gfp

Isn't there an anesthesiologist that is on this board? I'd be interested in hearing from someone who has experience in this.

methinks as usual we will have to do this ourselves!

Ketamine, Adolescents, and the Emergence Phenomenon

Lance Brown, Geoffrey Pableo, Thomas Sherwin, T. Kent Denmark, Aqeel Khan, Edward Vargas, James A. Moynihan, Besh Barcega, Grace Kim, Gail Stewart and Steven M. Green

Loma Linda University Medical Center and Children's Hospital: Loma Linda, CA

ABSTRACT

OBJECTIVE: Historically, the potential for unpleasant recovery reactions (the "emergence phenomenon") in adolescents recovering from dissociative sedation has led to recommendations against the use of ketamine in this age group. The objective of our study was to describe the incidence and severity of unpleasant recovery reactions in a cohort of adolescents receiving ketamine sedation in the emergency department. METHODS:We have an ongoing prospective, observational study of intravenous ketamine use in our pediatric emergency department. Since March 2002, we have enrolled 684 subjects. We identified all subjects 13-18 years of age in this cohort. For each subject, agitation and unpleasant hallucinations were recorded on an unmarked 100-mm visual analog scale (VAS) with "none" (0) on the left and "worst possible" (100) on the right. Other variables included age, gender, the use of benzodiazepines and atropine, and the procedure performed. This study is IRB-approved. RESULTS: We identified 96 adolescents aged 13-17.7 years (median 14.5, IQR 13.7-15.2 years). Twenty-six (27%) of the subjects were female. Benzodiazepines were given to 4 (4%) subjects, concurrently with ketamine in each instance. Atropine was given to 8 (8%) subjects. All subjects underwent painful procedures; 93% had fracture or wound care. Agitation and/or unpleasant hallucinations were observed in 4 (4%) subjects [95% CI 1%-10%]. Of these 4 subjects, 2 exhibited both agitation and unpleasant hallucinations, 1 exhibited only agitation, and 1 exhibited only unpleasant hallucinations. None of these 4 subjects received atropine or a benzodiazepine. The agitation VAS scores were 2, 15, and 24 mm. The hallucination VAS scores were 6, 20, and 22 mm. CONCLUSION: Although there is no validated measure of agitation or unpleasant hallucinations, relatively low scores suggest mild reactions. Unpleasant recovery reactions were uncommon and mild in adolescents receiving intravenous ketamine in our study.

Oh its sounds OK then?

Personally, for me, anyway, I like the amenisatic drugs.

Well they are readily available on the black market if you like em so much....

Half joking... If Im going to get all drugged out then I'd rather have a more traditional anaesthetic who's effects are well known for thousands of years..

I'm not fond of the idea of these drugs either, but from a totally different perspective.

I think that is my #3 perspective? Is it not?

The idea that its OK to experience pain so long as you don't remember it?

The point is if I'm being operated on I would want to remember it. I can't think of anythig worse than flashbacks... I remember a MD thinking I was weird when I asked to be propped up to watch him remove a (benign) melanoma... but I can't understand why people wouldn't want to see.

I'd rather watch the scalpel cutting than see it go up and then out of vision?

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SUMMARY

105 patients undergoing diagnostic laparoscopy were randomly divided into three groups (n=35 each). Group I received I.V. diazepam and ketamine, group II received I.V. midazolam and ketamine, whereas Group III received pentazocine, diazepam and ketamine. 26 patients had emergence phenomena and were treated with I.V. promethazine hcl. 25 mg 22 (84.5%) of these had excellent control whereas 4 patients required additional dose. Hence it is concluded that pentazocine and midazolam reduce the incidence where as promethazine effectively controls the emergence phenomena.

Again somewhat <word in English?> ...

I mean its obvious they spot emergence phenomenum because it happes post surgery ....but what happens if it happens 2 or 20 years down the line.

Unlike true psychedelics, ketamine is powerfully reinforcing to many users and compulsive use is frequently reported. Both ketamine pioneer John Lilly and pseudonymous author D.M. Turner reported experienced prolong periods of 'ketamine dependency' and the latter drowned in a bathtub while on ketamine.

Well at least he won't remember it....

From the pro-recreational drug site erowid.org

DRUG :

Ketamine Hydrochloride

STREET NAMES :

K, Ket, Ketamine, Special K, Vitamin K

BRIEF :

Ketamine is an anaesthetic used primarily for veterinary purposes. Ketamine blocks nerve paths without depressing respiratory and circulatory functions, and therefore acts as a safe and reliable anaesthetic. It is commonly injected intramuscularly, but can also be taken orally and nasal pharyngealically. Ketamine is only available to physicians, and is not commonly sold as an illicit drug, and is scheduled in several states. [Erowid Note: Ketamine was placed in Schedule III in August, 1999 making it illegal to possess in the United States without a license or prescription.] The most common trade name for Ketamine are Ketaset and Ketalar, which are intramuscular veterinary Ketamine HCls.

CHEMISTRY :

2-(2-Chlorophenyl1)-(methylamino)-cyclohexanone hydrochloride

M.W. - 274.2 C13H16CINO-HCL

LD50 (IPR-MUS): 400 mg/kg, LD50 (IVN-MUS): 77 mg/kg.

white solid - melting point 266*C - non-flammable.

Solubility: water 20g/100ml

REFERENCES :

Merck Index, 11th Ed., No. 5174

Anis, N.A., Berry, S.C., Burton, N.R., Lodge, D. "The dissociative anaesthetics, ketmine and phencyclidine, selevtively reduce excitation of central mammalian neurones by N-methyl aspartate." Br. J. Pharmacol 79, 565 (1983).

PSYCHEDELIC INDICATIONS :

Ketamine does not treat music so well. Expect a narrowing of your auditory bandwidth. Music will sound neat but not correct and not transcending. You will selectively lose frequencies. Use mellow music with a psychedelic flavor, and keep the volume less than loud because your perception of overall volume will increase. Visual hallucinations are most notable in low light. Touch is exceptional. Smells and tastes will be nulled. Do not expect to talk, although you may. Expect general reflection but not exceptional emotionality.

DOSAGE :

Due to its anaesthetic nature, K can produce wide ranging effects from different amounts. There seems to be a crucial line where the patient will lose grasp of his/her primary senses, and this will be termed a Line Dose. A further line exists where the patient will lose complete consciousness. In general, boosting is not adequate and it does not seem worthwhile to boost the original dose more than ten minutes after initial dose. General tolerance is appreciable and several weeks between uses are required to return to original tolerance. For most types, effects are linear with dose, and good experience can be had at low dosages.

ORAL DOSE :

A Line Dose is about 1.0 mg/lb. body mass. Anaesthetic doses are above 4.0 mg/lb. A maximum oral dose of 3 mg/lb. should be set for adequate recovery. Above line dose, increasing doses yield little psychedelic advantage except for greater temporary memory loss. A good first dose is 300-350 mg for average weight woman, and 350-375 mg for average weight men. A minimum dose of 150-175 mg will give a good psychedelic experience.

IM DOSE :

Intramuscular doses begin at perhaps .4 mg/lb. for a Line Dose. Anaesthetic doses to IM are about 1 mg/lb. Two injections should be made instead of one. Sterility of the bottle and needle are imperative. 100 mg seems to be a good IM dose for everyone. Expect soreness in the injection region for several days or weeks.

IV DOSE :

I do not recommend IV doses but have read reports of successful IV dosing. In the IV case you will probably lose motor control before you finish injecting so beware.

NASAL DOSE :

Nasal doses are highly unlinear next to oral and IM doses. The effects are quite different as well at low doses. At Line Doses, oral consumption is probably a better bet than nasal doses. A Line Dose nasally would again be about 1.0 mg/lb. A minimum dose nasally would be about .25 mg/lb, but will be short and much different from a comparable oral dose. 75-100 mg would be a good starter for most weights. Ketamine is relatively comfortable in the nasal region.

PREP :

IV and IM require fully sterile Ket bottle and needle. Powder for nasal use can be gotten from gentle boiling off of solution. To prepare an oral dose from a powder, place powder in a cup and pour about 1 cm of hot water (tap should be ok) in it and stir to solution. Fill remainder of cup with an acid such as orange juice.

SETTING :

As with all anaesthetics, Ketamine will make the patient nauseaous to varying degrees, directly related to dosage. Therefore, the patient should find him/herself in a place where he/she can stay for several hours, with most ammenities close at hand (any movement will compound nauseau). A non-Ketting person is a great help, and will be fun to talk to, and convenient for changing music, etc. Darkness will eliminate some very strange visual experiences. Music is very powerful. Warmth can also be important, as although your respiratory system will not be depressed, you may become cold from inactivity. A blanket is a good idea. Dope should be handy for nauseau, and a bucket should be available as a precaution. Vomitting should be rare, but in the case, it is not a good idea to have to travel to the bathroom. You should try to make sure that your co-trippers start when you do, as it is a rapid starting drug. Nasal doses can usually accomodate real scenes, i.e. clubs or company, but expect things to be very strange.

TIMING :

Taken intramuscularly, Ketamine will bring you up quickly in less than two minutes. Orally, with a medium-full stomach, expect 15-20 minutes, and as little as five minutes on an empty stomach. Nasal doses allow 5-10 minutes. The acceleration is great but not alarming. Expect to be semi-unconscious on a Line-Dose for about an hour intramuscualrly, and slightly longer when taken orally. You will come down quickly as well past the first line, and will begin to assimilate senses over about an half-hour. When taken orally, a soft trip will linger for approximately 2-3 hours after that and can be lots of fun. You will feel light, lanky, and queasy for several hours, and may be somewhat light-headed, though not incapacable the following day. Nitrous has had success in bringing Ketamine down quickly, despite its anaesthetic nature.

THE TRIP :

Before reaching the first line, fragmentation will occur- the world will begin to spin, but it won't be dizzying. Music will become fragmented. Chaos will ensue. At some point, you will find yourself complete removed from your surroundings and your body. Descriptions of the post-line experience vary substantially, but most include talk of alternate planes of existence, oneness, past and future revelations, and strange fabrics of all sorts. It will be very difficult to communicate at this point, and you probably will not be able to see or hear others in the room. Some revelations will be extremely heavy and some scary, but that fear does not seem to come back with you and is therefore difficult to describe as scary. You will probably find yourself coming back across the line again visibly, attempting to put an object in focus or define it. It is at this point that you will likely want to get in touch with your co-trippers. This is the "Wow" period. It is very important here that you do not try to move for awhile. The trip will continue mildly for an hour or so after this, with more conventional focuses.

PRECAUTIONS :

An overdose of Ketamine will knock you out as if in an operating room. This would prove to be a waste of a tripping experience, and will probably make you ill to your stomach. The danger dosage is much higher however, at 10 mg/lb. Interactively, Ketamine should not be used with respiratory depressants, primarily alcohol, barbituates, and Valium. Ketamine has been used with no ill interactive effects with dope, acid, nitrous, dextromethorphan, and MDMA, although no combinations are recommended and are highly unnecessary given the totality of ketamine. It does not have a build-on effect with halucinagins and will generally overpower other drugs. Nitrous in the up and down periods can be effective. Unpracticed trippers may be overpowered by the awesome revelations of Ketamine and may be somewhat overwhelmed, although in general fear seems to be unable to compound here (such as in an LSD trip or with other drug paranoias) and will probably be only episodic. Food should not be consumed within an hour and one-half before the trip, and should be avoided for longer periods of time if possible. A peculiar sort of loneliness can occur over the line, so it is a good idea to stay in close quarters with people you are close with, and best to have a sober monitor or experienced Ketter at hand.

TRIPS BY DOSE :

Doses that do not push one over the consciousness line can be very fun if you get close. In general, a 150 mg minimum would be required to realize an effect. Under that amount, you will only feel a very operable up and down over about an half-hour that will give you no insight into Ketamine. At higher doses, the up will last longer, but in less than linear fashion. In general it seems that oral doses last longer. Trips over 450 mg. can be severe on the stomach and have rapidly diminishing returns over lower doses, and are therefore not recommended, although 450 mg. itself is a very sound and powerful trip.

REPORTS :

A number of sources claim Vitamin K to be a boring drug. Some complain that it removes you so completely from your body that it is difficult to even work with. Others have found Vit K to be very potent and shapable, an experience that can be tailormade by dosage and setting. There is little question that there is no comparable experience on any other drugs. Most agree that it has a good to very good recovery with little negative effect on the following day and mild hangover. Setting is agreed to be crucial. Most agree that Ketamin not be used by inexperienced trippers unless they want a complete out-of-body experience that is sure to change their life.

Hmm seems like fun to take with a pleasant experience ...I wonder about taken with unpleasant ones?

I also have concerns about some of what you are saying. I insisted that I be completely out for my procedures. As someone who has repressed memories from a combo of childhood experience and early onset celiac I KNOW some of those memories need to stay right where they are. Those memories are a part of my subconsious mind but as was explained to me, bringing them to the surface would only bring the very bad memories into my everyday thought process and cause more trauma. The brain surpresses memories for a reason and it is not always wise to force them to the surface. If a psychologist were to know that the patient underwent a proceure of this type, and they should be aware of the patients total history, they could help them overcome the gag effect through many other methods that would be more benificial and less painful than 'reliving the experience' IMHO.

The gad is just an example, it could be horrible nightmares or daytime hallucinations, these happen with LSD after years...

The third part is an interesting analogy however, when someone is raped and this type of drug or alcohol is involved the person has no control over the situation. They did not make a concious decision to allow the rape before it occured. When someone undergoes a procedure and this type of drug is used they have made a choice to use it. They know someone is going to stick something up their butt or down their throat. The psychological trama that would occur during a rape, an uncontrolled and unplanned event, would not IMHO occur under the testing circumstance.

There are plenty of irritants in perfume, it's pure chemicals. Anyone with a nasal allergy will likely have a problem with at least some perfumes. The esters are pretty potent chemicals. I, like Richard, seriously doubt it's gluten related.

The effects might not be directly gluten related but I wonder if they are celaic related.

Considering most people don't have strong reactions to most perfumes (or people wouldn't wear them) I find it more than coincidence so many of us suffer from perfumes and so many suffer more when glutened or before gluten-free Diet

If water is sold at an event, I think patrons of that event should expect to pay for water inside, whatever the cost. But most festivals such as this will NOT be able to feed us, and therefore we should be allowed to bring something in to eat. I took my own food to the Dogwood festival here in April but it's a free event, and there is no one checking bags there and you can even take in non alcoholic beverages. When I was considering going to Dollywood with my nephew at an upcoming family reunion, I researched and found I could eat fries from one place and burgers at another.......and there was some safe ice cream.....and last but not least of course I could have a salad (no dressing). I can not bring any food into the park but I could leave to go eat elsewhere and come back....and pay the parking fee twice....no thanks folks. Others suggested I take a note from my Dr. but due to a major event going on that weeked at the park, I had no desire to go anyway.

I'm pretty sure Turner Field is not going to allow me to bring in my own gluten free beer to the park next year. It's just another inconvenience we have to put up with for now. I don't see it changing soon, but change will come eventually if we all do our part to make that happen. Complaining to each other is fine, but to affect change, you have to do something. Like others above have mentioned, write to this event planner and tell them they need to change their tune and accomodate all their patrons. For me, if I like the gluten free beer that Whole Foods is about to carry, I'm going to pester the home office of the Braves organizaion relentlessly about offering it at the games. If everyone with Celiac in Atlanta (and surrounding areas) does this, it will make a difference.

I think there is a big difference between commercial and charity events.

If an event claims to be for charity then it should make allowances for people who can't afford to eat inside. I can't see why going to a charity event to donate should have a income barrier!

"Sorry sir, we can't take your donation because we only accept it from people in a higher income bracket"

if someone can afford entry to see music or whatever but NOT afford eating then how can they justify denying them entry based on that?

In our case its a medical condition but this fundamental aplies.. its for charity but you won't accept to let me in with my own food because i can't safely eat inside. if you pay for entry and have to leave early because you can't eat that is discriminatory ....

Forget the sueing just think of the ethics. Its meant to be charity! You went to donate but since you can't buy food there they are not interested in your donation?

it doesn't cost to let you in.... and you are paying.... its just silly.

Commercial....

Well I think that's different.

They want to make money, they are only interested in money you can't provide as much as someone else. fine don't take my custom. its a shame when its someone you really wanna see (Im seeing BB King later this month)

The thing is i also have "other needs".... I can't be inside a crowd or have people touch me. Quite often I get to concerts where you have no choice and even though I paid i have to leave. Last time I tried to tough it out (Toto - yes they are still alive) I got in a lot of trouble and in my mind got assaulted (I really don't like strangers touching me or shoving me) the door-security people were really rude and physically pushed me about when I was trying to stick top a little nook

i did manage to see Saul Willams (slam poet) the other week but the venue was much smaller (50 people) and you could take in drinks (and even drugs judging by the smell) so long as no glass was taken in.

I had to leave a few times to go outside but I didn't freak out and the doormen were really nice about letting me get some space. - evn tried talking to me in English).

WARNING EXPECT EXPLICIT TALK AND SUBJECTS.....

Lister ... Please don't read this. I have been holding off asking this question until your tests today.

Everyone else who might not get offended....

The bottom line is I feel a bit concerned about amnesiac drugs.

The whole idea of being concious but not remembering sounds like a recipe for disaster to me.

Firstly, we never truly forget anything... we loose track of it and misfile it but until advance senility we remember almost everything just a lot is stored in deep storage.

Now the pretext for this seems to be "we are going to do something horrible but so long as you don't remember its OK"

I have three fundamental objections.

The first is that this is a recipe for repressed memories and repressed memories often cause sub councious problems. I can alsmost see therapists in 20 yrs time helping patients relive the biopsy to remember it because they have a gag reaction for no reason...

The second is that as human beings we are nothing but the sum of our memory and experience (religion aside) .... i don't want my memories repressed.. that is WHO I am. How do I know they will not interfere with other memories I want to keep?

Thirdly and this is the best analogy but some people might take offense....

These drugs are common date rape drugs... what are we saying? To me its saying if you don't remember then it doesn't matter. Its like saying yeah you were date raped but so long as you don't remember the actual event (and presuming no infections etc.,) then its perfectly OK.

But we know full well that victims of date rape drugs actually go through a lot more.. more perhaps even than those held at gun point. It absolutely isn't OK in my book ... in fact its far from OK....

Does anyone else wonder about this?

I can only speak from personal experience, and refer you to the book "Dangerous Grains"... before my dx of Celiac, I was very ill, my immune system was attacking itself. Plain and simple. I also have Fibromyalgia... while the Fibro has not gone away completely, the symptoms of it are greatly improved, so I don't necesarily think that going gluten-free CURED my fibro, I do think it has made the symptoms more manageable. I do think that in the case of my daughter, early dx and intervention MAY prevent her from developing the same autoimmune disorders that I have... is this just wishful thinking on my part? Maybe, but her recent checkup shows that she is an extremely healthy six year old...

So will my daughter's gluten-free diet prevent her from developing fibromyalgia or other autoimmune disorders? I hope so... Did my going gluten-free CURE my other autoimmune disorders? No, but would it have prevented them if I had been accurately dx'ed as a child? That is what I would like to know. I believe it to be the case, but I don't have any proof.

And here is the point exactly....

What proof is there that your daughter going gluten-free will be harmed by the gluten-free diet?

Absolutely none

On the other hand what if this offsets other autoimmune disorders by 10 years not even forever, isn't THAT worth it?

The point is i get a severe IgE response to lavendar when not gluten-free. When gluten-free I get a very mild and manageable response. The same goes for my hay fever...

Being gluten-free doesn't cure my hayfever but it makes it manageable. it benefits my heath overall.

I'm kind of confused. It seems like a lot of people on this board seem to think that other autoimmune diseases can be prevented by going gluten-free. Where is the scientific evidence for this? Where did this idea come from?

While it's true that Celiac is related to other autoimmune diseases, isn't it thought to be because of the shared common genetics and "leaky gut" letting in triggers?

Why is it that many people still continue to develop other autoimmunites despite going gluten-free, even if they start early on in life (I.e. infancy or early childhood).

Why is it that autoimmune diseases don't (generally) go into "remission" once gluten-free, since the body has been shown to repair itself if the autoimmunity can be removed? This is shown by the autoimmunity block research, and subsequent beta cell regeneration work of Dr. Denise Faustman.

How is it that 80% of kids with Type 1 diabetes (an autoimmune disease) and Celiac develop Type 1 FIRST, but do not express Celiac. They have the genes for it of course, but have not had them "triggered", like in all autoimmune diseases. Most people with Celiac, Type 1 diabetes genes, etc. do NOT develop the disease. You do not have the disease without the trigger. Celiac is NOT 100% genetics only. I don't mean gluten as the trigger, since these people tolerate gluten normally until the Celiac is set off by an initial "event".

I am excluding cases in which Celiac was previously present but not diagnosed, of course.

Also, why do most people with other autoimmune diseases NOT have Celiac?

So, you can see, I am quite confused. Why does everyone here think this? Does anyone have a legit scientific link (NOT a personal webpage, alternative medicine page etc.) that can set this straight?

Please help!

Most of this depends on the pretext that "leaky gut" in terms of zonulin is the only way autoimmune response is triggered and further that the permeability of the guy wall remains constant wrt proteins.

Firstly a ref for your direct question:

Ventura A,Magazzu G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in celiac patients. Gastroenterology 1999;117:297–303.

Lets consider it as science and not medicine.

Celiac is NOT 100% genetics only. I don't mean gluten as the trigger, since these people tolerate gluten normally until the Celiac is set off by an initial "event".

I am not aware of any studies that show biopsy proven celaics have increased zonulin OVER people who are biopsy negative but IgA and IgG positive. That is the difference is one person is repairing cells as fast as they are destroyed and the other is not. This obviously depends of the level of gliadin specific antibodies but also the persons own regenerative capacity which can be comprimised by disease, pregnancy or age.

The second precept is that the level of zonulin is the only control over relative permeability in large molecules in the same way that ion channels control anion permeability. However we know that not only can anions pass through a specific channel but large proteins can piggy back. If you weant to check this out read up on Alzhemers and also ion-delivered pharmacuticals.

The third as yet unmentioned and as far as I know unresearched area is the presense and type of intestinal flora.

Unlike the most parts of the digestive system the intestine is relatively flora free.

Until very recently the idea of bacteria living in the stomach was laughable....and the thought that those bacteria themself could affect enzyme production in the stomach science fiction.

I hypothesise that the flatttening and total destruction of villi in addition to associated inflamation may provide a foothold for other bacteria which do not normally survive the intenstine and themsleves can influenbce enzyme and permeability of the gut in addition to the inflammation itself increasing exposure to the tight junctions inside the intestine wall.

When a celaic goes gluten-free and the intenstine walls are repaired then perhaps the effective permeability decreases not only to gluten but to other potential toxins.

A parallel to this is the stomach wall in the case of h pylori.

"Many perfumes also use grain derived alcohols in their processing. These can also cause problems for celiacs."

"Grain derived" isn't usually wheat and is distilled anyway. Don't know why this would cause problems for people with celiac. Mind you, I'm not saying perfume isn't a problem for some, but I doubt it's a gluten thing.

richard

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Alarming people needlessly just doesn't make sense.

Its not really alarming people to let them know others have the same experience, indeed I think many people are relieved if they find others have the same reactions.

I'm not trying to be all psycho & "anti-distillation" here - this all started because I have had (and my sister has had) independent from one another reactions to distilled alcohols. So then I asked my friend, because it didn't make sense as to why, if this stuff is safe, we were reacting to it.

I started eating meat again just because it required too much planning not to. I still have a hard time thininking of it as "food" (4 months as an omnivore).

I think this is a very good reason.

Its not impossible to have a balanced vegan diet but it is very hard and you need a detailed knowledge of biochemistry to actually do it. I'm more than happy to beleive Jestgar has this knowledge and this is why it is so hard. Trying to maintain your essential amino aicds to anything like a balance on a vergan diet is pretty hard in itself.... if you remove gluten its even harder and if you don't want to eat a lot of soy protein .... pretty much a full time job!

Now I'm not rabidly anti-soy but I don't think it is a natural food that should play a major part of diet in anyone. Only the West actually uses soy as a protein source, oriental cuisine does not use significant amounts of non fermented soy... its a misconception, soy is usually a added compenent not the major protein source.

However I do think that if you already have one immune system intolerance then not making soy (or other allergens) a large part of your diet is a smart move ... its like asking for trouble later IMHO.

On the ethical issue...

That's very individual.

I had one friend who was vegan except for milk and got quite ill. At the time we were in our undergrad projects both on the North coast of scotland and he actually went fishing, caught a fish and ate it.

He felt a lot less guilty having caught it himself and killed it himself as humanly as possible rather than buying it in plastic and pushing the resposibility for killing the fish onto someone else. Once he knew he could catch and kill fish he was then OK with eating all wild fish.

True, but currently all the already mentioned restaurants are doing the best they can to accomodate us at no extra cost, and previously I seldom ate at most of them, so they have increased their number of customers. They see a benefit to doing more for us so that we can eat there and for no extra cost. Marketing is all about getting more people to chose your product ... if there were a TGI Fridays next to an Outback, the choice for me and those dining with me would be easy. Outback has an advantage because they are willing to do extra for me. Some restaurants would find this financially adventageous, others would not.

I am not talking about them having a separate kitchen and chef for us ... that would most certainly be cost prohibitive.

Yes I realise they are managing something but the question is if there were three chains, one TGI'f, and outback and a third who had a dedicated kitchen but charged a little extra for the gluten-free stuff BUT the gluten-free stuff was guaranteed.

Restaurants are generally businesses run on a small profit margin. The cost of doing something like this without conpensation would mean that nobody would do it.

I agree here completely... individual restaurants rarely make much money.. Especially a franchise the manager/owner might afford a nice newish car but he's not rich...indeed I have been told by friends who are in the business in the US that its practically impossible to make any real money by owning a single resto because the margins are so tight.

(I had a friend of a friend who owned several subway's, sold them all and took cooking and resto management courses here in Paris which is where I know him from and went back and set up a small but growing chain because he maintained it was impossible to make any real money owning a single resto which was what e really wanted)

The point is there are many resto chains that choose to exclude large sections of the community for purely practical reasons such as halal or kosher.

Anyway, I actually own a 50% share in a bar myself.. its a large bar and we had planned to do food and I had obviously a preference for doing something gluten free...

When I looked into it we had a architect who specialises in bars & resto's look at the possibility of a kitchen but even the cheapest we could legally put in would have taken years to repay itself, that in itself not being the obstacle because part of the reason for doing food was marketing.

To have actually done it and made a gluten-free area and sourced more expensive suppliers that could guarantee gluten-free would have been impossible... with the added cost of gluten-free food and a dedicated area the kitchen would never have paid back and I had cash to lay down... if I needed a loan to do the kitchen then I would never have paid back the loan.

The other point most people don't realise is most of the cost of putting ina kitchen isn't burners and ovens it is compliance with hygene rules and safety. You actually have to put in fire safety and stainless steel surfaces etc. and make structural alterations for working spaces etc.

The cost of running a resto is largely staff costs followed by food costs ....

I know a lot of resto owners and chef's personally and the margins are very slim.

They cannot afford to spend extra time on individuals on a regular basis... I know one chef very well if you send anything back when the resto is busy he just bins it, plate and all and cooks it fresh because its cheaper than faffing about... and he can't spend time on that or the other customers food gets out of synch and upsets his planning..

The point being that any resto catering for gluten-free is intrinsically going to have higher costs and lower margins than its neighbour. Someone has to pay.... either they increase the cost of all meals or gluten-free meals...

As eKatherine says

I can see that might work if the majority of celiacs were diagnosed and on the gluten-free diet, but right now the demand is pretty small.

Even if we all take people back on a regualr basis its still a small demand and really if a resto needs a few customers that much its already sliding out of business. There is a very good reason why franchises and chains are so popular.

You also have to consider that many of us do get glutened when we eat out, not every time but frequently enough to make us think twice about a place that does gluten-free along side regular.

I simply don't see a business model where gluten-free food can be prepared reliably and not cost extra and I think most customers would not be happy to be paying more for their food because of a tiny minority, they will simply take their business elsewhere.

Marketing is all about getting more people to chose your product .

Not really its so much more.... its about convincing customers to choose your product over someone elses.

With current diagnosis rates the number of actual celiacs is very small (1:4000 or so) so even if we all bring 10 other customers that's still 1:400....

As people on this thread have indicated they don't want to pay more.... but we are only 1:4000 .. the people we go with don't want to pay more either but might accept it.... BUT the most important thing is that MOST people will not want to go if its costs 10% extra to the TGI's next door.

Marketing is about the masses, not the minorities. Its about providing what MOST people want at the "right price " and quality that people are willing to pay for.

can it wait tomorrow when the doc comes in a hour before the procedure to talk to me? or should i call the office right now?

I don't think it will affect much... except you maybe being more relaxed....but I'd just mention it in passing to the Dr. if you're concerned... don't make a big deal its not great on your records...

Thanks, gfp. I thought you could swallow glutens that entered through the nose and were breathed in. I don't wear perfume either. I avoid it like the plague. I put my house up for sale back in January and the woman who listed my home had a lot of perfume on. You could literally hear what her perfume had done to my voice in one hour. So now whenever I smell perfume, I make sure I exhale as much as I can. I've even gone so far as to hold my breath.

Well I hate to contradict a pre-med student (I hated biol and paleo biol) or even MD but this particular misconception has gone on long enough.

I was talking to a woman today about celiac, she heard me talking to someone else about my recovery and said 'Gee that sounds like me' After we had been talking for a few minutes she mentioned her son recently been diagnosed and had been on the diet about a month and called him over. Imagine my surprize when I recognized this young man as the same one who had been shopping with his grandmother a couple months ago at the grocery store. We had gotten into a detailed conversation about celiac, (I will bring it up with anyone who will listen) and she had evidently gotten him tested and he was put on the diet. Needless to say since the Mom was undergoing testing for MS I heartily reccomended she also do the diet. Some people might think I am too pushy on the celiac issue but this time my 'sticking my nose into a strangers business' has really paid off for this family.

woooohoooo

Great... keep up the good work...

award yourself one gluten-free forum gold star

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Patients in the European Union should have the right to travel to other member countries for treatment, the EU health commissioner has said.

Markos Kyprianou is due to launch a debate at the European Commission on the issue later.

The Financial Times reports he wants patients to have the right to care in any of the 25 member countries.

Erm this is fabulous news for those in the UK.... a bit less fabulous for me... I guess!

Specifically cancer survival rates are much higher in France because they don't hold back expensive drugs... like the UK do and celiac diagnosis in Italy is a doddle!

I'd be really interested in a poll of how many people would pay more for their gluten-free meal than a regular meal.

.. and I guess so would outback!

I know a UK chain that makes a gluten-free range but they are all prepared off premises and just reheated to avoid CC issues.

Personally I would be happy to pay more to reduce the risk....

How much more I guess depends how they minimise the risk.... and the type of item.

For instance lets take a gluten-free burger ... I'd be happy to pay a 50% suppliment to have it in a gluten-free bun. Indeed if faced with you can have the regular one but without bun and risk of cooking contamination which we will try and minimise AND we have a gluten-free one with everything prepared off site except the burger which will be cooked ona dedicated gluten-free grill then I'd go for the suppliment everytime...

I disagree wholeheartedly with this. I think most of medicine is based on research, either past or current that is being updated all the time. 2 areas which have especially progressed at a rapid rate over the past 5-10 years are genetics and immunology.

However you can't just accept all research at face value. I think even most researchers agree that some types of studies like case reports, or non-pleacebo controled studies are pretty much useless, and the only research that is acceptable is double blind placebo controled trials.

Not really, that is part of the the problem.

IMHO med school does too good a job knocking the scientist out of the prospective MD.

10 years ago medicine was 100% convinced there was no link between GERD and celiac despite over 50% of celaics sufffering GERD. I was categorically told the two were unlinked because that is what the literature said.

However how can a GI who sees hundreds of celiacs over 50% of which suffer GERD not put 2 and 2 together?

What would be the harm in screening someone with IBS and GERD for celiac?

Why do we need a double blind test when every GI dealing with celaic has hundreds of patients with the same symptoms.

You never answered my earlier question regarding if you beleive in neurological symptoms of celiac disease.

I presume that even if 1000 subjects with white matter lesions on MRI and 80% of them have celaic that you will still dismiss this until a double blind test is run.

Several of the tests are unethical anyway. How can you do a double blind test on celaics and lymphoma and the effect of a gluten free diet without forcing a group of the celaic's to not eat gluten free and even if you get volunteers we will need to wait 50 years as we did with cigarette smoke and lung cancer.

Yeah, but it sucks when making a simple salad takes almost an hour.

Erm then get rid of all the gluten in your kitchen......

seriously... its not only easier but safer.

AH okay, here in USA Ragu' is a brand name of inexpensive tomatoteo sauce, and I have not seen/heard anyone use it anyother way.

Which is rather the point, especially since you have a fairly reasonable number of second language Italian speakers.... and ragu is a VERY VERY basic term that even a 10th generation Italian family who speak no Italian at home would use everyday.

Additionally it is also a frequently used Spanish (borrowed from Italian) word

m. Guiso a base de carne troceada y guarnecida con patatas y verduras.

I'm presuming I don't need to translate the Spanish...

Oh, I'm TOTALLY OCD right now! And I had an already diagnosed anxiety disorder, so I didn't have far to fall. LOL

What I'm OCD about is my own home. I wish I could be as strict as some of you, but I have DH, 3 small children and two pets, so it would not be fair (or cost effective) to only allow gluten-free foods in the house.

I do have a shelf for just my stuff, and a door shelf in the fridge, but every time the kids make toast in their toaster, you'd be surprised how far the crumbs fly.

Before I make anything for myself I scrub my "safe area" of the counter, I scrub the pot and utensil, the knives, put my gluten-free cutting board on the freshly scrubbed counter, etc. And then I still worry that there was something on the plate, that I touched something with gluten on it....

This is not OCD this is common sense!

Anyone working in an analytical lab works like this all day everyday, its just good practice because without it human error will occur.

If your making it from stratch... why are you cooking Ragu sauce too?

Ragù è un termine utilizzato per indicare un sugo o una pietanza composta da numerosi ingredienti (che variano a seconda delle regioni) ma sempre a base di carne.

Quasi sempre i ragù sono usati per condire pasta o sformati.

Ragu is a term utilised to indicate a sauce or "sauce dish" composed of several ingredients. (which varies according to the region) {presuming we conjugate seconda in the aggiuntive} but always with a meat base.

Usually the ragu is used to "dress" a pasta or "moulded dish"

moulded dish means like a souffle in this context being dervied from the verb to mould ... (or pie if you prefer)

I disagree. If a restaurant agrees to try to provide you with safe food, then you should give them feedback either way. While cross contamination is always a consideration, it is not the responsibility of the person with celiac to pretend that the restaurant did a great job when in fact they were seriously glutened. You say nothing, they'll think they did fine, and they'll do it again to somebody else.

Couldn't agree more.

but I'll add something....

gluten free preparation costs time and time costs money.

Ideally it should be a dedicated kitchen... at the very minimum preparation should take place before other gluten containing foods.

I make my own from scratch now too...

That's my point really.... its so simple...its cheaper and you can be a lot more flexible with your ingredients.

and... it really doesn't take any time if you start by boiling water for spagetti.... by the time its cooked the ragu is ready. I'm not saying it might not get better cooked slowly but its still got to be better than something in a jar packed with chemicals?

I really do try to educate them. I felt so good one day when the doctor ordered the panel on a patient in the hospital. They couldn't figure out why she had severe pain after eating and all sorts of other celiac symptoms. If I helped one person get diagnosed, then it is all worth it.

The only problem is one that I face everyday in my job -educating doctors is tough. They have more education than me and most of the time huge egos. You have to say things just right to get them to listen. Sometimes when I'm telling them how common celiac is or that I'm not crazy and everyone is sensitive, I start to lose credibility because they just think I'm crazy. Since these people are my customers I have to back down and preserve the relationship.

I hope that when a medicine gets approved for celiac that I will be able to sell it. Until we have drug reps talking to doctors everyday about celiac it won't ever be in the front of their minds. It is so frustrating to see how many doctors are not educated at all about it.

Honestly I understand which is why i suggest printing out a few relevant papers ....make sure they are good medical ones and conveniently have them. Im presuming as a sales rep you travel... so just say you printed em out for your own use but finished with them.

If you wanna play then let the Dr's EGO work and ask them to explain the paper over lunch ....

I respect that you are opposed to Western Medicine. You feel that it failed you. And maybe that is true. We still cannot prevent or treat many illnesses. But it is possible nature cannot heal you either. Well, I HOPE it can, but just needed to prove a point!

Of course I want you to get well and feel better. Maybe this board will help you find a diet that helps. I am simply stating a possible explanation. Sometimes we cannot fight genetics, with any kind of medicine.

Many people on this board would have died 100 years ago if it were not for modern medicine. True, that is "nature's way" or survival of the fittest, but I think we should use it if we have it.

QUOTE(tailz @ Sep 5 2006, 05:15 AM) *

This is just one problem with Western Medicine. We are all probably walking around with some sort of infectious disease like lyme that Western Medicine discounts because we didn't get the classic bull's eye rash, and the Elisa test was negative. Western Medicine is seriously flawed when you consider how many people on here and on the Lyme forum were diagnosed with Celiac's or MS when what they really have is late stage lyme.

No, actually the one problem with Western medicine is that doctors don't keep up with the research and end up being so misinformed as to be useless, unless you happen to have a popular disease.

Honestly I think its a mix of everything....

Firstly as eKatherine pointed out a week or so ago 90% of diseases treated by Dr's actually go away all by themselves.

Sometimes this treatment might accelerate healing sometimes it just relieves symptoms...

For instance taking vitamin C for a common cold ...

In the UK the second most common ailment for lost work is lower back problems ....

90% of the time its treated with anti-imflammatories ... but mostly posture and things are ignored, perhaps largely because the Dr. knows most people won't do anything that doesn't involve swallowing a pill!

However Dr's are equally guitly in many cases of just giving out pills.

broad spectrum antibiotics are used fairly indiscriminatly for instance that then lead to other problems.

In many cases I think the Dr's are just treating symptoms of lifestyle and their own medicine.

and equally most do not keep up with current research...mostly they are kept informed by drug companies selling product just like a car dealer selling cars. They are spoon fed the product (and in many cases benefit financially from prescribing it) .... all sorts of wonder products like thalydomide and in the same era formula milk enriched with gluten. ADHD take ritalin, then treat the side effects.... gastric ulcer take a acid inhibitor ...

See. That's the ONLY thing Western Medicine has on Eastern. We developed vaccines (which cause cancer). And if I need surgery or I'm giving birth, I have Western Medicine throwing a bunch of scientific terms around and making something *natural* like childbirth feel like a freak show. How can you say Western is better? If we would follow the Bible, we wouldn't need Western medicine. I guarantee smallpox and polio got their beginnings in something man did. I would think it'd be easier to prevent breast cancer than it would be to cure it. And we haven't cured it by any means.

Erm they also developed a vaccine for cervical cancer that is 75% efficent in saving lives.

If we lived as they did in blblical times then the average life expectancy would be 25-30 as it was then.

When we look at bones and preserved natural mummies of the biblical era we see that very rarely did anyone outside Roman or Hellenistic culture reach 30... wheras by the time of Christ 80 was not an uncommon age in Roman citizens and this can be tested by dating their remains.

And it is equally a fact that there was no disease or petulance until Promethiius stole fire and the King of the Gods gave Pandora a box. This is absolute FACT since it is written in many Hellenistic scriptures which are avery bit as true as the bible.

Additionally many of the potent life saving drugs have actually been derived from shellfish so if we lived by the bible we wouoldn't be able to eat them... since the bible specifically forbids them and nowhere does it say we can eat them under the new covenant.

are spicy things naturaly hard on the stomic?

Lister, this is your thread, at least read it.

You just give it easy to digest food and no irritants (or as few as you can)

Coffee, hot 'n' spicy ... alcohol (and nicotine) are irritants.

Anything with lots of water in it is usually easy to digest...

Zuccini, egg plant, cucumber (technically fruits) are all easy to digest...

Hard starchy foods are more work like corn, rice and perhaps potatoes...

A lot of people find a food combining diet easier on their stomach... (I do)

The theory is meats and protein rich foods like nuts need an acid environment to digest whereas vegetables need a less acid environment. It is suggested that by eating them together it kinds confuses the stomach...on how much acid to produce. While it can't digest everything it keeps making more acid = rumbling and stomach cramps etc.

A lot of people also debunk this.... personally I find it helps a lot.

You can get books or download from the internet lists of the different foods and you just try and eat them seperately...

10 yrs ago (having been biopsied for stomach cancer....ulcers and basically anything but celiac) I got put on a acid inhibitor which was then ranitidine and told it was for lfe.

A friend who's husband has Chrons recommended this diet. She did it herself and it has to be said she looked very healthy on it... she had convinced a few people to try it and they too all got healthier.

I was absolutely desperate so I tried it and it worked .....

The one I followed had gluten in it but I also found the book a bit "new world hippyish" but I was back in the UK for a short time and saw a TV audience show ... a bit like a watered down Oprah and the theme was diets.

They went through and blasted most of them... they had Dr.s in to blast them and then they came to this one and the Dr.s all blasted it.. no scientific evidence etc. ... then people who had done the diet all got up and started saying they didn't care... they were healthier than they had been ... they had lost/gained weight to a healthy weight etc. etc.

Non of the other diets had this sort of following... or convincing advocates... and one mentioned a different book that combined "food combining" with cycling "bad foods".

Bad foods were basically very starchy stuff like rice, corn and bread .(you were only meant to eat the same bad food once in 5 days maximum).. BUT he also advocated not eating wheat at all... if you could.

Well I got much much better... with little hickups every 5 days.(or so).. and when I cut out wheat as much as I could it suddenly struck me... its the freakin wheat. I had actually heard of celiac disease... but that was about it and I was certain I didn't have that... I was just a bit sensitive to wheat... however I cut out all non hidden gluten and did the diet ... and I really really improved.

To cut a long story short my mom started getting the same symptoms... to be honest she had always knocked my "wheat thing" ... and even been quite cruel accusing me of attention seeking (I once missed a flight because I was literally doubled over in pain and the pilot refused to fly me... (ironic I was flying back from Africa for a endoscopy!!) etc. etc. so after she had finally been referred to a physchiatrist for hypochondria and the Dr. had exhausted almost every last test known I managed to get her to suggest a IgA., IgG screening ....

Her Dr. laughed in her face (she didn't realise what the tests were for) and told her she was just mentally ill and nothing wrong with her except attention seeking and Munchausen... but he did run the tests.

He didn't actually apologise.... but when he did get the results he sent her for a biopsy and this was very postive....

Cool!

I thought it was probably asking to much that there would be gluten free dog food. I have so many other things I have to look into that this was on the back burner. Aimee isn't allowed to touch the dog's food or dish or mouth and usually the dog doesn't lick her. I just tell her that those things are dirty and might hurt her. Better though will be when I find where to get some good dog food in hicks ville USA.

Thanks for the info,

Gloria

Just feed it what you eat.....supplimented with low grade meats.

Its probably easier to buy from a butcher/farmer in hicksville than a big city....

Dogs are omnivorous though they do benefit from more meat than we do ....

root vegetables, left overs (preferably not spicy) ... and all of this will be healthier for the dog than dried food.

I really don't think that if the dog is eating dried food you can stop it transferring it round the house, they are such messy eaters.

Perhaps a cat since they are pretty exacting eaters somewhere on the internet is a joke about how to give a cat a pill... and then how to give a dog a pill.... the cat one is 2 pages which ends with the whole house wrecked and the owner in hospital... the dog one is stick it in a piece of meat!

Don't get me wrong I love dogs... but their eating habits are not very sophisticated to say the least.

When dogs eat they spread food everywhere... they carry it in their "beards" and "bury" bits of it everywhere...crumbs on the carpet and anything they touch... thats just dogs being dogs!