GREAT post Martin.  Very informative, well-balanced, and humanitarian
without neglecting the need for scientific rigor.


(Cross-posted to alt.psychology.personality since some personality typing
will be discussed at the beginning - Note: I've set all followups to sci.med
since most of my comments are more sci.med oriented and I'm sure most of the
replies, if any, will be med-related.)




They are just responding in their natural way:  Hyper-Choleric Syndrome (HCS).
Oops, that is not a recognized "illness" in the psychological community,
better not say that since it therefore must not, and never will, exist.  :^)

Actually, it is fascinating that a disproportionate number of physicians
will type out as NT (for those not familiar with the Myers-Briggs system,
just e-mail me and I'll send a summary file to you).  In the general
population, NT's comprise only about 12% of the population, but among
physicians it is much much higher (I don't know the exact percentage -
any help here a.p.p.er's?)

One driving characteristic of an NT, especially an NTJ, is their obvious
choleric behavior (driver, type A, etc.) - the extreme emotional need to
control, to lead, and/or to be the best or the most competent.  If they are
also extroverted, they are best described as "Field Marshalls".  This trait
is very valuable and essential in our society - we need people who want to
lead, to strive to overcome the elements, to seek and thirst for knowledge,
to raise the level of competency, etc.  The great successes in science and
technology are in large part due to the vision (an N trait) and scientifically-
minded approach (T trait) of the NT personality (of course, the other types
and temperaments have their own positive contributions as well).  However,
when the NT person has self-image challenges, the "dark-side" of this
personality type usually comes out, which should be obvious to all.

A physician who is a strong NT and who has not learned to temper their
temperament will be extremely business-like (lack of empathy or feeling),
and is very compelled to have total control over their patient (the patient
must be obedient to their diagnosis and prescription without question).  I've
known many M.D.'s of this temperament and suffice to say I don't oblige them
with a followup visit, no matter how competent I think they are (and they
usually are very competent from a knowledge viewpoint since that is an
extreme drive of theirs - to know the most, to know it all).

Maybe we need more NF doctor's.  :^)

Enough on this subject - let's move on to candida bloom.



You've helped me already by your post.  Of course, I believe that I have
been misdiagnosed on the net as suffering from 'anal retentivitis', but being
the phlegmatic I am, maybe I was just a little too harsh on a few people
myself in past posts.  Let's all try to raise the level of this discussion
above the level of anal effluent.



In my well-described situation (in prior posts), I definitely was immune
stressed.  Blood tests showed my vitamin A levels were very low.  My sinuses
were a mess - no doubt the mucosal lining and the cilia were heavily damaged.
I also was on antibiotics 15 times in 4 years!  In the end, even two weeks
of Ceftin did not work and I had confirmed diagnoses of a chronic bacterial
infection of the sinuses via cat-scans, mucus color (won't get into the
details), and other symptoms.  Three very traditional ENT's made this
diagnosis (I did not have any cultures done, however, because of the
difficulty of doing this right and because my other symptoms clearly showed
a bacterial infection).  Enough of this background (provided to help you
understand where I was when I make comments about my Sporanox anti-fungal
therapy below).


The first question I have is this.  Can fungus penetrate a little way into poor
mucus membrane tissue, maybe via hyphae, thus causing symptoms, without being
considered 'systemic' in the classic sense?  It is sort of an inbetween
infection.



I was concerned, too, because of the toxicity of vitamin A.  My doctor, after
my blood tests, put me on 75,000 IU of vitamin A for one week only, then
dropped it down to 25,000 IU for the next couple of weeks.  I also received
zinc and other supplementation, since all of these interrelate in fairly
complex ways as my doctor explained (he's one of those 'evil' orthomolecular
specialists).  I had a blood test three weeks later and vitamin A was normal,
he then stopped me on all vitamin A (except for some in a multi-vitamin)
supplement), and made sure that I maintain a 50,000 IU/day of beta carotene.
Call me carrot face.  :^)

Hopefully, Elaine's doctor will take a similar, careful approach and to
all supplements.  I'm even reevaluating some supplements I'm taking, for
example, niacin in fairly large dosages, 1 gram/day, which Steve Dyer had
good information about on sci.med.nutrition.  If niacin only has second-order
improvement in symptomatic relief of my sinus allergies, then it probably is
not worth taking such a large dose long-term and risking liver damage.



Though I do now believe, based on my successful therapy with Sporanox, that
I definitely had some excessive growth of fungus (unknown species) in my
sinuses, I still want to ask the question:  have there been any studies that
demonstrate candida "blooms" in the sinuses with associated sinus irritation
(sinusitis/rhinitis)?  (My sinus irritation reduced significantly after one
week of Sporanox and no other new treatments were implemented during this
time - I did not have any noticeable GI track problems before starting on
Sporanox, but some for a few days after which then went away - considered
normal).

BTW, my doctor dug out one of his medical reference books (sorry, can't
remember which one), and found an obscure comment dating back into the 1950's
which stated that people can develop contained (non-lethal or non-serious)
aspergillis infestations (aspergiliosis) of the sinuses leading to sinus
inflammation symptoms.  I'll have to dig out that reference again since it
is relevant to this discussion.



My doctor tested me (I believe a RAST or RAST similar test) for allergic
response to specificially Candida albicans, and I showed a strong positive.
Another question, would everybody show the same strong positive so this test
is essentially useless?  And, assuming it is true that Candida can grow
part-way into the mucus membrane tissue, and the concentration exceeds a 
threshold amount, could not a person who tests as having an allergy to
Candida definitely develop allergic symptoms, such as mucus membrane
irritation due to the body's allergic response?  As I said in an earlier post,
one does not need to be a rocket scientist, or have a M.D. degree or a 
Ph.D. in biochemistry to see the plausibility of this hypothesis.

BTW, and I'll repost this again.  Dr. Ivker, in his book, "Sinus Survival",
has routinely given, before anything else, Nizoral (a pre-Sporanox systemic
anti-fungal, not as safe and not as good as Sporanox) to his new chronic
sinusitis patients IF they have been on antibiotics four or more times in
the last two years.  He claims that out of 2000 or so patients, well over
90% notice some relief of sinus inflammation and other symptoms, but it
doesn't cure it by any means, implying the so-called yeast/fungus infection
is not the primary cause, but a later complication.  He's also found that
nystatin, whether taken internally, or put into a sinus spray, does not help.

This implies (of course assuming that excessive yeast/fungus bloom is
aggravating the sinus inflammation) that the yeast/fungus has grown partway
into the tissue since nystatin will not kill yeast/fungus other than by
direct contact - it is not absorbed into the blood stream.  Again, I admit,
lots of 'ifs', and 'implies', which doesn't please the hard-core NT who
has to have the double-blind study or it's a non-issue, but one has to start
with some plausible hypothesis/explanation, a strawman, if you will.



This brings up an interesting observation used by those who will deny
and reject any and all aspects of the 'yeast hypothesis' until the
appropriate studies are done.  And that is if you can't observe or culture
the yeast "bloom" in the gut or sinus, then there's no way to diagnose or
even recognize the disease.  And I know they realize that it is virtually
impossible to test for candida overbloom in any part of the body that cannot
be easily observed since candida is everywhere in the body.

It's a real Catch-22.

Another Catch-22:  Those who totally reject the 'yeast hypothesis' say that
no studies have been done (actually studies have been done, but if it's not
up to a certain standard then it is, from their perspective, a non-study which
should not even be considered).  I agree that the appropriate studies should
be done, and that will take big $ to do it right.  However, in order to
convince the funding agencies in these austere times to open their wallets,
you literally have to give them evidence, and the only acceptable evidence to
compete with other proposals is paradoxically to do almost the exact study
needed funding.  That is, you have to do 90% of the study before you even get
funding (as a scientist at a National Lab, I'm very aware of this for the
smaller funded projects).  I'm afraid that even if Dr. Ivker and 100 other
doctors got together, pooled their practice's case histories and anecdotes
into a compelling picture, and approach the funding agencies, they would get
nowhere, even if they were able to publish their statistical results.

It is obvious from the comments by some of the doctors here is that they have
*decided* excessive yeast colonization in the gut or sinuses leading to
noticeable non-lethal symptoms does not exist, and is not even a tenable
hypothesis, so any amount of case histories or compiled anecdotal evidence
to the contrary will never change their mind, and not only that, they would
also oppose the needed studies because in their minds it's a done issue - 
excessive yeast growth leading to diffuse allergic symptoms does not, will
not, and cannot exist.  Period.  Kind of tough to dialog with those who hold
such a viewpoint.  Kind of reminds me of Lister...



Aren't there also other nutrients necessary to the proper working of the
sinus mucus membranes and cilia?



Again, the evidence from mycological studies indicate that many yeast/fungus
species can grow hyphae ("roots") into deep tissue, similar to mold growing
in bread.  You can continue to kill the surface, such as nystatin does, but
you can't kill that which is deeper in the tissue without using a systemic
anti-fungal such as itraconazole (Sporanox) or some of the older ones such
as Nizoral which are more toxic and not as effective.  This is why, as has
been pointed out by recent studies (sent to me by a doctor I've been in
e-mail contact with - thanks), that nystatin is not effective in the long-
term treatment of GI tract "candidiasis".  It's like trying to weed a garden
by cutting off what's above the ground but leaving the roots ready to come
out again once you walk away.

The $60000 question is whether a contained candida "bloom" can partially
grow into tissue through the mucus membranes, causing some types of symptoms
in susceptible people (e.g., allergy), without becoming "systemic" in the
classical sense of the word - something in between strictly an excessive
bloom not causing any problems and the full-blown systemic infection that
is potentially lethal.



Also, if one is an 'anal retentive', like I've been diagnosed in a prior
post, that can also provide more sites for excessive candida growth.  ;^)



As I've said in private e-mail, there are flaws in our current medical system
that make it difficult or even impossible for a physician to attempt
alternative therapies AFTER the approved/proven/accepted therapies don't work.
For example, I went to three ENT's, who all said that I will just have to live
with my acute/chronic sinusitis after the ab's failed (they did mention
surgery to open up the ostia, but my ostia weren't plugged and it would not
get to the root cause of my condition).  After three months of aggressive and
fairly non-standard therapy (Sporanox, body nutrient level monitoring and
equalization, vitamin C, lentinen, echinacea, etc.), my health has vastly
improved to where I was two years ago, before my health greatly deteriorated.
Of course, skeptics would say that maybe if I did nothing I would have
improved anyway, but that view is stretching things quite far because of the
experience of the three ENT's I saw who said that I'd just have to "live with
it".  I'm confident I will reach what one could call a total "cure".  The
anti-fungal program I undertook was one necessary step in that direction
because of my overuse of ab's for the last four years.  (Note:  for those
having sinus problems, may I suggest the book by Dr. Ivker I mention above.
Be sure to get the revised edition.)



Dr. Ivker started off having chronic and severe sinus problems, and his
visits to several ENT's totally floored him when they said "you'll just have
to live with it".  He spent several years trying everything - standard and
non-standard, until he was essentially cured of chronic sinusitis.  He now
shares his approach in his book and I can honestly say that I am on the road
to recovery following some parts of it.  His one recommendation to take a
systemic anti-fungal at the beginning of treatment IF you have a history of
anti-biotic overuse has been proven to him time and time again in his own
practice.  I'm sure if I commented to him of the hard-core beliefs of the anti-
"yeast hypothesis" posters that he would have definite things to say, such as,
"it's worked wonders for me in almost two thousand cases", to put it mildly.
I also would not be surprised if he would say that they are the ones violating
their moral obligations to help the patient.

Maybe those doctors who are reading this who have a practice and are
confronted by a patient having symptoms that could be due to the "hypothetical
yeast overgrowth" (e.g., they fit some of the profiles the pro-yeast people
have identified), should consider anti-fungal therapy IF all other avenues
have been exhausted.  Remember, theory and practice are two different things -
you cannot have one without the other, they are synergistic.  If a doctor does
something non-standard yet produces noticeable symptomatic relief in over a
thousand of his patients, shouldn't you at least sit up and take notice?
Maybe you ought to trust what he says and begin hypothesizing why it works
instead of why it shouldn't work.  I'm afraid a lot of doctors have become
so enamored with "scientific correctness" that they are ignoring the patients
they have sworn to help.  You have to do both;  both have to be balanced, which
we don't see from some of the posters to this group.  There comes a point when
you just have to use a little common sense, and maybe an empirical approach
(such as trying a good systemic anti-fungal such as Sporanox) after having
exhausted all the other avenues.  I was one of those who the traditional
medical establishment was not able to help, so I did the natural thing:  I
went to a couple of doctor's who are (somewhat) outside this establishment,
and as a result I have found significant relief.

Would it not be better if the traditional medical establishment can set up
some kind of mechanism where any doctor, without fear of being sued or having
his license pulled, can try experimental and unproven (beyond a doubt)
therapies for his/her patients that finally reach the point where all the
accepted therapies are ineffective?  I'd like to hear a doctor tell me:
"well, I've tried all the therapies that are approved and accepted in this
country, and since they clearly don't work for you, I now have the authority
to use experimental, unproven techniques that seem to have helped others.  I
can't promise anything, and there are some risks.  You will have to sign
something saying you understand the experimental and possibly risky nature of
these unproven therapies, and I'll have to register your case at the State
Board."  Anyway, if my ENT had suggested this to me, I would've jumped on this
pronto instead of going to one of those doctors who, for either altruistic
reasons, or for greed, is practicing these alternative therapies with much
risk to him/her (risk meaning losing their license) and possibly to the
patient.  Such a mechanism would keep control in the more mainstream medicine,
and also provide valuable data that would essentially be free.  It also would
be morally and ethically better than the current system by showing the
compassion of the medical community to the patient - that it's doing everything
it can within reason to help the patient.  It is the lack of such a mechanism
that is leading large numbers of people to try alternative therapies, some of
which seem to work (like my case), and others of which will never work at all
(true quackery).

I better get off my soapbox before this post reaches 500K in size.



What dosage of B6 appears to be necessary to promote the healing and proper
working of the mucos memebranes?



I'd like to see the role of complex carbohydrates, such as starch.



Brave soul you are.  The venom on Usenet can be quite toxic unless one
develops an immunity to it.  One year ago, my phlegmatic self would have
backed down right away from an attack of cholericitis.  But my immune
system, and my computer system, have been hardened from gradual
desensitization.  I now kind of like being called "anal retentive" - it has
a nice ring to it.  I also was very impressed by how it just flowed into the
post - truly classic, worthy of a blue (or maybe brown) ribbon.  I might
even cross-post it to alt.best.of.internet.  Hmmm...



Thanks again for a great and informative post.  I hope others who have
researched this area and are lurking in the background will post their
thoughts as well, no matter their views on this subject.

Jon Noring


-- 

Charter Member --->>>  INFJ Club.