (8) hospitalized patients, especially in Intensive Care Units, or having major injuries;(10) burn victims; (54) nutritional deficiencies; (22) as well as aging. (22)(35)(36)(37) alcoholism, cirrhosis, tuberculosis, cancer, corticosteroids, marrow hyperplasia;

Researchers continuously broaden the scope of those being affected. Valdimarsson et al. state that there are no common immunological denominators. (1) may appear following even a slight modification of the host. (55) Berg et al. on behalf of Biocodex Pharmaceuticals states that Candida spreads in immunocompetent individuals. (68) Senet states that the pathogenic behavior of Candida

The widespread use of antibiotics, which induce neutropenia, an abnormally low number of neutrophils (white blood cells), and immune system suppression is commonly attributed by science to be the most consistent cause of systemic Candida.(3)(9)(12)(13)(14)(16)(17)(18)(19)(20)(21)(22)(55)(56)(57)(64)(67)(68)(69)(76)(77) Corticosteroids suppress immune system function. (11)(17)(68) Intestinal homeostasis is critical for human health. (6)(7)(55)(57)(68)(71)

Candida has been shown to be capable of causing systemic immuno-suppression via its cell wall proteins, (2) TLR2-mediated IL-10 release, (30) protease cleaving of leukocyte integrin CD11/CD18, (25)(31)(34)(62)(63) and intracellular components. (72)

Candida can manipulate inflammatory responses as needed (31)(32) and inflammatory responses can have systemic effects. (44)(45)(46)(47)

Candida has the ability to destroy immune cells, (3)(23)(24)(26)(49) hide from the immune system, (4)(19) adapt to the inner environment of immune cells, (5)(38)(39) resist and suppress ROI and NO production of immune cells, (15)(16)(27)(43) destroy binding sites and receptors of immune cells, (25)(31)(33)(34) manipulate immune responses, (28)(53)(70)(74) and affect immune cell structure. (42)(73)

Stress can cause accumulation of iron at the luminal surface of intestinal cells (75) and iron overload leads to impaired neutrophil function. (14) Stress can lead to immunosuppression facilitating the spread of Candida. (55) Sanchez et al. discuss the affect of starches vs. sugars on the immune system response to Candida. (29)

Macrophages, which are widely distributed immune system cells that play an indispensable role in homeostasis and defense, and are cells that function as a first line of defense against invading microorganisms, are historically ineffective against Candida albicans. (40)(41)

While evidence suggests that intestinal Dendritic Cells are critical for regulation of immunity in the gut, (50) Dendritic Cells are poor in both intracellular killing and damaging of C. albicans hyphae, (48) and only kill as effectively as macrophages. (51) Ingestion of hyphae by Dendritic Cells inhibits Th1 immune responses. (52)

Candida Albicans’ Secreted Aspartyl Proteases (SAPs) are a highly specific family of enzymes that assists in its ability to cause disease in the body. SAPs are believed to play a role in Candida’s ability to induce inflammation, invade and breakdown tissue barriers, digest proteins for nutrients, destroy and evade immune defenses, and spread throughout the body. (25)(33)(34)(58)(59)(60)(61)(62)(63)(65) Research has shown that the destructive effects of protease enzymes are associated with diabetes, hypertension, and immune system suppression. (25)(31)(34)(62)

Additional enzymes secreted by Candida albicans include phospholipases, lipases, glucoamylases, phosphatases, and β-N-acetylglucosaminidase.

Conclusion

As impressive as I find the above research to be, it is just a small representation of the research on Candida albicans and its effects in humans. With over 26,000 studies on Candida albicans since the introduction of antibiotics in the late 1940s, there is much more to be analyzed and reported. What is readily apparent from this data is the fact that systemic fungal Candida infections are a common occurrence in most individuals as a result of antibiotic use and other contributing factors.

– Dr. Jeffrey McCombs, DC

References

1. Immunological phenomena associated with chronic mucocutaneous candidiasis have recently been intensively studied by many workers (reviewed by Kirkpatrick, Rich & Bennett, 1971). The results have shown that there is no common immunological denominator in this disease. The most common finding, however, is defective cellular immunity, which may or may not be accompanied by failure of in vitro lymphocyte transformation.

Immunological Feautures in a Case of Chronic Granulomatous Candidiasis and its Treatment with Transfer Factor

H. VALDIMARSSON, C. B. S. WOOD, J. R. HOBBS AND P. J. L. HOLT

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1553624/pdf/clinexpimmunol00295-0003.pdf

2. The ability of Candida albicans to establish an infection involves multiple components of this fungal pathogen, but its ability to persist in host tissue may involve primarily the immunosuppressive property of a major cell wall glycoprotein, mannan. Mannan and oligosaccharide fragments of mannan are potent inhibitors of cell-mediated immunity and appear to reproduce the immune deficit of patients with the mucocutaneous form of candidiasis. However, neither the exact structures of these inhibitory species nor their mechanisms of action have yet been clearly defined. Different investigators have proposed that mannan or mannan catabolites act upon monocytes or suppressor T lymphocytes, but research from unrelated areas has provided still other possibilities for consideration. These include interference with cytokine activities, lymphocyte-monocyte interactions, and leukocyte homing. To stimulate further research of the immunosuppressive property of C. albicans mannan, we have reviewed (i) the relationship of mannan to other antigens and virulence factors of the fungus; (ii) the chemistry of mannan, together with methods for preparation of mannan and mannan fragments; and (iii) the historical evidence for immunosuppression by Candida mannan and the mechanisms currently proposed for this property; and (iv) we have speculated upon still other mechanisms by which mannan might influence host defense functions. It is possible that understanding the immunosuppressive effects of mannan will provide clues to novel therapies for candidiasis that will enhance the efficacy of both available and future anti-Candida agents. Immunosuppressive properties observed for isolated Candida mannan and its catabolites in vivo and in vitro provide additional evidence that fungal mannan is responsible for patient immune dysfunction.

Candida mannan: chemistry, suppression of cell-mediated immunity, and possible mechanisms of action.

R D Nelson, N Shibata, R P Podzorski, and M J Herron

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC358175/

 

Continue reading References below…

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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

H1N1 Vaccine: Licensed but Untested

Question: Dr. Jeff, What’s your opinion on getting the H1N1 vaccine?

Dr. Jeffrey McCombs: I don’t recommend the vaccine to anyone. The Swine Flu first appeared in 1976 and disappeared again until this year. At the time, there weren’t any of the mass marketing techniques used today by pharmaceutical companies. With viruses mutating thousands of times, you almost guaranteed that the vaccine wouldn’t cover what you’re exposed to. The majority of all mutations are weakened and non-infectious. Here’s another article put out by Dr. Tim O’Shea on the vaccine:

Licensed and Untested

This is exactly wherein lies the clear and present danger of the current swine flu vaccine program. This swine flu vaccine is actually being brought into existence for dissemination among the general public, starting with children. With 5 manufacturers having begun clinical trials only in August 2009, none scheduled for completion until next April, it is an astounding lesson in vaccine politics that the FDA approved the untested H1N1 vaccine on 15 Sep 09, just one month after the testing began!

Licensed and untested.

We see precisely the same sequence of events that led to the last swine flu fiasco in 1976 – 50 million were vaccinated with that untested vaccine. 21 deaths 565 paralyzed, withdrawn in 10 weeks. And never replaced. Never replaced – that’s the point. Why not? If the threat was so urgent that we had to start vaccinating before the vaccine was even tested, then where did that threat go? Why didn’t we just withdraw the toxic vaccine and then continue with researching and testing to develop one that worked?

With just a little research, independent of the popular media, a cognition begins to take shape in the mind of the discriminating reader, that there may be an ulterior agenda here, one that is not necessarily directed toward the overall well-being of children. If such a reader is a responsible parent, the next realization might be to change the default setting with respect to the decision to vaccinate. At present most parents default in favor of – when in doubt, vaccinate. Many today are changing that default setting: no more vaccines until it is proven to me beyond a doubt that – the vaccines have been tested and found to be 100% safe with no chance ofharming the child – that the child absolutely needs the vaccine for optimum immune development – there are no economic or political agendas involved in the vaccine being recommended.

It is becoming increasingly clear that natural selection will favor the lines of those parents who take these extra precautions to protect and safeguard the inner immunity of their children. Who else is going to come forward? The FDA, who does no testing of their own before making a decision, but relies entirely on the research submitted to them from the companies who stand to make billions in profits if the vaccine is approved? The vaccine manufacturers, who have been granted 100% immunity from liability for any deaths or injuries? The other regulatory agencies – NIH, CDC, HHS – whose political connections to the vaccine companies are a matter of public record? But that’s exactly what all the hurry, all the hyperbole, all the outright misdirection is about. They know that they don’t have time to come up with a fully tested vaccine – that would take a year. But by that time the imaginary disease will be gone, with no hope of raising it from the dead. The market is here and now. And everyone – the clinics, the manufacturers, the regulators, and the media – all want their share of the rewards.

10 Candida Myths

NASA does research on candida because astronauts come down with it while in space. Are astronauts immunosuppressed people by the medical definition? Absolutely not!

Myth #1 – Only women get candida infections

Candida Albicans is commonly considered to be a yeast infection that only women get. It is in fact a fungal infection caused by antibiotic use that affects both men and women. Research states that over 90% of the population might have systemic candida.

Myth #2 – Candida is a yeast infection

Candida Albicans in its normal yeast form is a commensal organism that has co-evolved with over 5,600 other micro-organisms taking up residence in the intestinal tract and other tissues.

Only in its fungal (hyphal/mycelial) form is it an infectious agent that uses its cell wall, adhesion, phenotypic switching, and enzymes to spread and destroy tissues throughout the body. Many people commonly refer to Candida Albicans as a yeast infection when it is actually a fungal infection.

Myth #3 – Candida needs sugars to become pathogenic and spread

The primary drive all living organisms is survial. If you remove food sources from the yeast form of Candida, it will convert to its fungal form and search for food in the body. If someone took all of the food out of your house, you’d go shopping too.

Sugars will fuel Candida very effectively, but it’s not an absolute that by excluding sugars and simple carbs from your diet, you’ll starve it to death. People who don’t spend the time researching Candida put out this information to the detriment of others. You’ll need to use non-toxic approaches that revert it back to its yeast form and then remove the excess yeast by empowering the immune system.

Myth #4 – Only immunosuppressed people get candida infections

The medical viewpoint is that only immunosuppressed people (AIDS, Immunosuppressive therapy, chemotherapy) get systemic candida. They state this as though that is the official position. Official position or not, for whatever reason, it is false, misleading, and demonstrates a complete lack of knowledge about candida, microbiology, and physiology. Additionally, it is exactly the opposite of what all the research has continually demonstrated since the 1940s when antibiotics were first introduced.

NASA does research on candida because astronauts come down with it while in space. Are astronauts immunosuppressed people by the medical definition? Absolutely not!

Research has repeatedly shown that the immune system does not need to be suppressed in order for candida to convert to its fungal form and invade the body. On the other hand, a depressed immune system or slightly suppressed immune system will contribute to the spread of fungal candida. What can depress or suppress the immune system? Worries, stress, food coloring, sugar, and among many other things, candida itself. As was correctly pointed out above, slight neutropenia would contribute to the spread of candida. So although a weakened immune system does help, it is not needed, but almost always present to some degree or another.

Myth #5 – Pathogenic Candida requires an acid pH environment to grow

This is another common myth put out by people who think everything is supposed to be alkaline in the body. The digestive tract is supposed to be acid and doesn’t even approach alkalinity until the rectum. The vaginal tissue is also supposed to be acidic.

The lactic acid bacteria produce lactic acid to help maintain an acid pH. The stomach is very acidic, and the acidity of juices leaving the stomach helps to stimulate pancreatic function, as well as maintain the proper acid pH of the intestinal tract. Bile acids also contribute to maintaining the acid pH. In an acid environment, candida exists in its yeast form, but once that starts to shift to a more alakline environment, the alkaline pH stimulates the conversion to the pathogenic, fungal form. The same is true for E. Coli. In an acid environment, it plays a role in the production of vitamin K for the body. In an alkaline environment it becomes the pathogenic form that causes so many problems for people. Fungal Candida does extremely well in an akaline environment such as the blood stream.

Myth #6 – Mercury feeds Candida

I’m not sure where this information came from, as I have yet to find any studies that mention this. This mainly seems to be put out by people who think that mercury determines everything in the body. The only possible explanation that I can come up with is that mercury would have a suppressive effect on the immune system, which would possibly allow fungal candida to spread unimpeded. I have yet to find anyone who had this problem. The amount of mercury needed to have a suppressive effect systemically within the body would be greater than most people deal with. Either way, I have never seen any research that states that mercury feeds candida.

People who usually support the idea that mercury feeds candida claim that some doctors have pointed out that most people who have candida infections also have mercury toxicity. If that were true just by association, then it would also apply for parasites, and other heavy metals and chemicals. The average American has a large load of chemicals in the tissues. This doesn’t mean that these chemicals also feed candida. It’s an erroneous assumption to make just because 2 or more issues exist in the body at the same time.

A deficiency of iron would slow down the spread of fungal candida, as it would many other micro-organisms. Dr. Sharon Moalem’s book, “Survival of the Sickest” points out how some people survived the plague simply by being anemic and not having enough iron stores in their bodies to allow the bacteria to thrive. Fungal Candida however, will steal iron from red blood cells in order to survive. This is another one of its many suvival and virulence mechanisms.

Myth #7 – Oxygen kills Candida

Another erroneous myth. Candida Albicans is facultative anaerobe, which means it can exist in oxygen-rich (mouth, skin) and oxygen-depleted (intestinal tract, body tissues) environments. Some studies indicate that is harder to eliminate in an oxygen-rich environment. That seems to be more true of thrush, but not as true for skin infections.

Candida has the ability to evade reactive oxygen species that are produced by macrophages to destroy foreign substances in the body.

Myth #8 – Only drugs can eliminate candida

Most people will be familiar with this myth. If anything drugs increase the resistance of candida. Candida is very adaptive to drugs that try to kill it off. Most research being done today is to find new drugs for fighting candida, because candida has developed resistance to all other antifungals. Antifungal drugs come with many side effects, which include destruction of liver tissue.

The better choice is to use natural antifungals that aren’t toxic to the body. Most every plant on the earth has developed some form of antifungal mechanism in order to avoid being destroyed by some 1.5-2.5 million fungus that inhabit the Earth. There is plenty of research that shows the antifungal quality of many natural substances found in nature.

Myth #9 – Use of antifungals needs to be rotated to eliminate Candida

I usually see this claim on holistic websites and not in the research. Fungal candida can and has developed resistance and immunity to anti-fungal drugs. I find claims about needing to rotate antifungals on sites where the approach they are using, or the substances that they choose to use, or some combination of the two, aren’t effective for eliminating systemic candida. They claim that candida is adapting to whatever their using, so you need to rotate antifungals. I find that they’re just not using an effective product or approach, and they subsequently rationalize its ineffectiveness as the candida adapting.

I’ve never found this to be the case with the McCombs Plan where we use a simple fatty acid to revert candida back into its normal yeast state.

Most natural products are fungistatic (inhibit) and not fungicidal (kill). Its better to be fungistatic, as fungicidal products (drugs) create resistant strains of candida. Nature is filled with thousands of antifungal products that plants make and each one is effective as a fungistatic agent.

Myth #10 – Medical Doctors are familiar with Candida infections

Most MDs won’t even be familiar with anything about Candida Albicans and will dismiss it rather than take the time to find out more about it. There is a large body of research on Candida Albicans that has been around since the introduction of antibiotics in the late 1940s. Research in the late 1940s, 50s, and 60s was driven by the fact that so many people developed systemic candida infections just by the use of a new drug, penicillin.

Some MDs will state that it’s only a concern in Immunosuppressed patients (AIDS, HIV) and patients receiving chemotherapy or immunosuppressive medications. It’s not. Research from the 1990s shows that even the slightest modification of the intestinal flora can create systemic candida infections. More recent research shows that antibiotics will cause candida and that these changes can lead to acute problems ranging from diarrhea to life-threatening colitis to chronic changes such as obesity, cancers, and many other diseases. Other research shows that the protease enzymes that candida uses can be responsible for diabetes, hypertension, and immune system suppression.

For better health, go to Dr. McCombs Candida Plan.

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,…

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