(Castlemen'' Disease)

Castleman disease is a group of rare disorders that involves lymph nodes that get bigger, called enlarged lymph nodes, and a wide range of symptoms. The most common form of the disorder involves a single enlarged lymph node. This lymph node is usually in the chest or neck, but it can occur in other areas of the body as well. This form of the disorder is called unicentric Castleman disease (UCD).

Multicentric Castleman disease (MCD) involves multiple regions of enlarged lymph nodes, inflammatory symptoms and problems with organ function. There are three types of MCD:

• HHV-8-associated MCD. This type is linked to human herpes virus type 8, called HHV-8, and human immunodeficiency virus (HIV).

• Idiopathic MCD. The cause of this type is unknown. This also is called HHV-8-negative MCD.

  The most serious form of this type of MCD is known as iMCD-TAFRO. This condition gets its name from the symptoms it causes.

• POEMS-associated MCD. This type is linked to another condition called POEMS syndrome. POEMS syndrome is a rare blood disorder that damages nerves and affects other parts of the body.

                    Enlarged lymph follicle in Castlemen's Disease

Idiopathic Multicentric Castleman Disease (iMCD): The first-line treatment is typically an anti-interleukin-6 (IL-6) monoclonal antibody.

Siltuximab (brand name Sylvant) is the only FDA-approved medication for iMCD and is the preferred initial therapy.
Tocilizumab (brand name Actemra), another anti-IL-6 agent, is also used, particularly in Japan or if siltuximab is unavailable.
Corticosteroids may be used in severe cases, often in combination with other therapies, to control inflammation quickly.
For patients who do not respond to anti-IL-6 therapy, second-line options include other immunomodulators (e.g., sirolimus, bortezomib) or chemotherapy regimens.

HHV-8-associated Multicentric Castleman Disease: This form is strongly linked to the human herpesvirus 8 (HHV-8) and often occurs in patients with HIV.
Rituximab (brand name Rituxan), a B-cell-targeting antibody, is generally the highly effective first-line treatment.
Antiviral drugs to block the activity of HHV-8 or HIV (such as antiretroviral therapy for HIV-positive patients) are often included.
Chemotherapy may be combined with rituximab for severe, life-threatening cases.
POEMS-associated Multicentric Castleman Disease: Treatment is directed at the underlying plasma cell disorder that drives the syndrome. This may involve radiation therapy for localized disease or chemotherapy-based regimens for more widespread disease. 
Due to the complexity and rarity of the disease, it is highly recommended to consult a physician or a center with expertise in Castleman disease. 

The Castleman Disease Collaborative Network (CDCN) offers resources and information on expert centers. The Castleman Disease Collaborative Network plays a crucial role in advancing research and treatment for Castleman disease. Through innovative studies, patient support initiatives, and a commitment to collaboration, the CDCN is making strides in improving outcomes for those affected by this rare condition. For more information, you can visit their official website at CDCN. 

Castleman Disease Collaborative Network | CDCN

 

 

Survival

We talk a lot about fixing healthcare, but none of it matters if the people delivering care cannot survive the system themselves.

More than half of physicians in America report burnout.

The same is true for nurses. These are not small numbers.

These are the people holding the entire system together, and they are exhausted.

When physicians tell surveyors they are thinking of leaving the workforce, we should be listening.

When nurses say they cannot sustain the pace, we should be listening.

And when clinicians at every level say the loss of autonomy is breaking them, we must listen.

Burnout is not a personal failure. It is a signal that the system has pushed its workforce past the breaking point.

When the work becomes more about documentation than healing, when decisions are dictated by insurance algorithms instead of clinical judgment, when autonomy disappears, purpose disappears.

That is when people walk away.

If we want a healthcare system that works, we need to protect the people doing the work.

That starts with restoring autonomy, rebuilding meaningful patient connections, and giving clinicians space to practice the medicine they were trained to deliver.

Healthcare will not heal until the healers do.

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Heart Attacks, What else is going on?

What causes heart attacks besides, placque and cholesterol? 

How do you explain the guy in his early 30s or 40s who exercises daily, eats clean, has normal labs, coronary calcium score of zero, yet drops from a heart attack?

No warning. No plaque buildup. Perfect LDL. Someone considered very low risk
The LDL model of heart disease is broken
It can’t explain why:
- half of heart attacks happen with normal LDL
- many with high LDL never have heart issues
- veins never clog unless turned into arteries
- you can have a massive heart attack with clean arteries
Instead of questioning the model, cardiology just keeps lowering the “optimal” number
LDL IS NOT THE INITIATOR. Something upstream must break first.
👉 The Missing Physics

Arteries aren’t designed to be scraped by blood
They’re lined with hydrophilic tissue that forms structured water (exclusion zone water aka EZ water) which is a gel-like negative layer that excludes blood components like:
- RBCs
- platelets
- bacteria
- LDL

If EZ is intact: blood never touches the arterial wall --> so no injury --> no inflammation --> no plaque
This is never even mentioned in the flawed “cholesterol clogs” narrative

So what is plaque?
Histology shows ~87% clot + repair material

Sequence: Damage --> clot --> repair --> plaque
(NOT: LDL --> plaque --> damage)
Plaque forms where flow becomes abnormal (high mechanical stress)
And heres the paradox:
People with severe plaque often feel fine bc the body builds collaterals (natural bypasses) to restore flow

Meanwhile, many heart attacks happen with no major blockage at all
They arent blocked pipe scenarios..they are:
- clotting failures
- autonomic stress failures
- flow collapse under oxidative stress

NOT “you ate too much butter and red meat”
So what destroys this EZ Water?
- circadian disruption
- chronic stress
- glucose heavy metabolism year round
- high O6 / AGEs
- poor mitochondrial function
- nnEMFs (alone reduce EZ up to 20%), low sunlight, no grounding
- pollution, metals, BPA
- oral infections

These steal electrons --> collapse EZ --> expose artery --> raise clot risk
What protects the artery?
Everything that supports EZ water + mitochondrial redox:

- sunlight (IR especially)
- cold
- sauna
- grounding
- mineral-rich water
- animal fats & metabolic flexibility
- strong HRV/parasympathetic tone
- darkness at night so melatonin can repair endothelium

When EZ is strong = endothelium protected
= smooth flow =RBCs repel (no clumping) = clots hard to trigger

That’s the real prevention strategy

So again heart disease is not:
- an LDL issue
- a saturated fat issue
- a cholesterol issue

It’s blood physics + redox issue

The danger starts when EZ collapses

So instead of obsessing over LDL, protect the environment your heart pumps through
Modern cardiology only saves you once you’re dying
If you want to avoid the table, stop breaking EZ water and start building it
Sunlight. Movement. Grounding. Dark nights. Low oxidative stress.

That’s how you protect the most energy hungry organ in the body

Key Changes in the Aging Gut Microbiome

As people age, their gut microbiome changes, leading to reduced diversity and a potential loss of beneficial bacteria, which is linked to an increased risk of age-related diseases and frailty. This process, sometimes called "biome-aging," can be influenced by diet, lifestyle, and medications, and may accelerate physiological decline. Interventions such as dietary changes, prebiotics, and probiotics are being explored to counteract these negative effects and promote healthier aging. 

Key changes in the aging gut microbiome

• Reduced diversity: The overall variety of microbes decreases with age.
• Shift in composition: There is often a loss of beneficial bacteria like Bacteroides and Bifidobacteria, along with an increase in potentially harmful bacteria like E. coli and other Proteobacteria.
• Increased inflammation: Aging is associated with increased inflammation, and the gut microbiome can contribute to this through increased "leaky gut" and the production of pro-inflammatory compounds.
• Impaired function: The microbiome's ability to aid in digestion, produce short-chain fatty acids (SCFAs), and support immune function declines with age. 

Effects of age-related microbiome changes

• Weakened immunity: Changes in the gut microbiome can weaken the immune system, leading to a reduced response to vaccinations and a higher risk of infection.
• Increased disease risk: The altered gut microbiome is linked to a higher risk of age-related diseases like atherosclerosis, hypertension, and neurodegenerative disorders.
• Frailty: The decline in gut function and integrity is a contributing factor to frailty, a hallmark of unhealthy aging.
• Metabolic issues: Changes in the microbiome can negatively impact metabolism, contributing to poor digestive health and other metabolic problems. 

Potential interventions

• Diet: A balanced diet rich in fruits, vegetables, and fiber is crucial for a healthy microbiome at any age. Avoiding processed foods is also recommended.
• Prebiotics: These are fibers that feed beneficial gut bacteria.
• Probiotics: These are live microorganisms, often found in fermented foods or supplements, that can help restore a balance of gut bacteria. However, their use in the elderly requires more research.
• Synbiotics: These are a combination of prebiotics and probiotics.
• Lifestyle: Staying physically active and avoiding pollutants like alcohol and tobacco can also support a healthy gut environment. 

Fecal Transplants

    Some Some patients suffer from an overgrowth of the baceterium Clostricium dificile as a r

    result of antibiotics.  Fecal transplants have not gained any support.

    While more research is needed to fully understand the causal relationship between           microbiome changes and aging, interventions that support a healthy gut micrmise for     improving health and potentially slowing the aging process.