Candidiasis Chronic

Overview: Candidiasis, Chronic

Positive demonstration of yeast overgrowth on stool culture

Higher than normal levels of candida antibodies or antigens in the blood

• An overgrowth in the gastrointestinal tract of the usually benign yeast (or fungus) Candida albicans is now becoming recognized as a complex medical syndrome called chronic candidiasis, or the yeast syndrome.

• Specifically, the overgrowth of candida is believed to cause a wide variety of symptoms in virtually every system of the body, with the gastrointestinal, genitourinary, endocrine, nervous, and immune systems being the most susceptible.

Important points to consider

• Normally, Candida albicans lives harmoniously in the inner warm creases and crevices of the digestive tract and in the vaginal tract in women. However, when this yeast overgrows, or when immune system mechanisms are depleted, or when the normal lining of the intestinal tract is damaged, the body can absorb yeast cells, particles of yeast cells, and various toxins.

• As a result, there may be significant disruption of body processes resulting in the development of the yeast syndrome.

• This syndrome is characterized by patients saying they “feel sick all over.” Fatigue, allergies, immune system malfunction, depression, chemical sensitivities, and digestive disturbances are just some of the symptoms patients with the yeast syndrome may experience.

  
  

The typical patient with the yeast syndrome is female; women are eight times more likely to experience the yeast syndrome than men, due to the effects of estrogen, birth-control pills, and the higher number of prescriptions for antibiotics.

Predisposing Factors to Candida Overgrowth

• Altered bowel flora

• Decreased digestive secretions

• Dietary factors

• Drugs (particularly antibiotics)

• Impaired immunity

• Impaired liver function

• Nutrient deficiency

• Prolonged antibiotic use

• Underlying disease states

Prolonged antibiotic use is believed to be the most important factor in the development of chronic candidiasis. Antibiotics suppress the immune system and the normal intestinal bacteria that prevent yeast overgrowth, strongly promoting the proliferation of candida.

While the appropriate use of antibiotics makes good medical sense, using them for such conditions as acne, recurrent bladder infections, chronic ear infections, chronic sinusitis, chronic bronchitis, and nonbacterial sore throats does not. The antibiotics rarely provide benefit, and these conditions can be effectively treated with natural measures.

Integrative therapeutics review

• If a patient presents with mild to moderate symptoms of carpal tunnel syndrome (CTS), has no thenar flattening, and has had symptoms for less than 1 year. a stepwise approach is appropriate. Most therapies can be combined with nighttime splinting. If a patient has unrelenting numbness or pain or a history of symptoms lasting longer than I year, a thorough examination should be conducted to ensure a correct diagnosis, and then referral to a surgeon specializing in CTS release may be the most appropriate therapy.

• If a patient presents with thenar atrophy, this indicates long-standing neurologic compromise, so more aggressive diagnostic and therapeutic options should be given priority.

Lifestyle Changes

• Have the patient

• Reduce activities that bring on symptoms.

• Take frequent breaks to rest hands.

• Perform stretching or strengthening exercises for the hands (see Fig. 66-2).

Splint Therapy

• The patient should wear a splint as often as possible, even during the day if tolerated.

• Start with a rigid over-the-counter appliance first. ensuring proper fit and prevention of wrist flexion.

• Better results may be achieved with the wrist held in neutral position rather than extended. Reconsider therapy if no benefit is seen after 3 weeks.

Yoga

• A patient who is willing to try yoga, despite the cost of an individualized program, may see some benefit from it.

Ginger

• The dose of Eurovita Extract 33 is 170mg three times/day or 255 mg twice/day

• Ginger may be of benefit in patients with both osteoarthritis and CTS, as well as in pregnant patients with CTS and nausea or vomiting.

• Ginger should be used with caution in patients taking anticoagulants.

Osteopathic Manipulative Treatment

• Osteopathic manipulative treatment (OMT) can be done in combination with other therapies.

• In addition to OMT in the office (see Fig. 66-1), patients can do self-stretching exercises at home (see Fig. 66-2) 5 to 10 times/day until symptom resolution or for 2 to 3 weeks, at which point reassessment is warranted if no improvement has occurred.

Oral Steroids

• Prednisolone is taken at 20 mg/day for 2 weeks.

• The use of steroids in pregnancy is controversial.

Steroid Injection

• Injection of methylprednisolone acetate, 20 mg mixed with 1 ml. of 1% lidocaine, into the carpal canal by a physician trained in this procedure may offer some relief of symptoms. It may also delay the need for surgery.

• Use of more than three doses in I year suggests a need for surgical intervention.

Ultrasound

• Although costly and time consuming, ultrasound may be beneficial in patients with mild to moderate CTS. It can be combined with splint therapy, OMT, or medications.

Traditional Acupuncture

• Acupuncture can be used as a possible alternative to surgery for mild CTS.

• It may be costly and is usually not covered by medical insurance.

Surgery

• Surgery is likely most useful for patients with unrelenting pain or numbness, thenar atrophy, or treatment failure with other modalities.

• The clinician must be certain of the diagnosis and must choose a surgeon who has performed many CTS procedures.

• Referral to a CTS specialist for evaluation is recommended before surgery is suggested to the patient.

• Surgery is not advised for pregnant patients with CTS, which will probably resolve with delivery.

• Indications for surgery are unrelenting pain, thenar eminence atrophy, loss of motor function with diminished finger strength, and failure of other treatments.

Key Web Sources

• http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm

• http://www.medicinenet.com/carpal_tunne_syndrome/article.htm

• http://www.assh.org/Public/HandConditions/Pages/Carpal_Tunnel_Syndrome.aspx