AN UNUSUAL RECOVERY

Case histories are usually despised by the medical profession, particularly if they are so called “anecdotal”. Every now and again, however, a physician will see something that is extraordinary, often not even attempting to report it because of lack of definitive data. A few years ago a lethal illness called Reye’s syndrome occurred in young children, often in relation to an outbreak of “flu”. Its cause remained a mystery for years and the treatment was usually futile. Initially thought to be caused by the “flu” virus, it was eventually tied to the administration of aspirin given to the child “to bring down the fever”. In fact it was this common home treatment that was, in the majority of cases, the cause of an unnecessary death. The word was promulgated widely and the disease is now uncommon, if not rare but there are still occasional incidences, unassociated with aspirin administration. So I am taking this opportunity to describe the case of an eighteen-month old girl who was admitted to our hospital with a diagnosis of Reye’s syndrome. In a post 0f March 16, 2011 I wrote an article entitled “A remarkable nutritional supplement” . To review this briefly, this agent is a derivative of thiamine (vitamin B1) that actually gives increased power to the vitamin and it has some remarkable therapeutic attributes that are almost completely ignored in America. This is because it is made in Japan and is regarded as a drug by the FDA. It would therefore require the expensive new drug studies by an American company to import it, even though its action is merely by an easy and fast introduction of thiamine into body cells. It is a prescription item in Japan under the trade name of Alinamin and is also known as Fursultiamine elsewhere. It has a rather long chemical name, so I will call it TTFD. I had an Independent Investigator license to study it in clinical situations and have sent in annual reports to the FDA indicating its lack of toxicity and the kind of patients treated. For technical reasons involving biochemical knowledge, I reasoned that the case of this child would be an ideal test of its therapeutic potential, particularly as I had not found the slightest evidence of toxicity from its use. The brain and particularly the lower, more primitive part, is highly sensitive to thiamine deficiency and this is associated with many dietary mistakes, the most common being the ingestion of sugar in all its different forms.
Without going into the details, the peculiarity of the disease could be seen clinically as a gradually descending paralysis of lower brain function that eventually affects the brainstem where the controls for life sustaining reflex mechanisms are situated. In most cases of Reye’s syndrome there is a huge increase in the concentration of ammonia in the blood. Although ammonia is a byproduct of liver metabolism it is toxic to the brain when it builds up. It is therefore evidence of a collapse of normal metabolism. When this eighteen-month old girl was admitted to the hospital she was comatose. Her jaw was clenched, she grunted as she breathed and there were random movements of her limbs. Her pupils reacted sluggishly to light and there was minimal response to pain. She rapidly progressed to becoming totally unresponsive to pain with little or no movement of her limbs. Her blood ammonia was extremely high and laboratory markers were observed that indicated liver toxicity. She was treated by a neurologist by a complete exchange of blood, the usual and customary treatment at that time, based on the idea that it was due to whatever toxic agent was deemed to be causative. It made no difference to her rapidly worsening status. On the following day her clinical condition had deteriorated and a respirator had to be used to control her breathing. She merely survived. One week after her hospital admission she was judged to be in a terminal state. I well remember the neurologist in charge of the case showing the child to a visiting colleague and indicating to him that there was clearly no hope of recovery. I hypothesized that the collapse of normal metabolism reflected damage in the complex mechanisms of energy synthesis and that therapeutic doses of thiamine might work since it is roughly equivalent to a spark plug in a car. It must be remembered that no conventional treatment was available and the child had been given up as hopeless.
Each tablet of TTFD contain 5o milligrams and it is also prepared in 25 milligram vials that can be given intravenously. So I started treatment with TTFD on April 21. In a 24-hour period she received 100 milligrams of crushed tablets every 4 hours by stomach tube and 150 milligrams intravenously, a total dose of 750 milligrams a day, an incredibly large dose. The Recommended Daily Allowance of thiamine is about 1 to 1.5 milligrams for a healthy person and it was long thought in Western cultures that 10 milligrams was the limit of intestinal absorption. This was in spite of the fact that it was known in Japan that beriberi, the mostly Eastern disease caused by consumption of white rice as a dietary staple, required as much as 300 milligrams of the vitamin a day for months. On the following day, April 22, the clinical situation was unchanged but there was some flushing of her cheeks and the lip vermilion was notably pink rather than the former dusky blue. This indicated that oxygen was being delivered to the tissues by the arterial blood, suggesting that oxidation (its use in creating cellular energy) had improved. By April 24 there was some response to pain and on the next day there was some relaxation of her limbs and some spontaneous movement. Her pupils responded to light. On April 26 the intravenous TTFD was discontinued and the oral dose reduced to 50 milligrams every 4 hours, a total dose of 300 milligrams a day.
Then a remarkable thing happened. She went into a state known as “coma vigilum”. This is a peculiar state of the patient who appears to be conscious but this is only superficial and responses are automatic and below conscious level. There was eye contact and she responded to sounds. She started to take jelly from a spoon and was beginning to show primitive emotional responses. By May 8 voluntary movements were appearing and she had some head control. By May 12 she was able to chew food and could support her own weight standing. Full consciousness had returned. On May 12 she was able to walk with a nurse holding her hand. She was beginning to feed herself and attempting to speak. She was discharged from hospital on May 21 and TTFD was discontinued on July 31. Muscle tone improved over the following year but never became normal. She was not seen again until the age of 8 years because of the onset of seizures. She was mildly overactive and had some intellectual and motor dysfunction. She had repeated kindergarten and was in first grade, so there was unfortunately a presumed legacy from her illness. The surprise, however, was that she survived.
I tell this story because I insist in stating that our overall approach to disease is on the wrong track. Drugs are simply not the answer because our brain/bodies are equipped with marvelous mechanisms that depend on sufficient cellular energy to carry out the process of healing. The research performed by Hans Selye on the effect of stress had shown that an injection of thiamine given in an emergency room to a patient in shock helped recovery. What was so remarkable about this case was that not a single colleague ever brought up the subject. It should have been discussed in case conference, the usual and customary sharing of information and seeking the right path in medical approach to diseases, particularly as there was, at that time, no idea of the cause of Reye’s syndrome. It might have lead to a better understanding of the cause of the increase in blood ammonia that occurs in other conditions besides this one. The Dean of Harvard said to a new batch of medical students: “Ladies and gentlemen, I regret to tell you that fifty percent of what we teach you here will be wrong. The only trouble is that we do not know which fifty percent”. History shows that it matters little whether something new is revealed in any shape or form. It is automatically despised. It applies to any profession and sometimes it takes years before someone catches up with something that confounded an issue occurring a long time before. It appears to be predictable of human nature. It may be that it is a good thing since it may very well weed out hypotheses that are erroneous and allow time and further contemplation by others to sanctify a new phenomenon outside contemporary experience.
There is no doubt that vitamin therapy is now coming into its own and that holistic medical methods will eventually be standard practice. All of these methods address the synthesis and flow of cellular energy where oxidation is the key factor. Perhaps that is why the FDA is beginning to clamp down on health freedom allowed by our ability to purchase supplements. It must, however, be acknowledged that the use of nutritional supplements requires some knowledge of their actions and potential toxicity from excess. The vast use of pharmaceuticals affects the economy and it is that which seems to be protected rather than our health. Watch out for the draconian methods advised by “Codex Alimentarius” coming from Europe.