Systemic Mycotoxin Management In The Paranasal Sinuses : A Treatment Protocol

Transcription

1 Systemic Mycotoxin Management In The Paranasal Sinuses : A Treatment Protocol Donald Dennis, MD, FACS 3193 Howell Mill Rd., Suite 215 Atlanta, GA ddennis@sinussurgery.com

2 3. All Mycotoxins Enter Through the Nose Into the Sinuses, Lungs and Entire System: Sinus Mucosa Has Highest Concentration Air Quality is key in prevention & and recovery So Clean the air, clean the nose, clean the home & clothes Sinus5.com 2

3 3 Key Facts About Environmental AIR & Health 1. The air you breathe is 5X more important to your health than all treatment rendered by hospitals, doctors & medication 2. The air you breathe is 2X more important to your health than your genetic code 3. Nearly 60% of all preventable deaths are due to the air conditions at home and work Rishi Manchanda TED.com Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA

4 Antigen Removal is the SINGLE Most Powerful Rx Control MOLD and you control Chronic Sinusitis & Systemic Inflammation. Air Quality is key! At what Air Quality level does Chronic Sinusitis clear endoscopically? 1. Particle Count of 0.3 microns per 0.1 cu. ft. 2. Mold count of 0-4 colonies with 1 hour gravity plate exposure, 0-2 for severely ill patients Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 4

5 The Mold count IS THE SAME IN BOTH OF THESE ROOMS. Counts can be toxic & invisible, 6/19/ Both Plates show high levels of mold present when exposed to the air for 1 hour. Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 5

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7 Before & After Mold Remediation Endo Photos 48 colonies Mold count below 4 colonies Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 7

8 Nasal Candidiasis & polyps resolves 3wks post Amphotericin, CitriDrops Spray, GSE 75mg po Bid 8

9 Aspergillus Sphenoid Sinus, Failed Previous Surgery Nose, Aspergillus TNTC & Penicillium TNTC Bath-T Den 30 Car 123 Aspergillus & Penicillium in all areas + Stachybotrys in car LR 14 M Br 15 Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 9

10 GET SINUS CT: Fungus Ball in Ethmoid & Sphenoid Sinus. Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 10

11 Fungus Ball Calcium Shown In CT Scan 11

12 GET SINUS CT on all fungal exposed patients: Fungus Ball in Ethmoid. Brown Trichothecene in Sinus mucosa caused ataxia & leg muscle atrophy, No improvement with treatment & beach environment because mycotoxins were locked in sinus mucosa. No clinical improvement with max therapy requires endoscopic removal of all mycotoxin containing mucosa & opening of all sinuses with intra op irrigation with Amphotericin-B and post op nebulization with Amphotericin-B (DL) BrownTrichothecene from brown "sinus mucosa leaching Trichothecenes into agar media.28 ppb causing muscle atrophy walking problems(ataxia). Muscle fasciculations resolved day of surgery Small white density in ethmoid sinus indicates likely fungus Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA Sinus Tissue containing mycotoxins.28 ppb 12

13 Trichothecenes and Aflatoxin create Brown Halo around mucosa as they leach out of the sinus mucosa into agar. Note no Brown Halo around sinus mucosa without Trichothecenes Trichothecenes 0.28 ppb Brown Halo No Brown Halo, No Trichothecenes Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA

14 Mycotoxin Halo Around Sinus Mucosa on SDA Agar Sinus mucosa Sinus mucosa Aflatoxin ppb Aflatoxin 2.20 ppb Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA

15 BrownTrichothecenes Isolated From Small Density in R.Ethmoid Sinus Mucosa. R. Sphenoid Sinus Aspergillus Fungus Ball, Mucosa Must Be Removed & Irrigated with Amphotericin-B to Resolve Trichothecene Mycotoxcosis Neurotoxicity (AS) Aspergillus Fungus Ball in Supra mucosa on CT scan 2 Aspergillus Fungus Balls in both supra mucosal & Subperiosteal planes. Note thickened periosteum Small mucosal density is full of Trichothecenes Aspergillus & Trichothecenes on SDA agar Note subpperiosteal Aspergillus fungus ball Aspergillus fungus ball Brown Trichothecene leaching from small ethmoid sinus mucosal lesion Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 15

16 Protect yourself from Mycotoxins when seeing these patients using isolation gowns. 100% O2 & EC3 Mold Fogger Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 16

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18 Environmental Treatment Protocol (ETP) Note: For Mild to Moderate Symptoms [ Severe must relocate ] 1. Natural Botanical as Spray & Candle is shown by Real Time Lab to remove mycotoxins in 3 hrs. 2. Each Room is set up with HEPA air filter with 1-2 air wicks on top, Candles, & spray mist or fog each room patient spends >= 1hr/day. 3. Double ETP until mold counts are 0-2 colonies & patient feels better BEFORE AFTER 18

19 Environmental Treatment Protocol Environmental Treatment Protocol (ETP) Improve your environment for your health until you can either fix the cause of the problem or move into a safe place where you begin to feel better by using the: Environmental Treatment Protocol (ETP) which is : 1. HEPA air filter use either IQ air or Whirlpool from National allergy supply see IQ Air here: Whirlpool here: 2. Fog or every whole house with Sanitizer fogger & EC3 to remove mold & mycotoxins here: 3.use candles in each room in which you spend one hr or longer. here: 4. Wash all clothes with EC3 laundry additive in each wash. here: 19

20 Sani Tizer Fogger on Sinus5.com 20

21 Clean the Nose & Boost the Immune System + + Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 21

22 Sinus Defense Contains Transfer Factor for: Alternaria, Aspergillus, Cephalosporium, Cladosporium, Curvularis, Epicoccum, Fusarium, Helmenthosporium, Mucor, Penicillium, Geotricum, Trichoderma Strep, Staph, Diplococcus, Haempphillus all in MRV vaccine Mold illness patients have low IgG subclasses which support coinfections Lyme s, Epstein Barr, Cytomegaly virus 9 types of Herpes we have seen oral ulcers, shingles, genital herpes resolve & remain in control in most cases Mycotoxin IgG antibody frequencies Stem Cell frequencies from patients who never get sick in severe mold toxic environments 22

23 Clinically, I find that if we: 1. Get the patient into a Mold Free Environment as soon as possible 2. Remove the mold from their nose and body Clean the nose, clean the home and clothes They get better! Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA

24 IGF-1 Was Normal in All GH Deficient Pts n= 79 IGF-1 Ave. 123 ng/ml Range Normal ng/ml 51% were GH Deficient (40 of 79) 24

25 Incidence of Anterior Pituitary Deficiency in CRS with Fungal Exposure & Fatigue: Possible Mechanism Fungal Glucan cell wall Ant. Pituitary Folliculostellate (FS) cells bind to & respond to fungal cell wall glucans resulting in stimulation of pituitary cell TLR4 and CD14 gene expression > pattern Anterior Lobe in recognition innate fungal air exposure immunity> cytokines & GH- 51% deficient macrophages. Macrophage TSH- 81% deficient rupture destroys FS ACTH 75% deficient Pituitary tissue GH TSH ACTH 44% Breuel 2004 FSH, LH, Prolactin Endorphins depression Intermediate Lobe MSH Melanocyte Stimulating Hormone Destruction of Folliculostellate Cells Disrupts: autocrine/paracrine regulation of anterior pituitary cell function via cytokines and growth factors, intrapituitary communication between various cell types, and modulation of inflammatory responses Rees DA Posterior Lobe Oxytocin ADH AVP Arginine Vasopressin 1. Significant fatigue or any compelling symptoms, Pts > 75% IGF1 not GH deff. 2. discordinant hormones relationships: Pts < 50% IGF1 are def a. Low freet3 and/or low freet4 with low TSH, b. low DHEAS (primary adrenal hormone) below10th percentile, suggesting under stimulation of the adrenal by pituitary, or low cortisol production with ACTH stimulation test. c. Menopausal females without high LH and FSH. Low LH and FSH with premenopausal low estrogen or testosterone 25

26 Serum IgG Molds IgE IgG MOLD IgG ug/ml 0/1 3 Alternaria alternata/tenuis Aspergillus fumigatus Candida albicans Cephalosporium acre Cladosporium herbarum Helminthosporium halodes Penicillium notatum/chry

27 MOLD MOLDS & THEIR MYCOTOXINS MYCOTOXIN Aspergillus flavus Aflatoxin (AT A. ochraceus Ochratoxin A (OTA) A. niger OTA Penicillium verrucosum OTA Strachybotrys chartarum Macrocyclic Trichothecenes A. fumigates Gliotoxin Chaetomium globosum Chaetoglobosin A, C Fusarium sp. Simple Trichothecenes A. Versicolor Sterigmatocystin 27

28 Treatment of Mycotoxicosis: Remove Fungus from Body, Air & Belongings! 1. Grade : Slight, Moderate, Severe see scoring 2. Must get into a safe, mold free environment and not take any belongings with them that cannot be washed in safe botanical while environment if being remediated or sold. Environmental Treatment Protocol (ETP) 3. Mycotoxins & fungi enter through the nose, get nasal mold culture, IgG molds & SINUS CT SCAN, urine mycotoxin levels as many can have sinus fungal masses which must be treated. 4. Saline nasal irrigations with Nasopure or Grossan irrigator BID 5. Antifungal nasal sprays or nebulization for more severe or pulmonary either Amphotericin or Voriconazole Pavilion Pharmacy O2 face mask 10l/min 1h BID or 2h QD, titrate if negative symptoms do not use concentrator in bad environment, use tanks liquid O2 last longer 7. Liver detox with Opticleanse GHI or Xymogen I-5 (pea) 8. Acetyl Glutathione 300mg BID or Nebulize GSH if cannot tolerate PO 9. IntraMax Vitamins & minerals organic carbon bound or separate vitamins PRN 28

29 Treatment of Mycotoxicosis: Remove Fungus from Body, Air & Belongings! 10. GERD causes: mechanical, food allergy, Candida, air fungal load, sugar, low digestive enzymes 11. Vitamin D3 get levels up to 80-90, increases immune & cancer resistance 12. HEAL GUT Inflammation: VSL #3 450 Billion/D or probiotic best tolerated, food allergies ALCAT & IgG test combine results, control Candida, ( if not improve :PRP from Colostrum, Enteragam) 13. Toxin binders: Zeolites, Glucomannan, Diatomaceous Earth. Cholestyramine (Ochratoxin only), Bentonite Clay (Ochratoxin & Aflotoxin only) 14. DIET: Yeast Diet (no sugar or refined carbohydrates. Sugar will defeat Antifungals) 15. Itraconazole (Sporonox) 100mg 1-2 BID PC titrate, or Voriconazole (Vfend) 200mg BID PC, not as effective Terbinafine (Lamisil) 250mg 1 QD, Ketoconazole (nizoral) 200mg QD 29

30 Differential for No or Little Improvement Patient s check list for why I m not better 1. >90% Fungal load continues, in Air, on belongings : History, Mold plates must be 0-2 colonies both in air & TAP test, no front loader washers or BMW cars, animals, pts react 9000X normal systemic inflammation. Must have 0-2 mold colonies to get well, or medical RX fails long term. Fungus & mycotoxin trapped in sinus mucosa, Sinus CT & ENT Consult. 2. Off DIET: NO SUGAR, Candida has sugar receptor which morphs from harmless yeast to invasive hyphal form & causes antifungal resistance 3. Pituitary not addressed need HGH, thyroid, cortisol etc. 4. Depressed immune system= Epstein Barr, CMV, Lyme s, Herpes RX TF 5. Heavy Metals 6. MTHFR test use methylb12, 5-tetrahydrofolic acid, carbon 7. Rare: cancer: lymphoma, leukemia, other Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 30

31 Conclusion Remove Antigen & Reaction Stops by Control of Air & Body Fungi Air Fungal load and air quality is Key in controlling Allergic Fungal Sinusitis (AFS) and Chronic Rhinosinusitis (CRS) Normal Saline nasal irrigation is key in removing fungal antigen and reducing inflammation from airborne antigens Antifungal and Antibiotic Nasal Sprays play a key role in long term control of Chronic Sinusitis Appropriate use of oral Antibiotics & Antifungals (Fluconazole, GSE, Terbinafine, Itraconazole, Vfend) antihistamine/decongestants is important Immunotherapy for IGE and IgG-specific molds, Neutralization, Sinus Defense with transfer factor as needed MRV (Mixed Respiratory Vaccine) vaccine for chronic Staph is helpful Endoscopic Sinus Surgery is essential for pts. who fail medical therapy and should be done ASAP Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 31

32 CASE: Mold Fibromyalgia, Severe Muscle Weakness RESOLUTION: Environmental Change, Antigen Reduction, Neutralization, Antifungals Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 32

33 BEFORE: Severe Aspergillus Aflotoxin exposure: Blind OD, OS vision decreased, L leg paralysis, L arm paresis, Neurogenic bladder. AFTER 5 WK. improved with ampho spray, sporonox, Intramax, Chelation EDTA

34 BEFORE: Mycotoxin neurotoxin affects gait and speech RESOLUTION: improves 6wks after leaving house, Glutathione, O2 100%, Sporonox, Voriconazole nasal spray, Intramax 34

35 Tremors form Mycotoxicosis Resolve with Oxygen & Recur When Oxygen Stopped Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 35

36 Muscle Fatigue & Cramps Resolve with Protocol Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 36

37 6. Brain Symptoms & Findings 37

38 QEEG &P300 Show Cognitive Dysfunction After Fungal Exposure Improves with Antigen Removal via Antifungal Nasal Nebulization No Response 38

39 EEG with Topographic Heads before & after ETP & Sprays Rx for severe AFS & Candidiasis, with fatigue, inability to concentrate to do professional work, & cognitive dysfunction Topographic heads were complied by Dr. RW Thatcher s normative database Neuroguide. Before heads (Left) show +3 standard scores (Z scores) of diffuse and bilateral high relative power levels in hertz range. Persons with excess high beta show varying degrees of cognitive dysfunction. Three weeks after Diflucan, nose sprays, environmental clean up, and eating a low carbohydrate diet, the "after heads" (Right) show normalized bilateral levels of hertz. The patient reported a return of memory, high energy, motivation in his work, and a return to normal working hours. 39

40 Systemic Candidiasis Face and Typical Symptoms IgG MOLD IgG ug/ml 0 Alternaria alternata/tenuis Aspergillus fumigatus Candida albicans Cephalosporiumacre (ASR) Cladosporium herbarum Helminthosporium halodes Penicillium notatum/chrysogenu 8.6 Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 40

41 9. Fiberglass 41

42 Fiberglass where we live & work I believe there should be a mandate requiring fiberglass to be contained in plastic and NEVER used inside air ducts. 1000s of airborne particles! Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 42

43 Severe Punctate Submucosal Hemorrhages from Fiberglass in Air Dr. Donald P. Dennis, M.D., F.A.C.S., Atlanta, GA 43