February, I attended The Society for Orthomolecular Health-Medicine's
13th Annual Scientific Meeting in San Francisco. This small group,
headed by Dr. Richard Kunin, MD, consistently puts on a terrific, information-packed
meeting in a quaint San Francisco hotel at a very modest price. Don't
let the title "orthomolecular" scare you off: Dr. Linus
Pauling referred to strategies of optimizing nutrition through diet
and supplemental vitamins as "orthomolecular." The meeting
is scheduled each year in February in San Francisco, a great time to
meet colleagues and escape the winter blues.
I graduated many moons ago from the Albany Medical College, and I am reminded
in monthly mailings for dues and school donations that I was not trained in orthomolecular
medicine at this institution. In fact, the classmates who I read about or occasionally
meet are actively practicing surgery and medicine and are not inclined to study
natural medicine except through the infrequent editorial that appears in a medical
journal. So, it was a particular pleasure to discover that one Albany Medical
graduate not only shared many philosophies of the orthomolecular society, but
also was speaking at the February meeting, relating his experiences practicing "orthomolecular" and "conventional" medicine.
Dr. Richard Gracer served as my third-year student mentor when I entered medical
school as a freshman. Dr. Gracer did a residency in family practice at Baylor
University and then was certified in occupational medicine. Having been exposed
to many patients with chronic pain, Dr. Gracer was interested in considering
alternatives to narcotic prescriptions. In the late 1980s, he was introduced
to orthopedic medicine (as compared to surgery) and learned about prolotherapy.
Prolotherapy is a skilled, anatomically based injection therapy developed to
progressively treat weakened ligaments in chronic back and neck pain. Gracer's
proficiency in prolotherapy led to a large referral-based clinic in the San Francisco
Bay area. During the time period that Dr. Gracer practiced prolotherapy, he was
introduced to the value of nutritional medicine and natural therapies. He integrated
many orthomolecular protocols into the treatment administered to chronic pain
patients. Despite the success that prolotherapy and natural medicine offered
patients, many remained addicted to opiods. Gracer was frustrated with the need
to fill prescriptions for hydrocodone and oxycodone for those who seemed to resist
improvement with prolotherapy and other rehabilitative modalities.
What Gracer observed was that among the population of patients who required opiod
medications for a period of time greater than two months, pain medication needs
tended to increase and any attempt to reduce medication resulted in pain aggravation.
Rather than reporting gradual improvement in pain, these patients reported greater
pain one year later, and the narcotic prescription was usually 50% higher with
poorer pain control. Patient visits were often arbitration sessions, with patients
arguing for more narcotics and the doctor arguing for less. The physician would
seek alternative means to control pain, including use of anti-depressant medication,
physical therapy, and rehabilitation evaluation, while the patient would refuse,
preferring more narcotic prescriptions. Both patient and physician were usually
frustrated: the physician wouldn't prescribe more narcotic; the patient
would complain that the pain only intensified more.
At the Orthomolecular meeting, Gracer discussed the problem occurring neurochemically
in the pain-addicted patient. Reduction in narcotic medication led to immediate
withdrawal symptoms: anxiety, insomnia, muscle tension, pain intensification,
and emotional instability. Long-term use of narcotics altered the neuron pain
receptor, the so-called "mu" receptor, in a process referred to in
pain medicine as neuroplasticity. Whereas the mu receptor requires minimal "neuro-chemicals" to "fill
up" in a non-addict, an addicted patient's mu receptor requires an
exceptionally large supply of opiod narcotics to fill up. Incomplete filling
of the receptor, characteristic of withdrawal from the drug, is ineffective in
pain analgesia. The challenge in addiction medicine has been to allow the patient
to withdraw from the narcotic agent, while satisfying the needs of the mu receptor.
Most pain addiction programs have been unsuccessful in answering this dilemma.
While counseling programs are useful for learning how to cope with narcotic withdrawal,
they fail to ameliorate the disrupted mu receptor.
In the last ten years, a new drug agent, Buprenorphine, has been developed, which
may satisfy the mu receptor deficiency in narcotic withdrawal. While narcotic
drugs act as full "agonists," or mu receptor fillers, Buprenorphine
is a partial agonist for the mu receptor. Whereas the opiate effect for a narcotic
is linear in analgesically shutting down pain sensation and systemic consciousness,
Buprenorphine is limited in analgesically quieting the system. From a practical
viewpoint, Buprenorphine satisfies pain needs analgesically but eliminates the
withdrawal effects encountered in narcotics discontinuation. A patient who is
addicted to 60 Norco or Vicodin tablets daily (there are many out there) can
literally be cut off the entire dose in days with Buprenorphine – with
no withdrawal, no cravings, and no pain intensification.
Unfortunately (or fortunately) Buprenorphine may NOT be prescribed by any practitioner
who is not trained in its use. The special training is not arduous, but uncertified
practitioners are prohibited from Buprenorphine prescription. Furthermore, the
number of patients a practitioner may detoxify with Buprenorphine is limited
initially. Nonetheless, many patients can be referred to Dr. Gracer or other
pain medicine specialists for narcotic detoxification now. Dr. Gracer's
book describing Buprenorphine and integrative medicine strategies for addiction
control, A New Prescription for Addiction: Subutex,
Prometa, Vivitrol and Campral – the
Revolutionary New Treatments for Alcohol, Cocaine, Methamphetamine and Prescription
Drug Addiction, is available at Amazon.com.
For information about Gracer Behavior Health Services in San Ramon, California,
please visit www.gracermd.com.
the author, email firstname.lastname@example.org.
To join the Orthomolecular Health-Medicine Society and/or get information about
future meetings, visit www.ohmsociety.com or
call 415-922-6462. To order CDs of the February meeting, contact PAR by emailing
PAR4AUDIO@aol.com or call 909-593-1862.
Oral Chelation and Mercury Toxicity
In this issue of the Townsend Letter, we examine the role mercury and other toxic
elements have played in causing chronic degenerative disease. In dentistry and
medicine, mercury is officially labeled as a toxin but is not considered a significant
factor in disease except in pregnancy. (However, as far as I know, dentists are
still placing amalgam fillings in the mouths of pregnant women.) Dr. Tom McGuire's
many years in the dental field has provided him a breadth of experience in examining
dental mercury's role in causing chronic mercury poisoning. He reviews
the strategies needed to successfully detoxify mercury. Dr. Hal Huggins is internationally
recognized for his stance on mercury dental toxicity. Dr. Huggins has established
protocols for removal of amalgams and testing of varying dental materials for
successful dental restorations. Huggins has also documented the toxicity of root
canals as well as dental micro-abscesses in the jawbone underlying infected teeth
as a major oversight in dentistry. His important work is updated in this month's
issue. Dr. Garry Gordon, MD has been recognized internationally for his long-standing
work in intravenous and oral chelation. Dr. Gordon's two-part article on
chelation is a must read for anyone interested in the detoxification of mercury,
lead, and other toxic elements.
We are also pleased to publish reports on the efficacy of oral and suppository
chelation by Partain et al., Payne-Salomon, and Braid. David Quig, PhD, of Doctor's
Data, considers the challenges and difficulties posed in detoxification of metals
by intravenous and oral chelation. While the academic medical institutions generally
define metal toxicity based on measurements of serum levels, Quig
notes the preferred method of defining tissue toxicity is based on measuring
levels in the urine
post-chelation treatment challenge.
Kinesiology Evaluation in the Treatment of Neurologic Disorders
Jonathan Walker, MD, a neurologist, submits a case review of migraine patients
who were treated through neural kinesiology. Dr. Walker's work offers
an alternative to migraine drug therapy. Coming in our July issue, chiropractor
Scott Cuthbert submits a case-review of Down syndrome pediatric patients treated
by chiropractic through kinesiology evaluation. His report suggests that Down
syndrome patients may have long-term improvement by early chiropractic/kinesiologic
Cancer Papers Request
We invite practitioners, researchers, and writers to submit papers, reviews,
and letters for our upcoming August/September issue, which will focus on
alternative treatments for cancer. Papers are due by June 6, 2007.