Role of mind-body techniques in the management of ITP disorder

 

This post deals with a case study of a 34years-old man who developed Immune thombocytopenic purpura (ITP) in 2014. His condition deteriorated despite the medications and plasma replacement therapy. However, he noticed a significant improvement in his condition as he practiced meditation, yoga, and SKY regularly.

As I reflect on Vikrat Saini's journey with ITP, his case presents a compelling narrative of resilience, exploration, and the pursuit of holistic well-being in the face of a challenging medical condition. From his initial diagnosis in 2014 to his current state, Vikrat's story embodies the intricate interplay between conventional medicine, alternative therapies, and personal empowerment.

What stands out prominently is Vikrat's proactive approach to his health. Upon receiving his diagnosis, he sought conventional medical treatment and diligently followed the prescribed regimen. However, as his condition persisted and even worsened, he embarked on a journey of exploration, delving into alternative healing modalities such as Sudarshan Kriya Yoga (SKY), meditation, and Ayurveda. His decision to join Art of Living (AOL) and immerse himself in their programs marked a pivotal turning point. Through AOL, Vikrat discovered a holistic approach to health that transcended mere physical symptoms. He embraced practices that nurtured not only his body but also his mind and spirit. The incorporation of SKY, meditation, and Ayurvedic treatments into his routine provided him with tools to manage stress, cultivate inner peace, and enhance his overall well-being.

What is striking about Vikrat's journey is his unwavering commitment to his practice. Despite facing setbacks and challenges along the way, he remained steadfast in his dedication to self-care. His consistent engagement with SKY, meditation, and yoga speaks volumes about his resilience and determination to reclaim control over his health.

Moreover, Vikrat's involvement in seva projects underscores the transformative power of service and community engagement. By contributing to the well-being of others, he found fulfillment and purpose beyond his own struggles, reinforcing the interconnectedness of personal and collective healing.

As I reflect on Vikrat's story, it prompts me to reconsider the conventional notions of health and healing. His journey serves as a testament to the multifaceted nature of well-being, encompassing physical, emotional, and spiritual dimensions. It reminds me of the importance of approaching health holistically, acknowledging the complex interplay between mind, body, and environment.

His journey with ITP is not merely a tale of medical challenges but a testament to the transformative power of resilience, self-discovery, and holistic living. His story serves as a source of inspiration and a reminder that healing is a journey, often nonlinear and unpredictable, yet filled with opportunities for growth, transformation, and renewed vitality.

Immune thrombocytopenia (ITP)

Immune thrombocytopenia (ITP) is an autoimmune disease which leads to unnecessary bleeding and bruising (Kistangari and McCrae,2013). This happens as a result of the abnormally lower level of blood platelets which aids in blood clot formation. ITP can result in purple bruises, and /or tiny reddish to purple rashes in the form of dots. Among children, ITP develops following a viral infection which generally gets well completely without requiring treatment. However, among adults, this can be a long term problem. In mild cases that is when there is not excessive bleeding and the platelet count is not very low, one may not require any treatment. However, in severe cases, treatment may comprise medications to enhance the platelet count and surgery to eliminate the spleen (Neunert, 2013). ITP may be present without signs and symptoms. However, diseases are identified as a result of easy or extreme bruising. There could be bleeding from the nose and/or gums. Other symptoms include blood in urine and/or stools and abnormally heavy menstrual flow. ITP generally takes place when the immune system by mistake attacks on platelets, blood cells which help in clot formation. The disease may be stimulated by HIV, H. pylori or hepatitis infection. ITP is also common in women. To establish immune thrombocytopenia after tests, the physician will eliminate other probable reasons of low platelet count and bleeding such as primary ailments or medications the patient was taking. To check the platelets blood tests are performed. Even bone marrow examination can be done to eliminate other problems. Individuals with a mild form of immune thrombocytopenia require only usual monitoring and platelet count. Children’s condition with the disease generally gets better with no treatment. However, the majority of adults with ITP will in due course require treatment, as the disease frequently becomes severe with time. The ITP condition is managed by the treatment which involves a number of approaches, such as medicines to increase the platelet count and/or surgery to eliminate the spleen (splenectomy) (Vianelli et al 2013). These treatments have associated risks as well as benefits. For some individuals side effects of these treatment options are more troublesome compared to the impact of the disorder itself. The physician needs to find out over-the-counter medicines or supplements which the patient is taking and see of these need to be discontinued if they hamper platelet function. Some such medications comprise ibuprofenm aspirin and ginkgo biloba. Medicines used in the treatment of  ITP may involve steroids, immunoglobulin, drugs involved in boosting platelet production. Oral steroids such as prednisone are generally prescribed by the doctor. As the platelet count comes back to a safer level, under the direction of a physician, patients can slowly stop taking these drugs. Long-term use of such medications is not suggested as they put the patient on the risk of opportunist infections, osteoporosis, and high blood sugar.  Immune globulin prescribed in case corticosteroids fails to be effective. These can be given through intravenous route by injections. It can also be given in condition of critical bleeding or when there is a need to increase the blood platelet count before surgery. Another important class of drugs in ITP treatment are involved in boosting the platelet production. Drugs such as eltrombopag (Promacta) and romiplostim (Nplate) enhance platelets production by the bone marrow. However, these drugs have some side-effects as they add to the risk of blood clot formation. Some other drugs such as Rituximab (i.e. Rituxan, Truxima) are immune suppressors and lessen the immune response which is responsible for the damaging the platelets. This way these drugs act by boosting the platelet count by immune suppression. However, this drug also has its side-effects as it reduces the efficacy of vaccinations, that may be required if in case the physician recommends surgery to take out the spleen (Vianelli et al 2013). Surgery is done in the severe case where the condition persists and drugs and alternative therapies are ineffective. Spleen is an organ of platelet destruction and its removal improves the platelet count. However, even surgery is not effective in some cases.  Spleen removal increases the risk of infections. In some of the severe bleeding emergency care is required.  In such rare conditions, platelet concentrates,  immune globulin, and steroids are given to manage the condition.

In ITP treatment therapies which impact the mind are as important as those which impact the body. It is well-established fact that psychosocial stress negatively affects the antioxidant capacity of the body and enhances the oxidative stress (Akbayram et al 2010; Sharma et al 2003; Zhang & Zehnder, 2013). Oxidative stress has a role in the development of ITP (Imbach,2011; Jin et al 2013). It is also well established that there is reduced antioxidant activity in individuals with ITP (Kamhieh-Milz et al, 2012). Psychoneuroimmunology which is based on the mind-body medicine and its impact on immune and endocrine systems by reducing stress level and inflammation, besides re-balancing of the immune functions, has an important role in ITP management (Kiecolt-Glaseret al 2002; Schedlowski,& Tewes, 2013). Such Mind-body methods play an important role in reducing side effects of the treatment, healing,  management of pain and decreasing the risk for complications.  These effective techniques help in the development of self-confidence, self-mastery, quality of life and peace of mind (Brown et al 2005). There is substantial evidence that mind-body interaction is crucial for ITP management. People’s perceptions, feelings as well as thoughts create immediate responses inside the body, through signaling pathways inside the brain. Everything in mind impacts the body. It is quite possible that a person despite being in a peaceful surrounding, focuses on negative aspects and as a result develops physical stress in the form of fear and anxiety which lead to the synthesis of the stress hormone cortisol. Those who deal with demanding situations in an optimistic way, release relaxation and happiness associated chemicals such as dopamine and serotonin in the brain, which are responsible for enhanced positive energy and elevated mood. Stress is common in life and automatically resolves with no permanent effects. Studies proved that excessive stress in the form of worries associated with work-related issues can cause immune system impairment which can add to the development of autoimmune disorders and suppressed immunity (Stojanovich,  & Marisavljevich,2008). Additional stress associated health problems involves high inflammation, pain intolerance, sluggish healing and mental health issues(Godin et al 2005; Lundberg,2005).  Psychological stress leads to the development of oxidative stress which may activate ITP, extend the period of the platelet disorder among children, and aggravate fatigue Imbach,2011; Sharma, 2003). Research shows that the incidence of ITP has been higher among people who are anxious, face mental turmoil, fear, and exhaustion. Moreover, such people have been found more emotionally exhausted compared to those devoid of the disease. Excessive stress has been found to be associated with a detrimental lifestyle which involves unhealthy habits such as alcohol abuse, smoking, excessive intake of painkillers, binge eating; lack of physical activity which may lead to heart disease, obesity, diabetes, high cholesterol, high blood pressure, cancer, and autoimmune disorders. Evidence from research studies proves that certain mind-body techniques may enhance the general well-being and decrease stress as well as inflammation which may contribute to the low quality of life and low platelet count among people with ITP disorder. These techniques can be used to deal with the signs and symptoms of ITP either alone, in combination with other therapies, or to harmonize these therapies. As autoimmune disorders have a base in emotional and psychological stress, adopting a therapy which tackles such factors can be very effective.  Some widely practiced mind-body techniques which have been found to be useful for the management of ITP include meditation, yoga, guided imagery, positive attitude, and positive thinking. There are several studies which show that such techniques reduce stress, lower blood pressure, reduce inflammation, improve well-being, enhance immune function, and lead to positive alterations in the brain (Holden‐lund, 1988; Tang 2010). The guided imagery technique enhances optimism and decreases anxiety and stress level with the help of images, words, or ways to induce positive mental imagery. Studies have shown that such practices have a straight effect on blood-related disorders (Holden‐lund, 1988; Tang 2010). Yoga has also been found to be effective in the management of ITP. Several studies show that individuals who consistently practice yoga have decreased the level of the inflammatory cytokines IL-6 than the nonpractitioners (Kiecolt-Glaser et al, 2010; Tusek 1997)It is crucial to note that IL-6 is the cytokine which is prominent in individuals with ITP who face fatigue (Pinheiro et al, 2010).

Vikrat's experience with conventional allopathic treatment initially brought relief but was accompanied by significant side effects. However, upon integrating mind-body techniques into his regimen, particularly through his engagement with Art of Living programs, he observed substantial improvements in his condition. Regular practice of SKY and meditation not only led to an increase in his platelet count but also enhanced his quality of life while reducing the adverse effects of medication.

The case of Vikrat Saini highlights the potential of mind-body techniques in psychoneuroimmunology, suggesting a profound interconnection between mental, emotional, and physical health. His journey underscores the importance of adopting a holistic approach to healthcare, one that acknowledges the intricate interplay between mind, body, and spirit in healing. While Vikrat's case offers promising insights, further research is warranted to validate the efficacy of these techniques in managing ITP and other autoimmune disorders. Large-scale case-control studies would provide valuable evidence regarding the role of mind-body interventions in complementing conventional treatments and improving patient outcomes. In essence, Vikrat Saini's journey serves as a beacon of hope, inspiring both patients and healthcare practitioners to explore integrative approaches that honor the holistic nature of human health and healing. By embracing the synergy between conventional medicine and mind-body practices, we can pave the way for more comprehensive and patient-centered care paradigms in the management of autoimmune conditions like ITP.

Bibliography

  Akbayram, S., Dogan, M., Akgün, C., Mukul, Y., Peker, E., Bay, A., ... & Oner, A. F. (2010). The association of oxidant status and antioxidant capacity in children with acute and chronic ITP. Journal of pediatric hematology/oncology, 32(4), 277-281.

Brown, R. P., & Gerbarg, P. L. (2005). Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: part I—neurophysiologic model. Journal of Alternative & Complementary Medicine, 11(1), 189-201.

Godin, I., Kittel, F., Coppieters, Y., & Siegrist, J. (2005). A prospective study of cumulative job stress in relation to mental health. BMC public health, 5(1), 67.

 Holden‐lund, C. (1988). Effects of relaxation with guided imagery on surgical stress and wound healing. Research in Nursing & Health, 11(4), 235-244.

 Imbach, P. (2011). Oxidative stress may cause ITP. Blood, 117(17), 4405-4406.

Jin, C. Q., Dong, H. X., Cheng, P. P., Zhou, J. W., Zheng, B. Y., & Liu, F. (2013). Antioxidant status and oxidative stress in patients with chronic ITP. Scandinavian journal of immunology, 77(6), 482-487.

Kamhieh-Milz, J., Bal, G., Sterzer, V., Kamhieh-Milz, S., Arbach, O., & Salama, A. (2012). Reduced antioxidant capacities in platelets from patients with autoimmune thrombocytopenia purpura (ITP). Platelets, 23(3), 184-194.

 Kiecolt-Glaser, J. K., Christian, L., Preston, H., Houts, C. R., Malarkey, W. B., Emery, C. F., & Glaser, R. (2010). Stress, inflammation, and yoga practice. Psychosomatic medicine, 72(2), 113.

Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R. (2002). Psychoneuroimmunology: Psychological influences on immune function and health. Journal of consulting and clinical psychology, 70(3), 537.

Kistangari, G., & McCrae, K. R. (2013). Immune thrombocytopenia. Hematology/Oncology Clinics, 27(3), 495-520.

Neunert, C. E. (2013). Current management of immune thrombocytopenia. ASH Education Program Book, 2013(1), 276-282.

Schedlowski, M., & Tewes, U. (Eds.). (2013). Psychoneuroimmunology: An interdisciplinary introduction. Springer Science & Business Media.

Sharma, H., Sen, S., Singh, A., Bhardwaj, N. K., Kochupillai, V., & Singh, N. (2003). Sudarshan Kriya practitioners exhibit better antioxidant status and lower blood lactate levels. Biological psychology, 63(3), 281-291.

Stojanovich, L., & Marisavljevich, D. (2008). Stress as a trigger of autoimmune disease. Autoimmunity reviews, 7(3), 209-213.

Tang, Y. Y., Lu, Q., Geng, X., Stein, E. A., Yang, Y., & Posner, M. I. (2010). Short-term meditation induces white matter changes in the anterior cingulate. Proceedings of the National Academy of Sciences, 107(35), 15649-15652.