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Low-Dose Ketamine Eases Fentanyl Withdrawal Symptoms

The AHA! Team — Thu, 17 Oct 2024 08:22:08 +0000

University of Washington School of Medicine via News-Medical – Drug overdose is the leading cause of injury deaths in young adults in the United States, with fentanyl causing over 70,000 deaths annually. Many people who use fentanyl become trapped in their addiction out of fear and a low tolerance for the withdrawal symptoms, which include muscle cramps, nausea, chills, sweats and intense cravings. They can’t stop using fentanyl, and they also have trouble starting either of the two medications, methadone and buprenorphine, that can dramatically reduce their risk of overdose death. Research findings published Aug. 29 in Addiction Science & Clinical Practice may offer hope. A pilot study showed that a small amount of ketamine can reduce or eliminate the withdrawal symptoms associated with quitting fentanyl. “The main takeaway is that we have found an easier way for people trapped in the grip of fentanyl addiction to get started in treatment.” Dr. Lucinda Grande, clinical assistant professor of family medicine, University of Washington School of Medicine She was the study’s lead author. “Methadone can be difficult to access due to strict federal regulations, and starting buprenorphine can cause severe withdrawal symptoms before those who start it become stabilized,” added study co-author Dr. Tom Hutch. He is the medical director of the opioid treatment program at We Care Daily Clinics in Auburn, Wash. “Ketamine, at an imperceptibly low dose, helps bridge that gap.” Over 14 months, Grande and colleagues in Auburn and Olympia prescribed ketamine to 37 fentanyl-addicted patients whose fear of withdrawal symptoms had deterred them from trying buprenorphine. Twenty-four patients actually tried the drug, and 16 completed the transition to buprenorphine. Most patients reported a reduction or elimination of withdrawal symptoms after each ketamine dose, the effect of which lasted for hours. Of the last 12 who completed the transition, 92% remained in treatment for at least 30 days. Patients placed a ketamine lozenge or syrup under the tongue. The 16 mg dose is a small fraction of that typically used for anesthesia, the main clinical role of ketamine for 50 years, according to Grande. That dosage also is less than half of the smallest ketamine dose prescribed for depression treatment, an increasingly common use of this medication. Researchers monitored patients daily or almost daily, and refined the treatment strategy based on patient response and prescriber experience. Grande developed the concept after she learned that emergency-medicine physician and coauthor Dr. Andrew Herring of Oakland, California, used a higher, sedating dose of ketamine successfully in his emergency department to resolve a patient’s severe case of withdrawal from fentanyl addiction. Grande is a primary-care and addiction doctor in practice near Olympia who, in the past dozen years, has used low-dose ketamine to treat more than 600 patients for chronic pain and depression. Ketamine has gained prominence in the news since actor Matthew Perry of the sitcom “Friends” overdosed on the drug and drowned. Perry had undergone high-dose ketamine treatment for depression, news reports have suggested. “Our study underscores the enormous potential of this medication for addressing important health problems such as depression, chronic pain and now fentanyl-use disorder,” said Grande. Ketamine’s positive attributes have been overshadowed by Perry’s death, she said. Grande hopes this pilot study’s results will be confirmed by larger studies. “I am excited about these results,” she said. “This is a wonderful opportunity to save lives.” Source: University of Washington School of Medicine Journal reference: Grande, L., et al. (2024) Ketamine-assisted buprenorphine initiation: a pilot case series. Addiction Science & Clinical Practice. doi.org/10.1186/s13722-024-00494-2. To read the original article click here.

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Hospitalizations Rise in Coronavirus Surge, but Death Rate Is Much Lower Than It Once Was

AHA Publisher — Wed, 28 Oct 2020 07:00:13 +0000

News Staff via CBN News – Coronavirus cases are rising again here in the US, as well as in multiple other countries in Europe. Many experts had expected the virus to surge again when the weather cooled down. Last week the seven-day average for new COVID cases hit its highest level on record with 16 states also hitting record hospitalizations. The only bright spot in an otherwise dreary outlook for COVID is that the death rate is much lower now. CBN News Medical Correspondent Lorie Johnson says the drop in the death rate is very clear among those who have been hospitalized. “The death rate has really gone down from 25 percent down to 7 percent. These are people who are hospitalized for coronavirus. So that’s down 18 percent, and that’s wonderful news,” she explained. Johnson says improved therapeutics and treatments are helping decrease the death rate. The broader percentage has also gotten better as the number of people tested increases. Right now Johnson says there are about a million people tested each day in the US. “The death rate is based on how many people test positive, out of that number how many people die from it and at the very beginning of the pandemic usually the only people who were tested were those who were very sick, and reported to the hospital.” For young people, 99.9 percent of them recover just fine from the virus. Still, the increasing number of cases is putting a strain on many hospitals with some not having enough space or staff to handle new patients. Data from the COVID Tracking Project shows that nationwide, in cases where race is known, black people are dying at 2.3 times the rate of white people. And while those who live in nursing homes make up 1 percent of the population, they make up 41 percent of COVID deaths. To read the original article click here. For more articles from CBN News click here.

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COVID-19 Survivors May Have Protective Antibodies for 4 Months

AHA Publisher — Mon, 12 Oct 2020 07:00:52 +0000

Angela Betsaida B. Laguipo, BSN via News-Medical Net – A new study by researchers at Harvard Medical School and the Massachusetts General Hospital (MGH) aimed to determine how long severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunity in COVID-19 survivors lasts. The researchers found that people who survive severe COVID-19 disease have long-lasting immune responses against SARS-CoV-2. The study, published in the journal Science Immunology, highlights the body’s immune response against COVID-19. Also, it offers hope that people who are infected with the SARS-CoV-2 virus will develop lasting protection against reinfection. The Study In the study, the researchers focused on the receptor-binding domain (RBD) of the virus “spike” protein, which binds to cells through the angiotensin-converting enzyme 2 (ACE2) receptors, leading to infection. The immune system generates proteins called antibodies when it senses that pathogens like the SARS-CoV-2 invade the body. Though the body produces an immune response, it is unclear how long these antibody responses last. To arrive at the study findings, the research team collected blood samples from 343 patients infected with SARS-CoV-2, most of whom had severe cases. These blood samples were obtained up to four months after the symptoms appeared. The researchers isolated the blood plasma and applied to laboratory plates coated with the RBD of the spike protein. They analyzed how different types of antibodies in the plasma attached to RBD. The study results were compared with blood samples collected from 1,548 people before the pandemic. The study findings showed that the immunoglobulin G (IgG) levels remained elevated in COVID-19 patients for four months and were tied to the presence of protective neutralizing antibodies, which exhibited a little reduction in activity over time. Hence, people are very likely to be protected for four months, which shows that key antibody responses to COVID-19 are present, the researchers concluded. IgG Level Measurements More Accurate Also, they found that measuring the IgG levels was more accurate in detecting people who had symptoms for at least 14 days. “These data suggest that RBD-targeted antibodies are excellent markers of previous and recent infection, that differential isotype measurements can help distinguish between recent and older infections, and those IgG responses persist over the first few months after infection and are highly correlated with neutralizing antibodies,” the researchers wrote in the paper. They added that since the standard test for SARS-CoV-2, the Polymerase chain reaction (PCR) nasal swab, loses sensitivity over time, supplementing it with an antibody test in patients who developed symptoms for at least eight days can aid in identifying some positive cases that may be missed. The team also added that people who were infected with the coronavirus had immunoglobulin A (IgA) and immunoglobulin M (IgM) responses that lasted for short periods decreasing to low levels in about two and a half months after infection. If patients tested positive for these antibodies, they might have been infected with COVID-19 in the past two months. Being aware of the duration of the body’s immune responses against SARS-CoV-2 by testing IgA and IgM levels will help provide more precise data about the spread of the infection. “There are a lot of infections in the community that we do not pick up through PCR testing during acute infection, and this is especially true in areas where access to testing is limited,” Jason Harris, a pediatric infectious disease specialist at MGH, explained. “Knowing how long antibody responses last is essential before we can use antibody testing to track the spread of COVID-19 and identify ‘hot spots’ of the disease,” he added. Of the more than 37.39 million cases of COVID-19 globally, more than 25.99 million have already recovered. Currently, numerous vaccines are being trialed to see if they are effective and safe to use by the general public. Having a better understanding of the body’s antibody responses to SARS-CoV-2 will also help scientists develop a vaccine that could offer protection against the raging virus. Sources: Harvard Medical School. (2020). https://news.harvard.edu/gazette/story/2020/10/covid-survivors-may-have-four-months-of-protection/ COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) – https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 To read the original article click here.

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Does Blood Plasma from COVID-19 Survivors Help Patients Infected with Novel Coronavirus?

AHA Publisher — Sat, 11 Jul 2020 07:00:30 +0000

University of California San Diego Health via Newswise – A new clinical trial at UC San Diego Health will investigate whether an old therapy might effectively treat a modern-day scourge. There is only one approved, specific treatment for COVID-19, the illness caused by the novel coronavirus SARS-CoV-2, albeit with modest efficacy. Numerous experimental or repurposed drugs are under investigation, including the arthritis drug tocilizumab. And one treatment that is more than a century old. Researchers at University of California San Diego School of Medicine and UC San Diego Health have launched a clinical trial to assess the safety and efficacy of convalescent plasma (CP) to prevent COVID-19 after a known exposure to the virus. CP therapy involves infusing patients with antibodies extracted from the blood of donors who have successfully recovered from COVID-19, with the hope that the resulting boost to their immune systems will shorten the length and reduce the severity of the disease. The UC San Diego trial is part of a larger, national effort approved by the U.S. Food and Drug Administration. The goal is to create a network of hospitals and blood banks collecting, isolating, processing and testing whether plasma from COVID-19 survivors has therapeutic, preventive value. The national trial is being coordinated by Johns Hopkins University and sponsored by the National Insitute of Health through the Department of Defense. “With convalescent plasma therapy, we want to act prophylactically, using a product with known high-titers (concentrations) of neutralizing antibodies,” said Edward Cachay, MD, an infectious disease specialist at UC San Diego Health and professor of medicine at UC San Diego School of Medicine. “We want to learn how we can prevent sickness, how we can prevent COVID patients from needed mechanical ventilation, and how we can prevent them from dying from the disease.” Before the emergence of antibiotics, CP was used to prevent and treat a host of bacterial and viral infections, including diphtheria, scarlet fever and pertussis. It was used during the 1918 influenza pandemic with reported good effect. In general, CP treatment has proven safe, but its effectiveness has varied with disease and among individuals. Studies of CP therapies for Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and the 2009 H1N1 influenza showed measurable reductions of mortality (compared to placebo or no therapy), but efforts to treat Ebola virus infections during the 2014-16 outbreak in West Africa were inconclusive. Chinese researchers treating COVID-19 patients have reported some success using CP, albeit not in randomized, controlled studies — the gold standard in clinical research. On April 13, the Food and Drug Administration (FDA) issued research guidelines for assessing CP as a potential COVID-19 treatment and the American Red Cross is currently seeking blood plasma donors who have fully recovered from novel coronavirus infections. Plasma is the liquid portion of blood that carries blood components throughout the body, such as red and white blood cells, platelets, salts and enzymes. It also contains proteins and antibodies produced by the body’s immune system to fend off invasive pathogens, such as SARS-CoV-2. To qualify as a plasma donor for COVID-19 patients, donors must be at least 17 years old and weigh 110 pounds; be in good health; and have a prior, verified diagnosis of COVID-19 but are now symptom-free and fully recovered. The UC San Diego Health clinical trial will recruit a total of 487 qualifying participants for the study. Criteria to qualify for participation include a high-risk factor, such as age or an underlying condition, like cardiovascular disease, diabetes, existing pulmonary impairment or employment as a health care worker; known exposure to SARS-CoV-2; and a negative PCR diagnostic test to show no current infection. Testing will be conducted inside tents set up across from the emergency department at Jacobs Medical Center and the Altman Clinical and Translational Research Institute (ACTRI) on the La Jolla health campus. The UC Health Blood Bank is coordinating efforts with the San Diego Blood Bank. The ACTRI is providing personnel, infrastructure support and other resources for the CP trial and for other COVID-19-related clinical trials at UC San Diego. In addition, the ACTRI has created a COVID-19 Biobank to provide materials for research projects to diagnose or treat the disease. In cases of infection by the novel coronavirus, it appears the human immune system begins producing antibodies to the disease five to 10 days after the initial infection. The antibodies bind to the targeted coronavirus, stopping it from latching onto new cells and beginning the production of more viral particles. Over the course of two or so weeks, the body clears out the virus, but antibodies to it (or the blueprints for making them) remain. The depth and length of subsequent immunity have not been determined. Cachay said he thinks CP will likely be most effective in persons with early exposure to the novel coronavirus, before symptoms appear, but it will require a clinical trial to substantiate that thinking. “If we don’t do this, if we just gather anecdotal evidence that isn’t conclusive, then we won’t be any better off when the next wave hits.” To read the original article click here.

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New Hydroxychloroquine Study Proves Trump Right, Says It ‘Significantly’ Cuts Death Rate

AHA Publisher — Sun, 05 Jul 2020 07:00:40 +0000

Benjamin Gill via CBN News – A substantial new study has found that the anti-malaria drug hydroxychloroquine helped patients survive COVID-19. In fact, the study from the Henry Ford Health System in Michigan said the drug “significantly” cut the death rate of patients. “Treatment with hydroxychloroquine cut the death rate significantly in sick patients hospitalized with COVID-19 – and without heart-related side-effects,” the health organization reports. Their analysis of 2,500 COVID-19 patients found the drug can be effective if patients received it early in their treatment. “Our analysis shows that using hydroxychloroquine helped save lives,” said neurosurgeon Dr. Steven Kalkanis, CEO, Henry Ford Medical Group and Senior Vice President and Chief Academic Officer of Henry Ford Health System. “As doctors and scientists, we look to the data for insight. And the data here is clear that there was benefit to using the drug as a treatment for sick, hospitalized patients.” President Trump had touted the drug early on as a possible experimental treatment for virus patients, but then studies found conflicting results about its effectiveness and the news media hammered him on it. One of the earlier negative studies was later retracted. Scientists from the Henry Ford Health System explained why their study was successful. “The findings have been highly analyzed and peer-reviewed,” said Dr. Marcus Zervos, division head of Infectious Disease for Henry Ford Health System, who co-authored the study with Henry Ford epidemiologist Dr. Samia Arshad. “We attribute our findings that differ from other studies to early treatment, and part of a combination of interventions that were done in supportive care of patients, including careful cardiac monitoring. Our dosing also differed from other studies not showing a benefit of the drug. And other studies are either not peer-reviewed, have limited numbers of patients, different patient populations or other differences from our patients.” To read the original article click here. For more articles from CBN News click here.

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How EMDR Therapy Can Help with PTSD, Trauma, Panic Attacks, and Anxiety

AHA Publisher — Mon, 09 Dec 2019 08:00:53 +0000

Dr. Mark Mayfield via Dr. Caroline Leaf – For many of us, asking for help is a difficult task. We don’t want to seem needy or weak. Add trauma to that “ask for help,” and the process of reaching out can almost be crippling. Why? • First, it can be scary to admit you need help • Second, it puts you in a vulnerable place, and—if if you’ve experienced any form of trauma—vulnerability is not a place you would willingly choose to be in. • Third, finding a mental health professional to help can feel overwhelming. Questions such as…How do I find one? How do I know if they are the right one? What should I look for? What type of therapy do they do?…swirl around in your head and can be crippling. Today I hope to take some of the guess work out of these questions by explaining the process of an amazing trauma therapy called Eye Movement Desensitization and Reprocessing or EMDR. Before I dive into the nuances of EMDR, I want to make sure we are all on the same page with the definition of trauma. 1. What is Trauma? Trauma is a real or perceived event whereby harm (mental, emotional, or physical) happens. This real or perceived event overwhelms the central nervous system and changes the way an individual processes and recalls memory. For those who have experienced a traumatic event, it is not a story of something that happened once in the past and is over; but a current daily reliving of the emotional, mental, and physical pain, fear, and anxiety. Trauma can be broken down into two types: Big “T” traumas are events such as a sexual assault, a major car accident, a catastrophic loss (e.g. losing a child to suicide), combat trauma, etc. Small “t” traumas are events such as being bullied, neglect, gaslighting, etc. Though there are two categories of trauma, the key is that the body does not discriminate how it responds to any trauma. Every individual’s traumatic experience becomes fragmented at the sensory site of reception in an effort to protect the body from current or future harm. What this means is that the sensory experiences of the event are not fully processed; thus, causing a similar reactive recurring response. For instance, if you’ve ever been in a car accident, you know the airbag intimately. Yes, the airbag saved your life, but the experience of the airbag going off was imprinted in your body visually (seeing it go off), auditorily (hearing it go off) and olfactorily (smelling the sulfuric chemicals). If/when you consciously or unconsciously experience something similar (smelling something sulfuric, hearing a loud pop, or seeing something explode), your body will automatically go into protective fight/flight/freeze mode and do what it needs to do to protect itself. In essence, it is as if you were actively reliving the experience all over again. If never processed, the unresolved trauma can cause lasting mental, emotional, and physical effects. 2. What is EMDR? EMDR stands for Eye Movement Desensitization Reprocessing. It was first developed by the late Dr. Francine Shapiro in the 1980’s. 3. How does EMDR work? EMDR is a process whereby the memory and the current emotional, mental, and physical experiencing of the trauma are processed through bi-lateral stimulation or the engagement of both sides of the brain. Essentially, bi-lateral stimulation (e.g., eye movement from left to right/right to left following a light bar; or the use of pulsars in the left and right hands; or the counselor tapping the client’s left knee or hand, then the right knee or hand, and alternating back and forth for a period of time) is coupled with simultaneously recalling the traumatic memory. This allows the brain an opportunity to collect the fragmented sensory experiences and bring them back to the place where they can be properly processed. The emotional reactivity is removed from the memory; allowing the memory to be properly stored as a story, not a current reliving. 4. How do I know I’m ready for EMDR? EMDR cannot be done without a highly trained professional. However, asking the question “Am I ready?” shows an awareness and a willingness to change and heal. This means you could be ready, but it is still a good idea to consult with a properly trained mental health professional and complete the appropriate assessments to gain clarity on whether EMDR will be right for you. 5. How do I find a good EMDR therapist? Choosing a therapist is like choosing a new pillow. You want to make sure it fits perfectly. When choosing a therapist, make sure you find one that fits well with your personality. It is okay to come to the initial session with interview questions of your own. To find an trained EMDR therapist, use the EMDRIA (Eye Movement Desensitization Reprocessing International Association) website www.emdria.org as a starting point. Using this website will help you know you will be starting with a highly trained individual. REMEMBER: Working through trauma is not an easy task. However, it is a good and necessary one. Don’t do it alone. Make sure you have a healthy and safe community around you to support you through the process. It is okay to be vulnerable, and it is okay to ask for help. These are signs of strength, not weakness. For more on EMDR and mental health, listen to this week’s podcast. Dr. Mayfield is founder and CEO of Mayfield Counseling Centers in Colorado Springs, Colorado, which serves over 15,000 appointments a year. He conducts therapy with families, couples, individuals, and groups and has a passion to provide exceptional care for military service members and their families. He is a contributing author to Focus on the Family’s Marriage and Parenting divisions and has recently completed a book for parents on self-injury and suicide. It will be published within the next year. Dr. Mayfield is also an Assistant Professor of Counseling at Colorado Christian University and hosts a weekly podcast called Candid Conversations with Dr. Mayfield. To read the original article click here. For more articles from Dr. Leaf click here.

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