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Caregivers care for patients based on trajectories of diseases

Different trajectories for different diseases

A century ago, death was typically quite sudden, and the leading causes were infections, accidents, and childbirth. Today sudden death is less common, particularly in Western, economically developed, societies. Towards the end of life, most people acquire a serious progressive illness—cardiovascular disease, cancer, and respiratory disorders are the three leading causes—that increasingly interferes with their usual activities until death.

Three distinct illness trajectories have been described so far for people with progressive chronic illnesses (fig 1)²^–⁶: a trajectory with steady progression and usually a clear terminal phase, mostly cancer; a trajectory (for example, respiratory and heart failure) with gradual decline, punctuated by episodes of acute deterioration and some recovery, with more sudden, seemingly unexpected death; and a trajectory with prolonged gradual decline (typical of frail elderly people or people with dementia).

Fig 1

Typical illness trajectories for people with progressive chronic illness. Adapted from Lynn and Adamson, 2003.⁷ With permission from RAND Corporation, Santa Monica, California, USA.

Summary points

Three typical illness trajectories have been described for patients with progressive chronic illness: cancer, organ failure, and the frail elderly or dementia trajectory

Physical, social, psychological, and spiritual needs of patients and their carers are likely to vary according to the trajectory they are following

Being aware of these trajectories may help clinicians plan care to meet their patient’s multidimensional needs better, and help patients and carers cope with their situation

Different models of care may be necessary that reflect and tackle patients’ different experiences and needs

We now consider each of these three trajectories in more detail.

Trajectory 1: short period of evident decline, typically cancer

This entails a reasonably predictable decline in physical health over a period of weeks, months, or, in some cases, years. This course may be punctuated by the positive or negative effects of palliative oncological treatment. Most weight loss, reduction in performance status, and impaired ability for self care occurs in patients’ last few months. With the trend towards earlier diagnosis and greater openness about discussing prognosis, there is generally time to anticipate palliative needs and plan for end of life care. This trajectory enmeshes well with traditional specialist palliative care services, such as hospices and their associated community palliative care programmes, which concentrate on providing comprehensive services in the last weeks or months of life for people with cancer. Resource constraints on hospices and their community teams, plus their association with dying, can limit their availability and acceptability. Box 1 illustrates this trajectory.

Trajectory 2: long term limitations with intermittent serious episodes

With conditions such as heart failure and chronic obstructive pulmonary disease, patients are usually ill for many months or years with occasional acute, often severe, exacerbations. Deteriorations are generally associated with admission to hospital and intensive treatment. This clinically intuitive trajectory has sharper dips than are revealed by pooling quantitative data concerning activities of daily living.⁴ Each exacerbation may result in death, and although the patient usually survives many such episodes, a gradual deterioration in health and functional status is typical. The timing of death, however, remains uncertain. In one large study, most patients with advanced heart failure died when expected to live for at least a further six months.⁸ Many people with end stage heart failure and chronic obstructive pulmonary disease follow this trajectory, but this may not be the case for some other organ system failures. Box 2 illustrates this trajectory.

Trajectory 3: prolonged dwindling

People who escape cancer and organ system failure are likely to die at an older age of either brain failure (such as Alzheimer’s or other dementia) or generalised frailty of multiple body systems.⁷

This third trajectory is of progressive disability from an already low baseline of cognitive or physical functioning. Such patients may lose weight and functional capacity and then succumb to minor physical events or daily social “hassles” that may in themselves seem trivial but, occurring in combination with declining reserves, can prove fatal.⁹^,10 This trajectory may be cut short by death after an acute event such as a fractured neck of femur or pneumonia. Box 3 illustrates this trajectory.

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Clinical implications

Trajectories allow us to appreciate that “doing everything that can be done for a possible cure” may be misdirected.

Optimising quality of life before a timely, dignified, and peaceful death are the primary aims of palliative care. Understanding and considering trajectories may help professionals take on board, at an earlier stage than would otherwise be the case, that progressive deterioration and death are inevitable. Before the terminal stages of a disease, some health professionals may allow the reality of the prognosis to remain unconsidered or unspoken, unwittingly colluding with patients and relatives in fighting death to the bitter end.¹¹ Patients often want palliative oncological treatment even if it is extremely unlikely to benefit them, and doctors usually offer it to maintain hope as well as to treat disease.¹² An outlook on death and expectations that are more acquiescent to reality may moderate the “technological imperative,” preventing unnecessary admissions to hospital or aggressive treatments. A realistic dialogue about the illness trajectory between patient, family, and professionals can allow the option of supportive care, focusing on quality of life and symptom control to be grasped earlier and more frequently. Figure 2 illustrates how the idea that palliative care is relevant only to the last few weeks of life is being replaced with the concept that the palliative care approach should be offered increasingly alongside curative treatment, to support people with chronic progressive illnesses over many years.

Fig 2

Appropriate care near the end of life. Adapted from Lynn and Adamson, 2003.⁷ With permission from RAND Corporation, Santa Monica, California, USA

Box 1: Example of a cancer trajectory

CC, a 51 year old male shop assistant, complained of night sweats, weight loss, and a cough. An x ray initially suggested a diagnosis of tuberculosis, but bronchoscopy and a computed tomography scan revealed an inoperable, non-small cell lung cancer. He was offered and accepted palliative chemotherapy when he had already lost considerable weight (too much to allow him to enter a trial). The chemotherapy may have helped control his breathlessness, but he was subsequently admitted owing to vomiting. Looking back, CC (like several other patients in our study) expressed regret that he had received chemotherapy: “If I had known I was going to be like this….” His wife felt they had lost valuable time together when he had been relatively well.

CC feared a lingering death:

“I’d love to be able to have a wee turn-off switch, because the way I’ve felt, there’s some poor souls go on for years and years like this, and they never get cured, I wouldn’t like to do that.”

CC’s wife, in contrast, worried that her husband might die suddenly: “When he’s sleeping, I keep waking him up, I am so stupid. He’ll say, `Will you leave me alone, I’m sleeping.’… He’s not just going to go there and then, I know, but I’ve got to reassure myself.”

CC died at home three months after diagnosis, cared for by the primary care team, night nurses, and specialist palliative care services. His death had been discussed openly. He and his wife were confident that nursing, medical, and support staff would be available.

Box 2: Example of an organ failure trajectory

Mrs HH, a 65 year old retired bookkeeper (photo), had been admitted to hospital several times with cardiac failure. She was housebound in her third floor flat and cared for by a devoted husband who accepted little help from social work or community nursing. Previously she had been very outgoing, but she then became increasingly isolated. Her major concern was that her rapidly deteriorating vision because of diabetes prevented her completing crosswords, not that she had stage IV heart failure. Her treatment included high dose diuretics and long term oxygen therapy. She required frequent blood tests.tests.

Figure 2

She had raised her prognosis indirectly with her general practitioner, by mentioning to him that her grandson had asked her if she would be around at Christmas. Prognostic uncertainty was a key issue for many heart failure patients and their carers in our study, as illustrated by the following quotations.

“I take one step forward, then two steps back.” 84 year old, male, retired engineer, living alone, several recent admissions to hospital.
“I’d like to get better, but I keep getting worse.” 72 year old widow, living alone, psoriasis and arthritis.
“Things I used to take for granted are now an impossible dream.” 75 year old man, large family nearby, recently celebrated 50th wedding anniversary.
“There were times last year, when I thought I was going to die.” 77 year old woman, living alone, several periods in hospital with acute breathlessness.
“It could happen at any time.” Wife of 62 year old former footballer and taxi driver.
“I know he won’t get better, but don’t know how long he’s got.” Wife of 77 year old retired flour mill worker with severe asthma.

Mrs HH died on the way home from a hospital admission due to a nosebleed. She had had these occasionally as she had hypertension and a perforated nasal septum. Attempted resuscitation took place in the ambulance. Her husband later expressed deep regret that his wife’s clear wish not to have her life prolonged was not respected.

Box 3: Example of frailty trajectory

Mrs LC, a 92 year old widow, lives alone in a ground floor flat in central Edinburgh.Edinburgh.

Figure 3

An external file that holds a picture, illustration, etc.
Object name is murs239905.f3.jpg

Bereaved 12 years ago, she is now housebound due to arthritis and general physical frailty.

She used to venture out occasionally to the shops but over the years has felt less able and confident, largely because of a fear of falling. She appreciates the chair and walking aids supplied by the occupational therapist as these provide support and a sense of security at home. Since a “little fright” she had before Christmas when her legs gave way, she retires to bed earlier than before.

She receives regular visits from friends and the local church and is undemanding of services. Current medications are paracetamol, thyroxin, and bendrofluazide (for hypertension) and an annual influenza vaccine.

Mrs LC understands her current trajectory in terms of gradual decline in activities that she is able to do, and she is concerned that she might one day lose her independence. She has no relatives but is supported by her trust in God, who has “given me a good while on the planet, and should be sending for me now.”

Trajectories allow practical planning for a “good death”

Dying at home is the expressed wish of around 65% of people at the beginning of the cancer and organ failure trajectories.¹³ An appreciation that all trajectories lead to death, but that death may be sudden (particularly in patients following trajectory 2), makes it evident that advanced planning is sensible. Eliciting the “preferred place of care” is now standard in some palliative care frameworks and helps general practitioners plan for terminal care where the patient and family wish. This may increase the likelihood of patients dying in the place of their choice, as was the case for CC (see box 1).

Sensitive exploration is needed and can allow issues such as resuscitation status to be clarified and “unfinished business” to be completed for patients on all these trajectories. However, advance directives may be ignored in the heat of the moment.¹⁴ Mrs HH’s death had (unusually in people with heart failure) been planned, but an emergency overtook the situation and she received inappropriate resuscitation as documentation was not at hand. Living wills (advance directives) may be becoming more popular with patients, but most primary care professionals still have relatively little experience with these (Polack C, personal communication, 2004). Such planning may be particularly relevant to people in the third trajectory, where progressive cognitive decline is common.

Understanding the likely trajectory may be empowering for patient and carer

Some patients attempt to gain control over their illness by acquiring knowledge about how it is likely to progress.¹⁵^,16 Had CC (box 1), who had lung cancer, been aware of his likely course of decline he might have been less worried about a very protracted death. Similarly, his wife might have been less worried about a sudden death. Both gave clear cues in the research interviews that they were concerned about the possible nature of the death and would have welcomed sensitive discussion of this with health professionals.

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Limitations of the trajectory approach

The trajectory approach gives a conceptual overview, but patients must not be simply slotted into a set category without regular review. Individual patients will die at different stages along each trajectory, and the rate of progression may vary. Other diseases or social and family circumstances may intervene, so that priorities and needs change. Some people cope by denial or disavowal, making open communication less appropriate in the earlier stages.¹⁷

Some illnesses might follow none, any, or all of the trajectories: a severe stroke could, for example, result in sudden death or a fairly acute decline as in trajectory 1; a series of smaller strokes and recovery could mimic trajectory 2; while a gradual decline with progressive disability could parallel trajectory 3. Renal failure might represent a fourth trajectory consisting of a steady decline, with the rate of decline dependent on the underlying pathology and other patient related factors such as comorbidity.² Patients with multiple disorders may have two trajectories running concurrently, with the more rapidly progressing trajectory typically taking centre stage. This is not uncommon in older patients with slowly progressive cancers.

Other dimensions of needs may have different trajectories

The trajectories we have considered relate to physical wellbeing. Other trajectories may exist regarding dimensions such as the spiritual or existential domain. In cancer patients, we have noted that spiritual distress and questioning may peak at diagnosis, again at the time of recurrence, and then later during the terminal stage. Spiritual distress in people with heart failure may, in contrast, be evident more uniformly throughout the trajectory, reflecting the gradual loss of identity and growing dependence.¹⁸ Psychological and social trajectories may also potentially be mapped. In dementia, the loss of cognitive function may cause parallel loss in activities of daily living, social withdrawal, and emotional distress.

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Implications for service planning and development

One size may not fit all

Different models of care will be appropriate for people with different illness trajectories. The typical model of cancer palliative care might not suit people who have a gradual, progressive decline with unpredictable exacerbations.

People with non-malignant disease may have more prolonged needs, but these are as pressing as those of people with cancer. Uncertainty about prognosis should not result in these patients, and their families, being relatively neglected by health and social services.³^,4 A strategic overview of the needs of and services available to people on the main trajectories may help policies and services to be better conceptualised, formulated, and developed to consider all people with serious chronic illnesses.

Planning care in advance may prevent admissions

Planning care and providing resources in advance on the basis of these trajectories might help more people die where they prefer. For example, many frail elderly and patients with dementia are currently admitted to hospital to die when terminally ill. The use of end of life care pathways in nursing homes is proving increasingly effective in preventing such admissions.¹³

Transferable lessons

Models of care for one trajectory may inform another. For example, cancer care can learn from the health promotion paradigm already established in the management of chronic diseases. Improving living while near death in North America¹⁹ and “health promoting palliative care” in Australia are two such examples. These have the potential to destigmatise death and maximise cancer patients’ quality of life right up to death. Conversely, patients with organ failure could benefit from ideas developed in cancer care, such as advanced care planning frameworks and end of life pathways.²⁰^,21

There are striking similarities between the burden of symptoms at any time of patients dying of cancer and those dying of non-malignant cardiorespiratory disease.²² Hospital palliative care teams, through offering specialist advice and sharing care with other specialists, can improve the care of many non-cancer patients.²³

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Conclusions

The key to caring well for people who will die in the (relatively) near future is to understand how they may die, and then plan appropriately. Since diseases affect individuals in different ways, prognosis is often difficult to estimate. None the less, it seems that patients with specific diseases and their carers often have common patterns of experiences, symptoms, and needs as the illness progresses. The notion of typical or characteristic trajectories is therefore conceptually sustainable and borne out in our longitudinal qualitative studies. Three typical trajectories have been described so far, and others may be characterised soon. More research is now needed to help understand how the insights offered by these trajectories can be translated into improvements in outcomes for patients and their families.

In Hippocrates’ day, the physician who could fore-tell the course of the illness was most highly esteemed, even if he could not alter it.²⁴ Nowadays we can cure some diseases and manage others effectively. Where we cannot alter the course of events we must at least (when the patient so wishes) predict sensitively and together plan care, for better or for worse.

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Are chemicals in old and new homes making us sick?

Q&A: Toxins We Overlook in Old Homes | Old House Web Blog

http://www.oldhouseweb.com › Old House Blog

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HEPATITIS B AND C MAY BE LINKED TO INCREASED RISK OF PARKINSON’S DISEASE

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Link Between Brain Inflammation and Gut Bacteria in Chronic Liver Disease

Summary: Researchers discover a link between gut bacteria and brain inflammation in patients with cirrhosis.

Source: Vigrinia Commonwealth University.

Jasmohan Bajaj, M.D., associate professor at Virginia Commonwealth University, had findings from his research on gut bacteria in cirrhosis published recently in the journals Hepatology and Scientific Reports.

The findings conclude that gut bacteria, found in the intestinal tract and stool, are associated with brain inflammation in cirrhotic patients and animals known as hepatic encephalopathy (HE). HE can lead to fatigue, the inability to concentrate, mental confusion and death.

“HE is an epidemic in patients with liver disease and cirrhosis,” said Bajaj, associate professor in the Department of Gastroenterology, Hepatology and Nutrition in the VCU School of Medicine. “Bacteria can result in inflammation in the systemic circulation, which in turn could inflame the brain.”

His research published in Hepatology involved the study of germ-free and conventionally raised mice with cirrhosis. The researched shows that gut microbes are essential for brain inflammation in cirrhotic mice. The human study published in Scientific Reports shows that specific bacteria were associated with nerve cell or neuron damage, while others were associated with damage to supporting cells or astrocytes.

Further investigation must include HE treatment that targets particular gut bacterial populations and specific affected brain region that might be affected as a result, said Bajaj, who practices at both VCU Health and the McGuire VA Medical Center.

Despite treatment for HE using the current standard of care, patients still experience the progression to overt HE and residual brain damage, Bajaj said. Consequently, further treatment options must be researched and made available to patients, Bajaj said.

To that end, Bajaj and the McGuire VAMC are performing fecal microbial transplants in HE patients. This process is the transfer of stool from a healthy donor into the gastrointestinal tract of someone with HE, for the purpose of treatment.

Patients who were part of Bajaj’s study were examined within the last two years. Mice were also used as study subjects during the last year of research.

ABOUT THIS NEUROLOGY RESEARCH ARTICLE

Funding: The study was supported by the National Institutes of Health.

Source: Michelle Uher – Vigrinia Commonwealth University
Image Source: This NeuroscienceNews.com image is credited to BruceBlaus and is licensed CC BY SA 4.0.
Original Research: Abstract for “Gut microbiota drive the development of neuro-inflammatory response in cirrhosis” by Dae Joong Kang, Naga S Betrapally, Siddhartha A Ghosh, R Balfour Sartor, Phillip B Hylemon, Patrick M Gillevet, Arun J Sanyal, Douglas M Heuman, Daniel Carl, Huiping Zhou, Runping Liu, Xiang Wang, Jing Yang, Chunhua Jiao, Jeremy Herzog, H Robert Lippmann, Masoumeh Sikaroodi, Robert R Brown, and Jasmohan S Bajaj in Hepatology. Published online June 23 2016 doi:10.1002/hep.28696

Full open access research for “Impaired Gut-Liver-Brain Axis in Patients with Cirrhosis” by Vishwadeep Ahluwalia, Naga S Betrapally, Phillip B Hylemon, Melanie B White, Patrick M Gillevet, Ariel B Unser, Andrew Fagan, Kalyani Daita, Douglas M Heuman, Huiping Zhou, Masoumeh Sikaroodi and Jasmohan S Bajaj in Hepatology. Published online May 26 2016 doi:10.1038/srep26800

CITE THIS NEUROSCIENCENEWS.COM ARTICLE

Vigrinia Commonwealth University. “Link Between Brain Inflammation and Gut Bacteria in Chronic Liver Disease.” NeuroscienceNews. NeuroscienceNews, 7 July 2016.
<http://neurosciencenews.com/liver-disease-microbiota-inflammation-4640/>.

Abstract

Gut microbiota drive the development of neuro-inflammatory response in cirrhosis

The mechanisms behind the development of hepatic encephalopathy (HE) are unclear although hyperammonemia and systemic inflammation through gut dysbiosis have been proposed.

Aim: Define the individual contribution of hyperammonemia and systemic inflammation on neuro-inflammation in cirrhosis using germ-free (GF) and conventional mice. Methods: GF and conventional C57BL/6 mice were made cirrhotic using CCl4 gavage. These were compared to their non-cirrhotic counterparts. Intestinal microbiota, systemic and neuro-inflammation (including microglial and glial activation), serum ammonia, intestinal glutaminase activity and cecal glutamine content were compared between groups.

Results: GF-cirrhotic mice developed similar cirrhotic changes to the conventional mice after four extra weeks (16 vs. 12 weeks) of CCL4 gavage. GF-cirrhotic mice exhibited higher ammonia compared to the GF controls but this was not associated with systemic or neuro-inflammation. Ammonia was generated through increased small intestinal glutaminase activity with concomitantly reduced intestinal glutamine levels. However, conventional cirrhotic mice had intestinal dysbiosis as well as systemic inflammation, associated with increased serum ammonia compared to conventional controls. This was associated with neuro-inflammation and glial/microglial activation. Correlation network analysis in conventional mice showed significant linkages between systemic/neuro-inflammation, intestinal microbiota and ammonia. Specifically beneficial, autochthonous taxa were negatively linked with brain and systemic inflammation, ammonia and with Staphylococcaceae, Lactobacillaceae and Streptococcaceae. Enterobacteriaceae were positively linked with serum inflammatory cytokines

Conclusions: Gut microbiota changes drive the development of neuro- and systemic inflammatory responses in cirrhotic animals.

“Gut microbiota drive the development of neuro-inflammatory response in cirrhosis” by Dae Joong Kang, Naga S Betrapally, Siddhartha A Ghosh, R Balfour Sartor, Phillip B Hylemon, Patrick M Gillevet, Arun J Sanyal, Douglas M Heuman, Daniel Carl, Huiping Zhou, Runping Liu, Xiang Wang, Jing Yang, Chunhua Jiao, Jeremy Herzog, H Robert Lippmann, Masoumeh Sikaroodi, Robert R Brown, and Jasmohan S Bajaj in Hepatology. Published online June 23 2016 doi:10.1002/hep.28696

Abstract

Impaired Gut-Liver-Brain Axis in Patients with Cirrhosis

Cirrhosis is associated with brain dysfunction known as hepatic encephalopathy (HE). The mechanisms behind HE are unclear although hyperammonemia and systemic inflammation through gut dysbiosis have been proposed. We aimed to define the individual contribution of specific gut bacterial taxa towards astrocytic and neuronal changes in brain function using multi-modal MRI in patients with cirrhosis. 187 subjects (40 controls, 147 cirrhotic; 87 with HE) underwent systemic inflammatory assessment, cognitive testing, stool microbiota analysis and brain MRI analysis. MR spectroscopy (MRS) changes of increased Glutamate/glutamine, reduced myo-inositol and choline are hyperammonemia-associated astrocytic changes, while diffusion tensor imaging (DTI) demonstrates changes in neuronal integrity and edema. Linkages between cognition, MRI parameters and gut microbiota were compared between groups. We found that HE patients had a significantly worse cognitive performance, systemic inflammation, dysbiosis and hyperammonemia compared to controls and cirrhotics without HE. Specific microbial families (autochthonous taxa negatively and Enterobacteriaceae positively) correlated with MR spectroscopy and hyperammonemia-associated astrocytic changes. On the other hand Porphyromonadaceae, were only correlated with neuronal changes on DTI without linkages with ammonia. We conclude that specific gut microbial taxa are related to neuronal and astrocytic consequences of cirrhosis-associated brain dysfunction.

“Impaired Gut-Liver-Brain Axis in Patients with Cirrhosis” by Vishwadeep Ahluwalia, Naga S Betrapally, Phillip B Hylemon, Melanie B White, Patrick M Gillevet, Ariel B Unser, Andrew Fagan, Kalyani Daita, Douglas M Heuman, Huiping Zhou, Masoumeh Sikaroodi and Jasmohan S Bajaj in Hepatology. Published online May 26 2016 doi:10.1038/srep26800

Stress and health

STRESS CAN LEAD TO RISKY DECISIONS

Researchers report chronic stress can influence how we make decisions. In a new study, mice who were affected by chronic stress were more likely to make more risky decisions with higher payoff options than those who were less stressed.… READ MORE…

HARMFUL EFFECTS OF STRESS ON THE BRAIN AND PROMISING APPROACHES FOR RELIEF

Researchers present new findings about how stress takes a toll on the whole body.… READ MORE…

MYSTERIOUS DNA MODIFICATION SEEN IN STRESS RESPONSE

When under stress, adenine methylation increases up to four times, a new Emory study reports.… READ MORE…

MIGRAINES MAY BE BRAIN’S WAY OF DEALING WITH OXIDATIVE STRESS

Migraine triggers can increase oxidative stress, a new study reports. Targeting oxidative stress may help to prevent migraines.… READ MORE…

Image shows a woman with her head in her hands.

STRESS MAY BE JUST AS UNHEALTHY AS JUNK FOOD TO DIGESTIVE SYSTEM

Stress causes gut microbiota composition to shift as though a female mouse is on a high fat diet, researchers report.… READ MORE…

STRESS HAS DRAMATICALLY DIFFERENT EFFECTS ON MALE AND FEMALE BRAINS: MOUSE STUDY

Researchers from Rockefeller University have identified what they claim to be ‘remarkable’ differences between the way the male and female brains respond to stress. … READ MORE…

LESS STRESS, MORE SOCIAL COMPETENCE

Mindfulness and meditation can affect brain plasticity, resulting in the ability for adults to acquire new social skills, researchers report.… READ MORE…

Image shows people sitting in front of a brain.

MENTAL TRAINING CHANGES BRAIN STRUCTURE AND REDUCES SOCIAL STRESS

Using three different training models, researchers report mental training, mindfulness and meditation can induce structural brain plasticity and reduce social stress. … READ MORE…

STRESS DIMINISHES OUR CAPACITY TO SENSE NEW DANGERS

NYU researchers report stress can lead to a diminished ability to predict new dangers.… READ MORE…

EXPRESSIVE WRITING COOLS BRAIN ON STRESSFUL TASKS FOR WORRIERS

Using EEG to measure brain activity, Michigan State University researchers discover expressive writing can help those who worry excessively to calm their fears before entering into a stressful task.…READ MORE…

LOOKING STRESSED CAN HELP KEEP THE PEACE

Scratching when stressed may have evolved as a communication tool to help reduce aggression and lessen conflict with others, a new study reports. … READ MORE…

CAN’T SLEEP DUE TO STRESS? HERE’S THE CURE

According to researchers, octacosanol, an active compound found in sugarcane can help reduce stress and allow people to achieve a sound sleep. … READ MORE…

Foods to fight virus and infections

Anti-viral Foods for Infections

Liver Doctor’s Articles

Anti-viral Foods to help those with viral infections of the liver

This information has been carefully researched and will be invaluable to those with chronic viral hepatitis who wish to optimize their chances of good health. Nutritional medicine can help to reduce the ability of these hepatitis viruses from damaging your liver and can reduce the risk of cirrhosis and liver cancer.
Let us begin!

All plants contain antiviral compounds but few foods have been thoroughly tested to confirm how many of these compounds exist in each plant and which viruses they kill. At this time we do not know how the viruses get blocked or killed but in general, we have laboratory study evidence, as well as immune enhancing effects in humans. These foods are also rich in essential nutrients needed for a strong immune system and a healthy liver.

Historical usage also counts; for instance, lemon has long been a cold and flu remedy, and citrus fruits contain 15 different antiviral compounds; lemon leaf having the highest known concentration of antiviral compounds of any plant.

More than 350 million people worldwide are infected with hepatitis B virus, which kills more than a million people each year due to acute and chronic hepatitis, and liver cancer. The hepatitis B virus, which attacks the liver, is spread through infected blood transfusions, needle sharing by intravenous drug abusers and sexual contact. Hepatitis B is the most common sexually transmitted disease in the world.

Examples of food that contain known antiviral compounds

Food	Concentration of antiviral activity in parts per million
Walnut	1,375,300 (4 compounds)
Pomegranate	752,000 (2 compounds)
Coconut	739,884 (4 compounds)
Common tea leaves	714,946 (18 compounds)

Source: Dr Duke’s Phytochemical and Ethnobotanical Databases
http://www.ars-grin.gov/cgi-bin/duke/activity.pl

Given the very different nature of the foods in the table this suggests that a diet rich in varied types of plant foods is basically an antiviral diet.
All these foods have been identified as containing antiviral activity and many have been shown to improve immune and liver function.

Some of my recommended foods, notably medicinal mushrooms and sea vegetables, are an acquired taste and I hope you will gradually get to enjoy them!
I am convinced that eating a wide range of plant foods and herbs, in as natural a state as possible, will help to reduce the severity of chronic infections with the hepatitis B and C viruses.
I am not recommending that eating only one antiviral food each day will help treat viral hepatitis, so don’t eat enormous quantities of any one food.

Anti-viral Foods List

Medicinal Mushrooms
Sea vegetables (sea weeds)
Citrus fruits but especially lemons
Cabbage family
Carrot family
Onion family – onions, garlic, leeks, shallots
Coconut flesh, milk and virgin cold pressed coconut oil
Tomatoes
Whey
Blackcurrants and their juice
Tea
Walnuts
Pomegranate
Flavonoid rich foods such as citrus fruits, buckwheat
Lignan rich foods such as whole ground flaxseeds
Highly coloured fruits and vegetables which are high-antioxidant foods – they are much more powerful if they are fresh and in season and have been ripened naturally

Anti-viral Mushroom Soup Recipe

8 whole dried shitake or reishi mushrooms
6 cups water
1 cup rice
2 carrots, sliced into pieces
3 teaspoons miso
1 tablespoon finely chopped fresh coriander
1 tablespoon finely chopped parsley

* Instruction:

Soak the mushrooms in one cup water.
Bring the rice to the boil in 5 cups water, and simmer for 20 minutes.
Cut each mushroom into three or more slices, and add to the rice, together with the soaking water; simmer for further 20 minutes.
Add the carrots, and simmer for a further 5 minutes.
Turn off the heat, and stir in the miso, parsley and coriander

If you like ginger, add in about 2 to 3 teaspoons fresh grated.
Serve with finely cut fresh parsley and/or chives.
Serves 3

Nori strips with salmon and rice

1 fillet Atlantic salmon (other fish could be used)
Juice of one lemon
1 tablespoon soy sauce*
4 sheets nori cut into segments about 5cm (2 inches) x 20cm (8 inches)
1 cup hot or cold cooked rice
1 large handful fresh herbs – chopped

* Instruction:

Place the salmon in a small baking dish, sprinkle with the lemon juice and soy sauce.
Cover the salmon with fresh herbs; then cover with foil or a lid.
Bake for 30 minutes at 180oC.
Carefully remove all the bones, flake the fish with a fork into a small serving bowl.
Each person makes their own sushi by placing about 2-3 teaspoons of the mix at one end of a nori strip and rolling it up with the fingers.
Serves two as an entrée

Lemon

Lemon and other citrus fruits contain at least 15 different antiviral compounds and should be consumed daily by those serious about avoiding liver damage from hepatitis viruses. Freshly squeezed lemon juice is the best source of anti-viral substances and vitamin C. I drink lemon juice everyday to control sinusitis and strengthen my immune system.

Other ways of getting antiviral properties from citrus:

Add some grated lemon peel to salads, soups, casseroles, and to baked goods such as cakes and muffins.
Eat or juice four different citrus fruits (lemon, orange, lime, mandarin or grapefruit) daily as a preventive.
Have one glass citrus juice, three times daily if you have the flu – use a combination of oranges, limes and lemons. If you pass the fruit through a juice extracting machine you can leave a lot of the white pith attached so that this is juiced along with the flesh; this makes its healing properties stronger.
Changing your diet and lifestyle can be stressful but if at the very least you can –
Add in one healthy food or recipe a week
Make or buy a raw juice several times a week
Drink the juice of 2 limes or 2 lemons every day – you will not only strengthen your immune system, you will also slow down the aging process !

Selenium is the most important mineral for the immune system to function at its optimal level; indeed without adequate selenium in your body, your immune system will remain vulnerable to attack. It’s amazing to think that despite the profound importance of selenium to a strong immune system, many people remain deficient in this life enhancing mineral.

Research has proven that selenium is vital for healthy immune system function. A selenium deficiency suppresses your immune system and makes you more prone to infections, especially viral infections. Viruses replicate more easily in selenium deficient people. For this reason selenium is sometimes called the “viral birth control pill”. Selenium enhances the function of your white blood cells. Selenium is found in Brazil nuts and some seafood.

Connie’s comments: My mom’s neighbor gave ripe jackfruit to her daughter with big stomach who later expelled a lot of worms.

Trump tax bill giving billions in handouts to the 1% paid for by millions of American families

The House of Representatives has just passed its tax bill — giving billions in handouts to the 1% and mega-corporations, paid for by millions of American families.

And now the Senate’s version of the bill is moving at lightning speed, with a provision that will destroy Obamacare hidden in the fine print.

If this bill gets through the Senate and to Donald Trump’s desk, the consequences will be disastrous. Millions will lose health care. Education, infrastructure, and other services will suffer deep cuts. Middle-class families will see their taxes skyrocket. And all the work we did to defeat Trumpcare will be lost.

Courage Campaign is not going to allow the GOP to wear us down and steamroll over the American people with their agenda. We’re bringing the full force of our grassroots powerhouse to stop Congress’s corporate windfall. Will you chip in $5?

Yes, I’ll chip in $5 to help stop the Trump-GOP tax scam from passing in the Senate.

Before the Affordable Care Act provision was added, the Trump-GOP tax scam was bad enough. Massive tax cuts for the super wealthy. Tax incentives for corporations that shifted their profits offshore. Repeal of the estate tax and the alternative minimum tax, allowing the 1% to consolidate America’s wealth at the top even more than it already is.(1)

But now the Senate has added a provision repealing the individual insurance mandate to their version of the Trump-GOP tax bill. Without the mandate, fewer healthy people will sign up for insurance, and the Obamacare marketplace will go into a death spiral.(2)

Republicans aren’t even pretending anymore that this tax bill is for the good of the people at large. Only 1 in 3 Americans support this disastrous tax scam on the people.(3) And just as few support the Obamacare repeal — which is why it was shut down last summer.(4) But the Senate is pushing ahead anyway.

The GOP seems to have given up entirely on serving its constituency and is solely focused on one master — its deep-pocket donors. The billionaire GOP-supporting Koch brothers have made no secret that they are insisting these tax cuts happen, and they’re not alone.(5) One House Republican admitted that his donors told him, “Get [the bill] done or don’t ever call me again.”(6)

That’s why it’s so important that we band together and fight to stop this awful bill from passing. We need to stand up to the 1% and reclaim our democracy for us all. We need to stop the giveaway to the super wealthy. We need to save Obamacare. But we’re running out of time.

Will you chip in $5 to help stop the Trump-GOP tax scam from passing in the Senate?

Yours in the fight,

William, along with Annie, Brenna, Caitlin, Eddie, Emma, Lindsay, Mahdi, Mary, MJ, Molly, Raquel, Scottie, Susannah, and Tim (the Courage team)

Sources:
1. https://www.nytimes.com/interactive/2017/11/15/us/politics/every-tax-cut-in-the-house-tax-bill.html?_r=0
2. http://abcnews.go.com/Health/wireStory/obama-health-mandate-now-target-gop-big-tax-51160122
3. http://thehill.com/homenews/house/358578-poll-americans-oppose-tax-plan-by-17-point-margin
4. https://www.politico.com/story/2017/07/25/poll-obamacare-repeal-no-replace-240937
5. https://theintercept.com/2017/10/13/koch-brothers-internal-strategy-memo-on-selling-tax-cuts-ignore-the-deficit/
6. https://www.vox.com/policy-and-politics/2017/11/7/16618038/house-republicans-tax-bill-donors-chris-collins

Like what we do? Chip in to help fund the fight for a more progressive nation. Or find us on Facebook or Twitter.

Courage Campaign fights for a more progressive California and country. We are an online community powered by more than 1.4 million members.

http://act.couragecampaign.org/go/586?t=16&akid=4734%2E2868460%2EQ6nHmf

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Soon

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Different trajectories for different diseases

Trajectory 1: short period of evident decline, typically cancer

Trajectory 2: long term limitations with intermittent serious episodes

Trajectory 3: prolonged dwindling

Clinical implications

Figure 2

Figure 3

Trajectories allow practical planning for a “good death”

Understanding the likely trajectory may be empowering for patient and carer

Limitations of the trajectory approach

Other dimensions of needs may have different trajectories

Implications for service planning and development

One size may not fit all

Planning care in advance may prevent admissions

Transferable lessons

Conclusions

Link Between Brain Inflammation and Gut Bacteria in Chronic Liver Disease

Anti-viral Foods for Infections

Anti-viral Foods to help those with viral infections of the liver

Anti-viral Foods List

Anti-viral Mushroom Soup Recipe

Nori strips with salmon and rice

Lemon