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Expert Insights: The Systemic Amyloidoses vs. Parkinson’s vs. Alzheimer’s

Current medical education on amyloid diseases is 25 years old and materially outdated, punctuated by rapid advancement in the last five years. Hear from renowned Dr. Jeff Kelly from Scripps Research, developer of ATTR drug tafamidis, about the current biology and how amyloid diseases such as the Systemic Amyloidoses (ATTR and AL), Parkinson’s and Alzheimer’s are today believed to be more similar than different.

 

For those interested in learning more about neurodegenerative diseases driven by amyloid protein misfolding, below is an excellent video from May 17, 2024 by Dr. Kelly.

Peripheral Neuropathy & Amyloidosis

Neuropathy, also known as peripheral neuropathy, is a broad term that is used to describe damage to the nerves outside of the brain and spinal cord. There are over 100 types of peripheral neuropathy that can be classified into four categories, with each type having their own symptoms and prognosis. In this article, we’ll discuss the types of peripheral neuropathy and its connection to amyloidosis.

 

Symptoms

One of the challenges with neuropathy is the fact that symptoms can vary significantly based on what nerve is damaged. Additionally, symptoms can develop over the course of months to years (chronic neuropathy) or come on suddenly (acute neuropathy). Some of the most commonly seen symptoms are listed below:

  • Muscle weakness
  • Cramps
  • Muscle twitching
  • Loss of muscle and bone
  • Changes in skin, hair, or nails
  • Numbness
  • Loss of sensation or feeling in body parts
  • Loss of balance or other functions as a side effect of the loss of feeling in the legs, arms, or other body parts
  • Emotional disturbances
  • Sleep disruptions
  • Loss of pain or sensation that can put you at risk, such as not feeling an impending heart attack or limb pain
  • Inability to sweat properly, leading to heat intolerance
  • Loss of bladder control, leading to infection or incontinence
  • Dizziness, lightheadedness, or fainting because of a loss of control over blood pressure
  • Diarrhea, constipation, or incontinence related to nerve damage in the intestines or digestive tract
  • Trouble eating or swallowing
  • Life-threatening symptoms, such as difficulty breathing or irregular heartbeat

 

Types of Neuropathy

  1. Motor Neuropathy → Damage to the motor nerves control how you move.
  2. Sensory Neuropathy → Damage to sensory nerves control what you feel.
  3. Autonomic Nerve Neuropathy → Damage to autonomic nerves that control functions that are involuntary (ie. you do not consciously control).
  4. Combination Neuropathies → Damage to a mix of 2 or 3 of these other types of neuropathies. For example, damage to both sensory and motor nerves would result in sensory-motor neuropathy.

 

Amyloidosis

Peripheral Neuropathy is one of the hallmarks of amyloidosis, often seen in the transthyretin form of amyloidosis (ATTR). ATTR-PN, or transthyretin amyloid polyneuropathy, is a disease where the transthyretin protein becomes unstable and misfolds. This unstable protein (“amyloid”) then deposits in the nerve tissue, resulting in damage to these nerves. While amyloid deposits primarily in the peripheral nerves, it is not uncommon for amyloid deposition in the autonomic nerves as well. 

While peripheral neuropathy is most commonly associated with ATTR amyloidosis, it should be noted that peripheral neuropathy is also seen in 15-35% of patients with AL amyloidosis.

Most importantly, these are the most common and important signs and symptoms to be aware of, in order to diagnose ATTR amyloidosis.

 

Neurological Complications of ATTR Amyloidosis

Patients with ATTR amyloidosis are commonly faced with neurological complications. In this presentation, Dr. Chafic Karam from the University of Pennsylvania goes through four areas: an overview of the neurological systems, how amyloid damages the nerves, neurological signs of ATTR amyloidosis, and how to detect amyloid and diagnose ATTR amyloid neuropathy.

 

 

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References:

https://my.clevelandclinic.org/health/diseases/14737-neuropathy

https://www.hopkinsmedicine.org/health/conditions-and-diseases/peripheral-neuropathy

https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061

https://practicalneurology.com/articles/2021-july-aug/neuromuscular-amyloidosis

https://healthjade.net/familial-amyloidosis/

 

Humanizing Medical Education: Beyond Bullet Points

The content of medical education is appropriately clinically centered. The delivery of this content remains relatively unchanged over the decades – typically taught by medical professionals through lectures, PowerPoint presentations, and patient case studies. We posit that there is an essential missing component: the patient voice. During the didactic years, medical students rarely hear from patients about their symptoms, diagnostic journey, emotional management, support and resources, and relationship with the medical community. By humanizing medical didactic education, patient insights can offer an impactful and durable education that complements traditional didactics, developing what we believe will be better and more empathetic future medical practitioners.

Expert Insights: Why is amyloidosis so often misdiagnosed?

Dr. Angela Dispenzieri from the Mayo Clinic discusses why amyloidosis is often misdiagnosed. The complexity of the disease and commonality of symptoms are two of the reasons she examines. In addition, she offers guidance on appropriate diagnostic pathways.

Expert Insights: The Future for Patients with Transthyretin Cardiac Amyloidosis is Looking Brighter

The treatment for patients with Transthyretin Cardiac Amyloidosis has advanced significantly since 2018 when there were no FDA-approved therapies. In this presentation, Dr. Mat Maurer from Columbia University shares how diagnostic imaging techniques have significantly improved, thereby reducing the need for an invasive heart biopsy. In addition, he shares fascinating statistics on how the age and stage of diagnosis has been evolving. Based on today’s clinical trials, providers are optimistic that the expansion of options for patient care will continue.

The future is indeed looking brighter.

Transplant: Inpatient vs Outpatient

There is no cure for Amyloidosis.

There are, however, an increasing number of treatment alternatives that can significantly reduce, if not eliminate, the disease and put the patient into remission. The most aggressive treatment is a stem cell transplant (SCT); sometimes referred to as a bone marrow transplant.

Stem cells are cells in the bone marrow from which all blood cells develop. This treatment aims to eradicate, typically through high-dose chemotherapy (e.g., melphalan), the faulty plasma cells which make the amyloid light chains. Once eradicated, fresh cells, harvested from the patient themselves (autologous), a donor (allogeneic), or an identical twin (syngeneic), are infused into the patient. This will help to recreate a healthy bone marrow and hopefully stop further production of the amyloid protein.

This complex treatment typically takes four to six weeks and is performed on an inpatient, outpatient, or some combination, depending on the hospital. There are meaningful differences that are important to know and incorporate into each patient’s personal situation in order to make an informed decision.

From the Healthcare Perspective

Across the country, there are multiple hospitals that perform SCTs to treat amyloidosis. While hard data is elusive, the tally of transplants at each facility, we know, is not spread evenly. We do know that Mayo Clinic (Mayo) and Boston University (BU) dominate the list and perform the majority of transplants. It may not be a surprise, then, that these two hospitals are considered amyloidosis Centers of Excellence in the U.S. They see a high volume of cases, have extensive depth and breadth of expertise, and have sophisticated diagnostic equipment. They are also the two hospitals who have pioneered performing outpatient transplants. The good news is this is evolving, with more centers across the country expanding their transplant program to treat amyloidosis.

Everyone would agree that hospitals are germ and bacteria magnets, which can be dangerous for transplant patients with low to no immune systems. BU and Mayo, for example, found patients were better able to withstand the everyday germs outside of the hospital better than the more potent ones within hospitals. This provides a strong incentive for hospitals to consider outpatient, or if they choose the inpatient route, must be ever super mindful of this reality.

There are risks with SCT, and patient safety is key. Having a patient in-house during the treatment affords the hospital maximum control during the process, while being outpatient transfers some responsibility to the caregiver, such as monitoring the patient’s temperature, food, and fluid intake. Being inpatient also affords the quickest access to experts, equipment, and drugs in the event things go awry, which does happen. Mayo has found that a meaningful percentage (38% according to Dr. Morie Gertz) of patients never need hospitalization during the SCT process; however, on the occasions where it is necessary the duration averages a handful of days.

Treating patients on an outpatient basis requires hospitals to alter their process and training, and rely on the patient and caregiver to assume a more engaged role. Without question, hospitals benefit significantly from the experience of performing high volumes of outpatient transplants. Mayo, according to Dr. Morie Gertz, performed their first SCT in March 1996, and their first outpatient SCT in September 1998. In total, they have performed 744 SCTs and currently average about 33 transplants per year. According to Dr. Vaishali Sanchorawala, BU performed their first SCT in July 1994, and their first outpatient SCT in October 1996. In total, they have performed roughly 675 SCTs for AL Amyloidosis, with an annual run rate ranging between 25 and 50. Together, these institutions have over two decades of valuable experience. According to experts, small volume and the resultant lack of experience is likely the key driver behind why hospitals elect to perform SCTs on an inpatient basis.

From the Caregiver Perspective

Caregivers play a critical role in the SCT process, working closely with the healthcare team to ensure the patient is progressing appropriately. They are so critical, in fact, that regardless of inpatient or outpatient, hospitals will not proceed with a SCT unless they are confident the patient has capable and continuous caregiver support.

The role of a caregiver varies greatly between an inpatient and outpatient process. When inpatient, the caregiver provides important emotional support, as being confined to a hospital for weeks on end can be draining and discouraging. This can range from just being present, to chatting, to light activities. Caregivers also assist in the physical need for exercise, helping and encouraging the patient to walk whenever and however many steps possible. The caregiver role may be filled by one or more persons, often impacted by the distance the hospital is from home.

Outpatient SCT procedures are significantly more demanding of caregivers. For the duration of treatment, the hospital will require the patient and caregiver(s) to be proximal to the hospital. Mayo, for example, requires patients to be within ten minutes of the hospital. Fortunately, there are many hotels, motels, inns, and homes for rent (HomeAway, VRBO) that are transplant-friendly and reasonably priced. It is 24/7 support, monitoring the patient’s key indicators, administering and monitoring meds, transporting the patient to/from the hospital daily, securing meds, shopping and preparing food, maintaining the household (e.g., laundry, sanitizing, etc.), and on and on. The list is extensive and exhaustive. Arranging for such intensive support can be a challenge. Some patients assemble a series of caregivers who rotate in/out for periods of time, others are able to secure one dedicated caregiver for the entire time, and in rare instances, the patient is able to have a team of caregivers for the duration.

Whichever caregiver structure is chosen, it is important to also consider self-care for the caregiver. Mini breaks can go a long way to help sustain their ability to meet the needs of the patient and the requirements set forth by the hospital.

From the Patient Perspective

For patients, it is all about getting through this treatment and hopefully arriving at a successful outcome. Time distills down to weeks, then days, and then when things are their most difficult, just getting through the next hour is the focus.

Having a good and capable caregiver(s) in place can help the patient focus only on themselves, knowing the caregiver will take care of everything else.

Side effects of the SCT can be multiple and vary from patient to patient. The list of effects can include fatigue, fever, diarrhea, nausea/vomiting, loss of appetite, mucositis, and hair loss. Fortunately, the healthcare team can be very helpful in mitigating these effects.

Exercise is important to ward off muscular atrophy and does improve recovery. Every step matters. Both Mayo and BU find patients do better and are home quicker if they spend less time in bed and more time moving around. In addition, patients tend to benefit from the required additional movement needed when living away from the hospital.

Emotionally, a SCT is tough. No way around that. But having distractions, whether provided by the caregiver, getting out of bed to exercise or being out and about via outpatient does contribute to an improved psyche. Having any sense of normalcy is welcome.

Cost differs greatly between inpatient and outpatient treatment, with outpatient coming in meaningfully less expensive. Anecdotal information has outpatient transplants at roughly 50% off the cost of inpatient transplants. Yet regardless of the approach, SCTs are extraordinarily expensive, and most likely patients need their insurance to sign off before treatment can begin. One of the considerations by insurance companies is which hospital the patient is proposing for treatment. During our personal experience, where we dealt with two national insurance companies, both informed us that having treatment at a Center of Excellence made a difference.

Finally, what is it really like? While situations vary widely from patient to patient, as may treatments and outcomes, hearing about a SCT straight from a patient who has been there is helpful. Having had an outpatient stem cell transplant in July 2017, hear Mackenzie’s perspective while fresh post-Mayo. Additionally, preparing for an outpatient SCT is more involved for the patient and caregiver; we have provided SCT and Post-Chemo Tips on the Resources page of our website which others may find helpful.

Closing Thoughts

There is strong evidence over many years and many transplants that patient outcomes are better when performed on an outpatient basis. There are, however, notable implications for the healthcare providers, patients and caregivers, depending on which approach is chosen. Inpatient, outpatient and hybrid approaches can provide successful outcomes, but knowing these differences in advance is helpful to the decision-making process.

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Special Thanks

Morie A Gertz, M.D., M.A.C.P.

Consultant | Division of Hematology | Roland Seidler Jr. Professor Department of Medicine | College of Medicine | Mayo Distinguished Clinician

Mayo Clinic

Vaishali Sanchorawala, M.D.

Professor of Medicine | Director, Autologous Stem Cell Transplant Program | Director, Amyloidosis Center

Boston Medical Center and Boston University School of Medicine

 

Helping Patients Find Their Voice

In the words of Dr. Rodney Falk, “Amyloidosis is a paradigm for thinking outside the box.” The disease can be challenging to diagnose, even for the most seasoned physicians. In the case of the patient, the unknown, with all of its potential disease symptomatic variables, can make for a daunting situation. Developing one’s “patient voice” can seem unduly intimidating. Advocating one’s position may come natural to some, but terrifying for others, especially when the physician is viewed as the expert. Additionally, many patients may find it difficult to translate their feelings without having a medical vocabulary.

With regard to effective collaboration between physician and amyloidosis patient, there have been many success stories, but unfortunately numerous failures as well. One hereditary amyloidosis patient shares a story where after several years of increasing symptoms, and failed attempts with multiple physicians, he finally saw a cardiologist who went out of his way to put the patient at ease, telling him that he wanted to make it perfectly clear that the patient was of utmost importance and that he was being listened to. This was effective in allowing that patient to “find their voice,” with a resulting diagnosis being made shortly thereafter.

Another amyloidosis patient, a woman with AL amyloidosis, had to endure a nine-year journey of increasing symptoms prior to her diagnosis. “I was seen by nine doctors of various specialties, including hand surgeons who performed multiple carpal tunnel release surgeries, an electrophysiologist who diagnosed an unexplained autonomic dysfunction after a tilt table test, gastroenterologists who addressed three separate gastro-intestinal bleeds, multiple cardiological specialists who addressed atrial fibrillation, enlarged heart and diastolic dysfunction, and then finally a cardiologist who listened to my long list of symptoms and reviewed my relevant test results and medical history. This cardiologist maintained a sense of curiosity, resulting in him ordering a “free light chain” assay, leading to additional tests that ultimately confirmed a diagnosis of AL amyloidosis.” The patient states that “the cardiologist listened to me, was not dismissive of my complaints, and did not give up on me. It was this man’s persistence and curiosity that led to my diagnosis and saved my life.”

These two patient stories illustrate how imperative it is that the physician fosters an open and supportive avenue of communication such that the patient can “find their voice” and effectively function as their own advocate. Per Dr. Falk, “…you have to listen to the patient, because the patient is telling you an awful lot.” He goes on to say “…when that person comes through the door, they’re the most important person in the room and not the physician.”

There are several straightforward but effective catalysts that the physician can use to help the patient find their voice:

  • Empower your patients. Some patients are intimidated by physicians and feel the power is entirely in their hands, so in order to foster better communication, give your patients a greater sense of participation in their care. This means making the patient feel important. Again, per the words of Dr. Falk, “…when that person comes through the door, they’re the most important person in the room and not the physician.”
  • Listen without interrupting. According to the Journal of General Internal Medicine, patients on average have 11 seconds to explain the reasons for their visit before a physician interrupts. However, if the doctor lets them speak longer, they will tell you what brought them into the doctor’s office.
  • Seek and provide information. Knowledge is power, both for the patient and the physician. Patients need to be able to effectively explain their situation to the physician and also have their situation explained back to them in terms that they can understand. This may include asking clarifying questions and allowing the patients to write down any questions that they may have, or any information that they may feel is important.

In summary, with a disease such as amyloidosis, it is imperative that a diagnosis be made in a timely manner, making “the patient voice” all the more critical.

 

Sources

The Power of the Patient/Physician Collaboration, https://mm713.org/the-power-of-the-patient-physician-collaboration/, Dec. 7, 2021`

6 Ways to Improve Patient Communication, https://www.jotform.com/blog/patient-communication/, March 23, 2023

ATTR-CM (cardiomyopathy) vs ATTR-PN (peripheral neuropathy)

 

Over the course of the past two months, we spent time discussing two of the most common hallmark symptoms of ATTR amyloidosis: cardiomyopathy and peripheral neuropathy. In this article, we’ll briefly recap both hallmark symptoms as well as bring it all together by discussing the two most common forms of ATTR amyloidosis: ATTR cardiomyopathy (ATTR-CM) and ATTR peripheral neuropathy (ATTR-PN).

To recap …

 

Cardiomyopathy

Cardiomyopathy is a broad term that is used to describe disease of the heart muscle, making it difficult for the heart to provide the body with an adequate blood supply. It is a common cause of sudden cardiac arrest and sudden cardiac death, which can lead to heart failure and even death. 

Types of Cardiomyopathy:

  • Dilated Cardiomyopathy → dilation of the left ventricle prevents the heart from pumping effectively
  • Hypertrophic Cardiomyopathy → abnormal thickening of the heart muscle most commonly surrounding the left ventricle
  • Restrictive Cardiomyopathy → stiffening of the heart muscle results in an inelasticity
  • Arrhythmogenic Right Ventricular Dysplasia → scar tissue replaces healthy tissue of the right ventricle
  • Unclassified Cardiomyopathy → all other forms of cardiomyopathy fall within this category

 

Peripheral Neuropathy

Peripheral neuropathy, also referred to as polyneuropathy, is a very broad term used to describe damage of the peripheral nerves. Damage to these nerves most commonly causes numbness, pain, and weakness but can affect other areas of the body including, but not limited to, circulation, digestion, and urination. 

Types of Neuropathy:

  • Motor Neuropathy → damage to the motor nerves 
  • Sensory Neuropathy → damage to sensory nerves 
  • Autonomic Nerve Neuropathy → damage to autonomic nerves that control involuntary functions 
  • Combination Neuropathies → damage to a mix of 2 or 3 of these other types of neuropathies

 

ATTR Amyloidosis

The origin of this disease can be genetic (hATTR) or non-genetic, or “wild-type” (wtATTR). Regardless, in ATTR amyloidosis, the transthyretin (TTR) protein is misfolded and aggregates, forming amyloid fibers that deposit into tissues and organs. The deposition of protein causes organ dysfunction and can even cause organ failure and death. 

 

ATTR-CM and ATTR-PN

Depending on the location of protein deposition, the disease is referred to in different ways. For instance, when the primary location of amyloid deposit is in the heart, the disease is referred to as ATTR cardiomyopathy (ATTR-CM). On the other hand, when the primary location of amyloid deposit is in the nerves, the disease is referred to as ATTR peripheral neuropathy (ATTR-PN).

ATTR-CM impairs the heart’s ability to pump effectively. A major challenge surrounding this disease is that symptoms of ATTR-CM are often similar to other heart conditions like enlarged heart and heart failure. This makes diagnosing the disease increasingly more difficult. Individuals with hATTR typically present symptoms in their 50s and 60s, whereas those with wtATTR may not present symptoms until their 70s and later. 

Common Symptoms of ATTR-CM:

  • Fatigue
  • Swelling of legs, ankle, or abdomen
  • Shortness of breath with activity
  • Orthostatic hypotension
  • Difficulty breathing when lying down
  • Arrhythmia

ATTR-PN impairs the function of the nervous system. While amyloid most commonly builds up in the peripheral nervous system, deposition can also occur in the autonomous system. This results in a diversity of symptoms that are specific to the site of amyloid deposition. Symptom presentation is much more diverse, occurring as early as the 20s, or as late in life as the 70s. 

Common Symptoms of ATTR-PN:

  • Carpal tunnel syndrome
  • Diarrhea and/or constipation
  • Nausea, vomiting
  • Loss of appetite
  • Sexual dysfunction
  • Muscle weakness
  • Eye problems
  • Orthostatic hypotension

 

 

 

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References:

https://www.pfizer.com/news/articles/understanding_this_rare_disease_called_attr_amyloidosis

https://www.mayoclinic.org/diseases-conditions/cardiomyopathy/symptoms-causes/syc-20370709

https://www.yourheartsmessage.com

https://healthjade.net/familial-amyloidosis/

https://my.clevelandclinic.org/health/diseases/14737-neuropathy

https://www.hopkinsmedicine.org/health/conditions-and-diseases/peripheral-neuropathy

https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061

https://practicalneurology.com/articles/2021-july-aug/neuromuscular-amyloidosis

https://healthjade.net/familial-amyloidosis/



Spinal Stenosis & Amyloidosis

WHAT IS SPINAL STENOSIS?

Spinal stenosis is narrowing of the spinal column that causes pressure on the spinal cord, or narrowing of the openings (called neural foramina) where spinal nerves leave the spinal column.

This can develop as you age from drying out and shrinking of the disk spaces. (The disks are 80% water.) The narrowing can cause compression on nerve roots resulting in pain or weakness of the legs. If this happens, even a minor injury can cause inflammation of the disk and put pressure on the nerve. You can feel pain anywhere along your back or leg(s) that this nerve supplies.1

 

SYMPTOMS1

Symptoms often get worse slowly over time. Most often, symptoms will be on one side of the body, but may involve both legs.  Symptoms include:

  • Numbness, cramping, or pain in the back, buttocks, thighs, or calves, or in the neck, shoulders, or arms
  • Weakness of part of a leg or arm

Symptoms are more likely to be present or get worse when you stand or walk. They often lessen or disappear when you sit down or lean forward. Most people with spinal stenosis cannot walk for a long period. More serious symptoms include:

  • Difficulty or poor balance when walking
  • Problems controlling urine or bowel movements

 

A POTENTIAL CLUE TO AMYLOIDOSIS?

Amyloid is a very common finding in cartilage and ligaments of elderly subjects, and transthyretin has been demonstrated in some deposits. Lumbar spinal stenosis is also a condition of usually elderly individuals in whom narrowing of the lumbar spinal canal leads to compression of nerves to the lower limbs.

“Another very important historical clue is spinal stenosis, and actually that’s much more commonly seen in patients with ATTR than AL, and in fact, again, almost exclusively in wild type,” according to Dr. Mazen Hanna2

 

WHAT IS SENILE, AKA WILD-TYPE, AMYLOIDOSIS (ATTRwt)?

Amyloidosis is a generic name for a very diverse group of protein folding disorders, all characterized by creation of cross-beta-sheet fibrils. At least 30 different human proteins have been shown to form amyloid fibrils in vivo (). Two main groups of amyloid conditions exist: systemic and localized. In the systemic conditions, deposits occur in many organs and tissues, and the diseases are usually life-threatening; in each of these diseases one out of at least 15 plasma proteins forms amyloid fibrils far from the place of parent protein synthesis. In the localized conditions, the proteins are expressed at the site of deposition (). In both groups, fibrils usually deposit extracellularly and can form conspicuous masses that deform a tissue and interfere with its normal functions.5

Senile systemic amyloidosis (SSA), derived from wild-type transthyretin (TTR), is common in association with aging, although symptom-giving disease usually is comparably rare and affects males at least 10 times more often than women. Restrictive cardiomyopathy is the main clinical expression. However, carpal tunnel syndrome is common in SSA, and widely spread wild-type ATTR amyloid deposits at other connective tissue sites have been demonstrated ().5

Joint cartilage and ligaments are targets of both localized and systemic amyloid. Of the systemic forms, Aβ2-microglobulin [for nomenclature, see ()] amyloidosis is well-known to engage skeletal and joint structures in patients under hemodialysis due to renal insufficiency (). Also, immunoglobulin light chain (AL) amyloidosis is known to generate a variety of symptoms from joints and skeleton, sometimes with neural lesions. Carpal tunnel syndrome is often noted in transthyretin (ATTR) and Aβ2-microglobulin amyloidosis ().5

 

CONCLUSION

From the studies referenced therein, results suggest that transthyretin-derived amyloid deposits may occur more frequently in various ligaments and tendons than originally expected3 and that lumbar spinal stenosis quite frequently may be a consequence of senile systemic amyloidosis [also known as wild-type amyloidosis; ATTRwt]5.

 

Stay suspicious.

 

 

 

 

Sources:

1 https://www.mountsinai.org/health-library/diseases-conditions/spinal-stenosis

2 https://www.neurologylive.com/view/cardiac-amyloidosis-management

3 https://pubmed.ncbi.nlm.nih.gov/21334722/

Sueyoshi T, Ueda M, Jono H, Irie H, Sei A, Ide J, Ando Y, Mizuta H. Wild-type transthyretin-derived amyloidosis in various ligaments and tendons. Hum Pathol. 2011 Sep;42(9):1259-64. doi: 10.1016/j.humpath.2010.11.017. Epub 2011 Feb 21. PMID: 21334722.

4 https://pubmed.ncbi.nlm.nih.gov/14640042/

Westermark P, Bergström J, Solomon A, Murphy C, Sletten K. Transthyretin-derived senile systemic amyloidosis: clinicopathologic and structural considerations. Amyloid. 2003 Aug;10 Suppl 1:48-54. PMID: 14640042.

5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116761/

Westermark P, Westermark GT, Suhr OB, Berg S. Transthyretin-derived amyloidosis: probably a common cause of lumbar spinal stenosis. Ups J Med Sci. 2014;119(3):223-228. doi:10.3109/03009734.2014.895786

6 https://en.wikipedia.org/wiki/Spinal_stenosis

 

 

Support Groups: Can They Play A Role In Your Treatment?

Have you recently been diagnosed with Amyloidosis? Wondering if joining a support group, whether online or in person, would be right for you?

When I was diagnosed with AL Amyloidosis, I thought that it wouldn’t be for me. It took me over a year to join. I had a picture in my mind of what it would be like. I envisioned a group of people gathered together to complain about how sick they were. I was afraid to get a glimpse of my future. I pictured a giant pity party.

What I experienced was extremely different. These groups are full of survivors! They are handling this disease with the most positive attitude possible and are making the best of the hand they have been dealt. I have learned so much from these people.

In these groups, you will find people who have been where you are, recently diagnosed, scared, and overwhelmed. You will find people willing to share the tips and tricks that helped them face some of their darkest moments and most difficult times. You will find people to help support and encourage you through your journey.

To find out more about the role of the support group, I reached out to Muriel Finkel from the Amyloidosis Support Groups (ASG) and Marsha McWhinnie from the Canadian Amyloidosis Support Network (CASN).

 

WHO IS THE SUPPORT GROUP FOR?

Support groups are for patients with all types of Amyloidosis and their caregivers. Their websites are full of information and resources. Online support groups such as the Amyloidosis Support Groups on Facebook, CASN, Smart Patients, and One Amyloidosis Voice are private and require access permission by the administrators. Such security for access offers comfort for the participants to reveal more personal information. In person support groups provided by Amyloidosis Support Groups, CASN, and the Amyloidosis Foundation, offer additional services and support for patients, as well as access to expert medical professionals.

 

WHAT IS THE GOAL OF THE SUPPORT GROUP?

Support groups, in general, are concerned with awareness and education. Their goal is to educate and empower patients, promote awareness, support medical research, and to improve the quality of life for those with Amyloidosis.

 

WHAT SERVICES DO SUPPORT GROUPS PROVIDE?

  • Both ASG and CASN operate a toll – free number, the primary goal of which is to provide a compassionate, understanding ear to those recently diagnosed. If you have received this life-altering and scary diagnosis, this call can let you know you are not alone and that there is hope.
  • Their websites provide educational videos and articles, medical referrals, patient stories, links to Amyloidosis support resources, and lists of upcoming meetings.
  • Both groups host support group meetings, which provide an opportunity to meet other patients and caregivers. During these meetings, an Amyloidosis expert presents, and there is an opportunity to ask questions and share your story. The ASG hosts meetings throughout the United States and the CASN has meetings in Toronto and Quebec.
  • The Amyloidosis Support Group also holds a special meeting for ATTR in Chicago every two years, with the top experts in the country participating and presenting.
  • ASG sponsors multiple groups on Facebook so patients and caregivers can chat with each other, share stories, and ask questions. These groups are mediated by wonderful volunteers who are up to date with the latest treatments and advances in the field, with assistance from medical advisors. The groups on social media allow patients from all over the world to connect.
  • Smart Patients is an online forum with conversations among the amyloidosis community, with topics ranging the full gamut from symptoms to treatment.
  • A new online community was recently launched called ‘One Amyloidosis Voice,’ which has a message board, social wall, trusted resources, a news and meetings section, and a diagnosis educator.
  • Through online forums and participation in local events, Support Group administrators and volunteers spread the word about Amyloidosis, with the goal of increased awareness.
  • Both groups are interested in supporting medical research by sharing information about clinical trials with patients. Pharmaceutical reps are sometimes present at meetings to answer questions, and to help connect patients with trials that might be right for them.

 

WHAT A TYPICAL SUPPORT GROUP MEETING LOOKS LIKE

Although each meeting varies and ends up with a flow of its own, administrators do follow a basic outline which includes the following:

  • New Business – A discussion of what is new in the field of Amyloidosis and what the Support Group has been working on
  • Guest Speaker – An interactive presentation from an Amyloidosis expert (usually a doctor or other medical professional)
  • Question and Answer Period – Questions are encouraged, and one on one time with the presenter may be possible
  • Meal or snack is provided (depending on the timing of the meeting)

The atmosphere is laid back and comfortable, and patient confidentiality is paramount. It is absolutely your choice as to whether you share your story and ask questions.

 

BENEFITS OF THE SUPPORT GROUP

  • You hear inspiring stories which can provide comfort and hope for the future.
  • You are kept up to date with the treatments, clinical trials, and medical breakthroughs.
  • You can share your story with people who genuinely get it.
  • You can ask for help if you have questions. Facing symptoms and looking for relief? Concerned about a new symptom or side effect? Chances are there is someone in the support group who has faced it and can offer help and support.
  • You can find information on what to expect from treatment. There are people in these groups who have endured stem cell transplants, chemotherapy, and have participated in clinical trials. In some cases, patients have tried various types of treatments and can offer suggestions of what to expect, and how to deal with side effects.
  • You can also find information on the leading Amyloidosis Specialists and Centres of Excellence. Because Amyloidosis is such a rare disease, it is vital to get the experts on your team.
  • Need to vent? We do that too. Sometimes it just becomes too much. The weight of it all hits and you feel overwhelmed and lost. There’s someone here who can provide a listening ear.

I am so glad that I decided to join these support groups. Not only do I get to hear the inspiring stories of those who are making life happen despite the challenges they face, but I have learned SO MUCH.  Amyloidosis patients who have been living with this disease for years have a wealth of information. The administrators of the groups are also up to date with current treatments, clinical trials, and medical breakthroughs happening in the field of Amyloidosis.

I have met people whose advice has helped me through challenging times. There is something special about talking with someone who has been where you are now. Someone who has received the same diagnosis and faced the same overwhelming feelings of fear and uncertainty. To know that others have been where you are and have come out the other side is comforting and inspiring.

Thanks to these support groups I know I am never alone.

 

 

How to contact a support group near you

Amyloidosis Support Group

http://www.amyloidosissupport.org/

1-866-404-7539

Canadian Amyloidosis Support Network

http://thecasn.org/

1-877-303-4999

Amyloidosis Foundation

http://amyloidosis.org/resources/#websites-and-support-groups

One Amyloidosis Voice

https://www.oneamyloidosisvoice.com/

Smart Patients

https://www.smartpatients.com/

 

Lori Grover is a guest blogger for Mackenzie’s Mission. She was diagnosed with AL Amyloidosis in 2016 and writes to share experiences and lessons learned during her journey.  More wonderful blogs by Lori can be found on her page Amyloid Assassin.  When not writing, she is mostly a stay at home mom, florist, crafter, lover of books and food. Enjoy!

 

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