Wednesday, March 18, 2015

Meniere's Disease: An Antiviral Approach to Eliminating Vertigo

I've been trying to get to the root of my Meniere’s Disease.  As I've stated before, there is no known cause or cure for the disease but many have found some relief from symptoms through different methods.  I’ve tried almost all methods except the antiviral method and I have also not yet been tested for candida overgrowth.  

My ENT doctor was unwilling to listen when I talked about doing an antiviral method so I contacted my family doctor and she is willing to try it.  It starts as a high dose and tapers down to a maintenance dose.  I had to get blood work done before starting the regimen.  The blood work is to get a baseline for kidney function as the long term use of the antiviral medicine can cause kidney issues.  I will then have to get regular blood monitoring every two months.  





I'm sharing this information for anyone else who may be suffering from this disease.  Below is the letter I sent to my doctor along with links to the medical studies.  If you are suffering from this I highly suggest sending your doctor this letter along with a printed copy of both medical articles a week or two prior to your appointment so they have time to review it before your appointment.  Once the doctor received my letter she called me to set up a 30 minute appointment to discuss.

Links to the medical studies I've referenced in the letter to my doctor below.
Dr. Gracek's Article -- HERE

Autoimmune Condition Article -- HERE


Dear Doctor ...,

Sorry for not getting this information to you sooner.  Just this morning I was able to secure an appointment for tomorrow afternoon to discuss my Meniere’s Disease, Bell’s palsy and an active cold sore. 

I had seen Dr. ENT but he is reluctant to take a look at viral issues being a cause for my Meniere’s disease.  Since Meniere’s disease has no cause or cure he is taking a wait and see approach.  Waiting for it to get worse then suggesting ear injections or surgery to destroy the inner ear and that is something I’m not willing to do. 

I respectfully ask you to scrutinize the information in this recent journal article. The author, Dr. Richard Gracek of Boston, is extremely experienced in antiherpetic therapy of Meniere’s, as the article will reveal.

Read closely the information on P. 103, for effective dosages and durations. Dr. Gracek gains an 88% to 90% complete relief of Meniere’s symptoms with his protocols, described in the paper.
I’m asking you to consider this antiviral treatment for me in hopes of some relief from not only Meniere’s, but the Herpes virus that is causing my cold sores and the Bell’s palsy causing the drooping of my left eye.

My thanks,
Sara 


For your information — here’s the cogent treatment text. I’ve taken the liberty to highlight crucial information:

The antiviral treatment protocol for patients with recurrent vertigo is as indicated below.

Discontinue all previous medical treatments; ensure that patients are cleared for normal
renal and liver function; use acyclovir tabs 800 mg t.i.d. for 3 weeks and reexamine. If there
is significant relief of vertigo, decrease to 800 mg b.i.d. for 3 weeks, then to 800 mg daily as a
maintenance dose. If valacyclovir is selected (in those who fail to respond to acyclovir), use
1 g t.i.d. for 3 weeks with taper to b.i.d. for a further 3 weeks and then 1 g daily as a maintenance
dose. The starting dose of acyclovir was given for a longer period (3 weeks) than that
used for zoster because it was felt necessary to cross the blood-brain barrier to reach ganglion
and satellite cells with virus.
Most patients experienced relief from vertigo in the first 2 weeks
but some required a longer period. The gradual lowering dose was then used to find the
lowest level maintenance dose for a given patient. Most were controlled on a single dose daily
but occasionally a patient required an adjustment to 1,200 mg of acyclovir or 1,500 mg of
valacyclovir.

These dosages may require adjustment in patients with impaired kidney or liver function.
The follow-up period was as short as 3 years in the most recent patients and 8 years in the
earliest patients in the series. Of 106 patients with VN (the earliest patients evaluated up to
8 years), 93 (88%) had complete relief of symptoms with oral acyclovir, 54 of 60 patients
(90%) with MD [Meniere's disease] were relieved of vertigo,
and 27 of 45 patients (60%) with posterior canal
BPPV were relieved of symptoms. Between the use of antivirals and repositioning maneuvers
(physical therapy), the number of chronically disabled patients who were candidates for
ablation of posterior semicircular canal function (canal occlusion or singular neurectomy)
was reduced significantly.
As a result of these morphological and clinical observations, our approach to the patient
with recurrent vertigo has been simplified. It goes without saying that the patient without
recurrent balance symptoms needs no further treatment after a hearing test and MRI of the
brain (assuming that these are normal). A Hallpike maneuver is included in the initial examination.
Those patients with recurrent vertigo are offered a trial of oral acyclovir (or Valtrex)
for 3 weeks.

Examination at the 3-week period will determine the sensitivity of the particular NT
virus to the antiviral. If there is no relief of vertigo with acyclovir or valacyclovir, treatment
is followed by vestibular tests (videonystagmography and vestibular-evoked myogenic
potential) to determine the responsible ear. If these results are abnormal chemical labyrinthotomy
is offered. The patient is offered a choice between dexamethasone (12 mg/ml) or
gentamycin (80 mg/2 ml), considering the risk of hearing loss (dexamethasone 0%; gentamycin
usually negligible if used in a single small dose).
Bell’s Palsy Information on Page 93. 
 A major deterrent to the acceptance of a viral neuropathy in these common vestibular syndromes is the lack of history pointing to a recognizable viral insult to the ear. However, the mucous membrane of the aero digestive tract is a ready portal of entry for NT viruses to invade sensory terminals of cranial nerves (olfactory, trigeminal, facial, vagus and glossopharyngeal). The facial nerve has a unique location adjacent to the vestibular nerve and ganglion in the internal auditory canal.

A neuropathy causing facial nerve dysfunction (Bell’s palsy) is thought to be caused by virus reactivation in the sensory ganglia of this nerve ( fig. 1 ). The human facial nerve has 2 sensory ganglia, geniculate and meatal [41, 42]
Although the geniculate ganglion represents the major sensory input (80–85%) in most facial nerves, the meatal ganglion is present in all specimens and may outnumber the geniculate in 10–15% of TB.

Four TB from patients with a history of facial paralysis (Bell’s palsy) demonstrated only degenerated meatal ganglion cells and no degeneration in the geniculate [43]. Several MRI studies of patients with Bell’s palsy show that the earliest enhancement of the facial nerve is in the fundus of the internal auditory canal where the meatal ganglion is located [43]


Article: Meniere’s Disease Might Be an AutoImmune Condition



Arnold and Niedermeyer [32] evaluated the presence of higher IgG antibodies against herpes simplex virus (HSV) in the perilymph of patients with Meniere's disease. This result supported the hypothesis that the herpes simplex virus may play an important role in the aetiopathogenesis of Meniere's disease. Higher titres of IgG against adenovirus (ADV) and varicella zoster virus (VZV) were found in patients with Meniere's disease compared with a control group. These findings support the hypothesis that adenovirus and varicella zoster virus may be important in the development of Meniere's disease [39].

"Recently, direct evidence of viral neuropathy in Meniere's disease has been provided by the transmission electron microscopic observation of viral structures in vestibular ganglion cells excised from a patient with Meniere's disease (Picture 3 and Picture 4) [45] and [46]. The clinical response to antiviral medication indicated that vertigo due to Meniere's disease was relieved in 85–90% of patients. It is not surprising that control of vertigo was not greater than 85–90%, as mutant strains of the herpes virus group would be resistant to the acyclovir class of antivirals. Until newer antivirals are developed, approximately 10% of Meniere's disease patients with vertigo will not be controlled. The auditory symptoms are less effectively treated by the antiviral approach because loss of hair cells and spiral ganglion cells secondary to the toxicity of viral proteins in the perilymph is not reversible."

"The antiviral approach to the very common disabling balance symptoms experienced by patients with Meniere's disease has virtually eliminated the use of various surgical methods used in the past. These include labyrinthectomy, endolymphatic sac decompression and vestibular nerve transection. The high (90%) rate of vertigo control with orally administered antivirals should be considered as a frontline treatment for vertigo."

Take-home messages


Meniere's disease is an autoimmune disorder. Its etiopathogenesis includes viral infection. The histopathological correlate of Meniere's disease is endolymphatic hydrops and vestibular endorgans demonstrates variable degrees of neuroepithelial degeneration

Due to the possible autoimmune pathogenesis of the disease, pharmacotherapy for Meniere's disease may include corticosteroids, etanercept and warfarin. The use of antiviral agents corresponds to the viral hypothesis and has eliminated the various surgical methods of the past.

Gene therapy could be used in the future to transfer genetic material into inner ear cells using viral vectors and to protect, rescue, and even regenerate hair cells of the inner ear

Month 8 update ---> HERE

8 comments:

  1. I just found your blog today! I had the endolymphatic sac decompression two years ago in January. It has given me much relief from the vertigo, but I still have problems with occasional vertigo, however, it doesn't last long.

    I am very interested in your story, and your research.

    Mary
    from Virginia

    ReplyDelete
    Replies
    1. Thanks for stopping by Mary! I have several blog posts about my Meniere's disease and different methods I've tried. I will keep posting updates on the anti-viral approach as I continue with it. ~Sara

      Delete
  2. 8-27 -15
    so how did things go? did you have the antiviral treatment?

    ReplyDelete
    Replies
    1. Yes. See my update here --> http://breezybeachlife.blogspot.com/2015/10/antiviral-approach-to-menieres-month-8.html

      Delete
  3. Hi Sara, Thank you for sharing your MD journey. I have been on antivirals for about a year now. It is the first thing that has helped my MD for any length of time. I have had to stay I fairly high doses as my symptoms start to return when I taker too low. Would love to get an update of how it's going for you. Thanks!

    ReplyDelete
    Replies
    1. See my update here --> http://breezybeachlife.blogspot.com/2015/10/antiviral-approach-to-menieres-month-8.html

      Delete
  4. Hi Sara,
    Started JohnofOhio Regimen on 8-10-2016 that's the day I lost my hearing on right side.prior to that been doing with fullness in head,imbalance,n O vertigo - more like a rocking boat sensation though.When I lost my hearing them the vertigo obviously kicked in. Read Dr Gaceks journal of otolaryngology report from another source online and was excited to try the AV approach.met with ent and he agreed to try the 3 week course after showing him the report. I'm hoping he would continue after 3 weeks if not ive already contacted my family dr as a backup and gave him the reference material I've been reading. Good to know you've had success! Just as a side note your website says dr gracek - type O..just so your readers know not to reference dr gracek.

    ReplyDelete
  5. Hi Sara,
    Started JohnofOhio Regimen on 8-10-2016 that's the day I lost my hearing on right side.prior to that been doing with fullness in head,imbalance,n O vertigo - more like a rocking boat sensation though.When I lost my hearing them the vertigo obviously kicked in. Read Dr Gaceks journal of otolaryngology report from another source online and was excited to try the AV approach.met with ent and he agreed to try the 3 week course after showing him the report. I'm hoping he would continue after 3 weeks if not ive already contacted my family dr as a backup and gave him the reference material I've been reading. Good to know you've had success! Just as a side note your website says dr gracek - type O..just so your readers know not to reference dr gracek.

    ReplyDelete

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