AGP Clinical Meeting; “New Developments in Medicine”
Clarion Hotel, Liffey Valley, Dublin, Saturday 17th of September 2011
The AGP likes to present advances of medicine in areas that might not be so widely
apparent. In sponsoring this meeting two medical topics were taken
1) Low Dose Naltrexone
This was done in cooperation with the LDN research trust in Britain. There are
hundreds of doctors now prescribing Low Dose Naltrexone (LDN) in Britain and
Linda Elsegood, the President on the LDN research trust organises an awareness week
every year for the past few years which ends in a meeting in some part of Britain.
This year they decided to come to Ireland for the final meeting and the AGP was glad
to associate with them.
2) Chronic Cerebral Spinal Venous Insufficiency (CCSVI)
A new reality in medicine discovered by Prof. Zamboni in Feraro, Northern Italy
about four years ago. Prof. Zamboni a vascular surgeon and researcher decided to
ultrasound everybody’s venous system in the neck and chest particularly those people
with Multiple Sclerosis as he had developed a particular interest in that disease.
Much to his surprise it was discovered that the jugular venous system and the azygous
venous system in the chest were often abnormal in people with Multiple Sclerosis.
According to his studies over ninety percent of people with Multiple Sclerosis had
moderate to severe degree of narrowing of one or other vein drainage system. This is
been checked both in America and other parts of the world and his finding is correct.
Prof. Zamboni has developed software for the use of the ultrasound machines used in
this procedure and Dr. Vic Fernando, Radiologist from London who is skilled in their
use along with Mr. Donald Reid, Consultant Vascular Surgeon Lanachshire, Scotland
attended. Mr Reid has done nearly two hundred dilatations of the jugular and/or
azygous veins in people who present with this condition. In other parts of the world
stents are being put in to stop the blockage and the world leader in this is Prof. Ivo
Petrov in the Japanese hospital, Sofia, Bulgaria who has treated fifteen hundred cases
with a combination of dilatation/ballooning and stenting.
Morning session: LDN (Low Dose Naltrexone).
Dr. Patrick Crowley GP, Kilmoganny gave his understanding of the development of
the therapy using Naltrexone in low dosage. This involved the research done by Dr.
Bernard Bihari, a Neurologist in New York who was head of research for the city
authority during the Aids epidemic and was looking for any therapeutic agent that
would improve the function of the immune system. A so called ‘designer drug’
Naltrexone had been developed for the use of addiction patients (heroin) to try and get
them off their addiction. This involved using Naltrexone, an opiate analogue in doses
of 50 to 150mg a day. It worked quite well in stopping the people taking their
addictive substance but they didn’t feel well on it and it was very a hugely successful
drug. It was subsequently produced as a long acting injection and used in America
and Australia with some success in all forms of addiction including alcohol.
Although it is significantly good in its primary affect the secondary effects or side
effects rendered it unusable by a large number of people. Dr. Bihari subsequently
started to experiment with the drug in his research in New York by reducing the
dosage to see what affect it would have. He already knew that the drug tripled the
endorphin levels and rejigged the T cell mechanism and that this could have a very
beneficial effect. By reducing the drug from 50mg down to 40, 30, 20, 10 and then
5mg he discovered that he could get the same effect using 3 to 5mg of Naltrexone that
you would get with the higher dosage particularly in relation to endorphin levels. He
therefore started to use it in HIV positive patients at the lower dosage of 3 to 5mg and
was reasonably successful at this as many of them did not progress to full blown Aids.
When Dr. Bihari returned to his Neurological practice after his period as head of
research he began to use LDN in the treatment of Multiple Sclerosis (MS) and found
that many of his patients did very well and that there was no progress of the condition.
He also used it in other auto immune conditions generally and had similar success in
many of them. Dr. Crowley went to New York in 2005 and had an extensive
interview with Dr. Bihari who convinced him that it was a valuable therapy. He has
been using it increasingly since then in all forms of auto immune conditions and has
had some notable success particularly in relation to people with MS, Lupus,
Fybromyalgia, ankleosing spondylitis and other auto immune conditions. Low Dose
Naltexone is practically non toxic and can be used in so many different conditions.
Dr. Bihari died after a stroke in 2010 and on the first anniversary of his death an hour
long interview with him which was made in the early 2000’s was put up on a website
called honestmedicine.com. People who wish to know more about that Dr. Bihari’s
work would do well to consult this. Also the official American website for more
information on this is lowdosenaltrexone.org. Essentially the patients are driving the
movement for use of LDN.
Mr. Skip Lenz and Mr. Brendan Quinn (both chemists one from Florida and the other
from Gort, Co. Galway) talked about the chemistry of LDN, its production and
distribution. Because the Naltrexone tablet is 50mg you need compounding facilities
to get the low dose correctly. There are many compounding chemists still in the
United States but there were none left in Ireland and Mr. Brendan Quinn got in the
equipment and started to make up the medication in the dosage required. However
the Irish Medicines Board eventually closed him down and now Q &M specials, a
pharmaceutical manufacturing company in Lismore, Co. Waterford makes low dose
naltrexone on a wholesale basis for supply to chemists. Mr. Skip Lenz is one of the
biggest suppliers of it in the United States with many thousands of customers and he
said that the feedback from the people over the ten years he has been prescribing it is
essentially very positive.
Next we had some patient case histories. Their were two patients with cancer, one of
lung and one of bowel who had been taking LDN. The work of Prof. Ian Zagon in
Penn State University over forty years with Low dose Naltrexone has concluded that
cancer cell metabolism is slowed up by the use of Low Dose Naltrexone and it can be
quite useful. He has produced over two hundred and twenty research papers with his
assistant Dr. Flanagan a great number of them in relation to cancer and Low Dose
Naltrexone. It is largely ignored as most of the oncologists do not seem to be aware
of it. Linda Elsegoode from the British LDN research trust who has Multiple
Sclerosis and has been using LDN for many years gave her case history as did a
number of people with Fybromyalgia and Rheumatoid type Arthritis.
Next item was meant to be Dr. Burton Burkson from New Mexico, USA who was one
of the main protaganisists for the use of LDN particularly in Cancer with other
substances such as alphalipoic acid. Dr. Burkson is the world leader in this field and
his story can also be viewed by going into the website honestmedicine.com.
Unfortunately Dr. Burkson had been very ill a few weeks previously with pneumonia
and was not able to fly and therefore could not be present. He sent his apologies and
did a skype interview with Dr. Crowley who gave the main contents of that to the
Next was Dr. Phil Boyle from the Galway clinic. Dr. Boyle is an expert in the use of
LDN as it was his sister Mary Boyle Bradley in New York who first put us in contact
with Dr. Bihari. She had been wanting to get her husband who has a diagnosis of MS
to Dr. Bihari and eventually he did start on LDN and did quite well. She subsequently
published a book on the subject called ‘Up the creak with a paddle’ which can be got
on the web. Dr. Boyle is a fertility expert working in Galway and Dublin and uses a
technique developed in America which includes the use of LDN as part of the
programme. His experience of using LDN has been very positive and while it is not a
penacea for all it is quite a useful drug particularly in any autoimmune condition.
After this a panel discussion with Dr. Crowley, Brendan Quinn, Skip Lenz, John
Donnelly, Linda Elsegoode, Dr. Boyle and Dr. Gilhooley took place fielding
questions from the floor and this was a generally positive experience for everybody.
Afternoon session Chronic Cerebral Spinal Venous Insufficiency (CCSVI).
Dr. Tom Gilhooley a GP from Glasgow spoke. His practice takes a special interest in
Multiple Sclerosis. Dr. Gilhooley uses LDN with other therapies and was familiar
with Professor Zamboni’s work in Italy and went to see him. Various doctors around
the world who have been involved in the research were known to him and he talked to
some surgeons in Scotland about starting this work in the UK. He introduced the
meeting to Mr Donald Reid, Consultant Vascular Surgeon in Lanarkshire, Scotland
who has started work in this field. Mr Reid gave an account of his experience so far
in dealing with this new condition. It has long been postulated that there is a
neurovascular factor involved in MS which may involve the leakage of iron into the
brain area and which may be related to anomalies in the venous system in the brain
such as narrowing of the jugular veins in particular. There is a new international
society for neurovascular diseases which has many prominent surgeons and
radiologists from around the world. Their second meeting will be on the 18th to 22nd
February 2012 in Orlanda Florida. A Polish doctor, Dr. Simca and Professor Robert
Zidandinof, Professor of neurology in the University of Buffalo are heavily involved
in the promotion of this new research. Mr Reid stated that it was too early yet to be
sure of any outcomes for the therapy but that ongoing research was being done around
the world particularly in Europe and the Middle East and Japan. It was his impression
at this stage (he is carrying on the research in Scotland) that a certain number of
people definitely got some improvement whether temporary or permanent in the
condition of MS and that further research is needed to quantify it on a long term basis.
So far it is only available on a private basis in the UK but he is working towards
establishing it as a registered therapy which would be available on the NHS. The next
speaker was Mr Gianafranco Compalani, a Cardiac surgeon in the Royal Victoria
Hospital Belfast who has had MS for many years and has had two ballooning
procedures of his jugular veins done in Italy where he originally comes from. He is
quiet enthusiastic about the therapy saying that it has definitely helped him in his
mobility and he looks forward to the ongoing research.
Next to speak was Dr. Nick Fernando, a Radiologist from London who uses Prof.
Zamboni’s techniques for Doppler scanning of the jugular and azygous veins. The
only person doing it in Ireland is Monica Healy in Dublin who is a sonographic expert
who has taken a particular interest in this and has gone to Poland for training. Dr.
Fernando took a number of patients in the audience and demonstrated his technique
with a machine that was supplied by a company in Ireland. It is a procedure that has
to be done with the highest expertise and with the proper equipment as without this
there can be many false negatives.
Finally there was a panel discussion with the various people involved in this
procedure answering questions from the floor and the meeting was concluded with the
hope that this particular research would gain substantial benefits for people suffering
with MS. There is no surgeon in Ireland performing any intervention therapy so
patients who require this therapy have to go abroad at present. Dr. Crowley stated
that he had been in Scotland and Sofia in Bulgaria in theatre with various surgeons
during the procedure. Angiography studies using dye positively concluded that the
narrowing of the jugular veins or azygous veins on sonography was confirmed before
any intervention procedure was preformed. This intervention procedure more
commonly was the ballooning of the vein to open it. In the theatre it was seen to
create a much more normal blood flow in the vein. In some parts of the world (Prof.
Ivo Petrov in Sofia Bulgaria) stenting is now used also and Mr. Reid would hope to
proceed to this when he has enough experience of the general condition in a larger
number of patients. This concluded the business of the meeting.
There were about a hundred people at the meeting with about twenty doctors and
people in general were very interested in these two items which had been sponsored
by the AGP.
Patrick Crowley MB
Medical Council Reg No: 003783
Secretary of the AGP