On my back, I lay and lean into this sleepy wisdom — we all have pain — every single one of us humans.

It may be heart-sting or a bruised ego or a bruised body. We all have pain.

I turn 43 years old this summer. For years my back would hurt so bad people could read on my face something was wrong. They’d say, “Aimée, are you okay?” I’d rub my lower back, which felt on fire with pain, and say, “Yes, I’m fine. My back’s just a little sore.” It hurt so much I needed to sit down. Standing hurt. I didn’t know what to say or how to explain this.

I was supposed to be fine. A genetic specimen of good health. 

My dad has a genetic disease called Gaucher. It can cause weakening of bones, intense pain, and myriad other problems.

My knees feel raw and tender as I lay still, wondering when and if sleep will overtake the nagging feeling of persistent pain cues from my body to my brain. At 10:00 pm I took some cannabis tincture. It’s 2:16 am. I hurt. 

I know I’m not the only one.

Yesterday when I typed, my stiff fingers ached. My back started to scream. My wrists firmly demanded, “Be careful. Be gentle with us.” 

I tried to listen. I tried to gain ease knowing I’m not the only one. We all have pain. 

In the world of Gaucher, many carriers have been asking if we could have pain associated with being gene carriers. For decades the answer was a definitive “No.” 

Why are so many carriers expressing symptoms of pain if that’s true?

There are new tests with more precision to identify carriers. In the late 1970s, they thought the carrier test was reliable. 

After the past year, in which I finally shared my pain with my family and friends, my mom began to wonder if there might be a connection between my pain and my being a Gaucher gene carrier. She researched and forwarded the information to me to share with my doctor. For example: 

There are more than 400 genetic mutations known to cause Gaucher disease. Not all of these were known decades ago, nor do all screening tests today cover every single one of them. In rare cases, it is possible for genetic screening to miss a mutation. An enzyme test called a beta-glucosidase leukocyte (BGL) test will almost certainly show if you have Gaucher disease. Find out about testing for Gaucher disease.

In the late 1970s, my mom got a test to see if she was a Gaucher gene carrier before my parents conceived me. They didn’t want to pass on the disease. They thought they were free and clear when her test was negative. They thought I wouldn’t have pain. 

We all have pain. 

My hip still stings this morning. My ankles, knees, and wrists are nagging, “We hurt. Go easy. Be gentle. Please.”

Yesterday I heard my husband in the kitchen, loading the dishwasher. He sounded annoyed. How do I know? 20 years together. The clanking of dishes. I just know.

I’d told him I’d been flaring and exhausted for days. I don’t think I’ve conveyed what that means very well. Or maybe I don’t give him enough credit. Maybe I feel guilty and ashamed and misinterpret the clanking of the dishes. 

It takes all my energy to get out of bed. Running a load of dishes feels like running a marathon. 

Yesterday, I felt guilty, so I got up to run a load of laundry. I opened the garage door and heard the machine already whirling. I checked the dryer. Empty. I picked up my clean clothes off the back of the dining room chairs and hung them up. I didn’t touch the kid’s clean laundry; I handed David a pile of his clean shirts and pants. I knew I couldn’t do it all. Or rather that the pain would start screaming if I did too much.

Determined to do something useful, I grabbed plastic bags and headed into the sunny June day to pick up the dog poop in our backyard. 

The sun heated my back and shoulders. It felt like a gentle massage. Heat therapy. I am thankful for our pets. They are my pet therapy. I wandered the yard and repeated the stooping motion to pick up Nugget’s small poop piles (Chihuahua and Jack Russel Terrier mix) and Juno’s huge poop mounds (Chow, Staffordshire Terrier, Weimaraner, Akita, Rottweiler). 

Near the Red Haven Peach Tree were scattered fallen peaches that never got the chance to ripen. I picked up the peaches to add to the bag. The tree is diseased or has a pest problem. Or both. The tree’s buds swell and bloom. Peaches set and begin to grow. But, about a month into their growth, the fruit begins to ooze clear gooey sap from their flesh and out of their skin. I wonder if peaches feel pain. We all have pain. 

I tied up the bag of dog poop and tossed it in our outdoor trash can. I washed my hands. Washed the faucet. Washed my hands; realized a little bit of my OCD was creeping back in.

We all have pain.

I know this will shock you, but I’m not perfect. Caffeine and sugar likely contribute to my pain flares. I drank coffee yesterday and had a Payday candy bar and a bag of chewy Sprees. I quit eating processed sugar like that over a year ago, but last night I indulged.

My pain hadn’t abated and I wanted a sugar high. The hug of candy. I told my husband. He doesn’t usually indulge me with my candy cravings. I don’t usually ask for candy anymore. He went to the gas station and bought me some.

Earlier in the day, my intuition told me I needed to drink cold water, so I asked him to go get me ice. He grabbed a huge gas station cup of ice and brought it to me. I added electrolytes and sipped the icy water. I felt a wave of relief wash through my brain, my body. I thanked myself for leaning into my intuition. I was thankful I asked my husband and my husband went to get the ice. Lately, even driving anywhere feels like a monumental task. 

I didn’t chastise myself for this. 

I asked for help. 

I was honest with myself and my husband. 

I was gentle.

I’ve felt pain since I was a child. I don’t remember exactly when I realized my body talked to me through pain signals. I do remember being a teenager and feeling intense pain. I told myself I shouldn’t feel pain. That I was young and healthy. That I should tough it out. My dad was the one in real pain. Not me. I tensed up and barreled on — exacerbating the pain, I’m sure.

The scent of BenGay triggers memories of my dad in excruciating pain, rubbing the minty cooling ointment onto his skin, his tender screaming pains, searching for some relief. 

My pain isn’t the same as my dad’s. Over a year ago, a doctor finally confirmed I am flare-y. I show symptoms of someone in chronic pain. She sent me to a rheumatologist. After a slew of tests, nothing was found, except I might have some arthritis in my hands. I failed (passed?) the fibromyalgia pain points test (though I’ve read this information from Mayo Clinic that this is no longer the best or only way to diagnose fibromyalgia). 

My PCP advised me to accept my pain and to focus on treating my symptoms. She told me that research hasn’t caught up to autoimmune disorders that cause chronic pain.

She told me she believed me.

You see, for years I thought I might be crazy. I might be making this up. It might all be in my head. I might be over-reacting to my aches and pains.

When I was diagnosed with OCD, I was informed that Cymbalta helps with the treatment of faulty pain processors (what happens with fibromyalgia) and OCD symptoms. It has helped alleviate my symptoms of both OCD and pain. I think it’s more effective for OCD, anxiety, and depression, but it also puts a dent in the pain. For that, I am thankful. 

We all have pain.

Getting the genetic tests ordered has taken several weeks. On June 17, I go to see my doctor to pick up a prescription to bring to a special lab. That’s when we’ll start looking at whether or not my pain is related to being a Gaucher gene carrier or if further tests are required to see if I have a version of Gaucher disease. This could only happen if the 1970s test my mom took was incorrect and she is a gene carrier. 

My feelings are mixed. Most people might think I want a result that clears Gaucher from having anything to do with my pain. 

In my family history, there’s osteoporosis, arthritis, mysterious chronic pain. It’s not exactly shocking I live with pain when I think about my family’s health history.

Part of me wants the test to say, “Yes! Gaucher is the reason for your pain. Here are some treatments to try.” 

Because then there’s an answer instead of a mystery.

I can’t get comfortable as I type this, laying on my back, in bed, thumb-typing on my phone. My hips are stiff and sore. My shoulders and neck ache. My husband came in to check on me. He squeezed my leg and asked how I was doing. I tried not to cringe. All my pain receptors seem to be on overdrive. 

“I’m still flare-y,” I said. 

He nodded and let me get back to thumb typing.

Now I’ll make some coffee — espresso and oat milk. I’ll add some cannabis tincture. I’ll wonder when this flare will pass. My aunts come to visit us from out of town in a few days. Will I still feel like this?

I’m done tensing and barreling through pain and crying behind closed doors. If I feel like this, I’ll be honest with them, with myself.

When I finally drifted off to sleep last night, it was with this wisdom I knew I’d share with you in the morning: 

We all have pain. It helps when we are gentle with ourselves.

Go gently into the world, friends. 

It took me decades to realize the inherent strength and wisdom in gentleness. To talk with my physical, emotional, and psychological pain with kind honesty.

We all have pain. 

This approach of interacting with pain in a gentle manner feels like a balm, a massage for my deep wounds and aches — physical, emotional, and psychological. 

I invite you to try the same approach.

The post We All Have Pain appeared first on Medika Life.

What are lipids?

Lipids are fat-like substances that are important parts of the membranes found within and between cells and in the myelin sheath that coats and protects the nerves.  Lipids include oils, fatty acids, waxes, steroids (such as cholesterol and estrogen), and other related compounds.

These fatty materials are stored naturally in the body’s cells, organs, and tissues. Tiny bodies within cells called lysosomes regularly convert, or metabolize, the lipids and proteins into smaller components to provide energy for the body.  Disorders in which intracellular material that cannot be metabolized is stored in the lysosomes are called lysosomal storage diseases.  In addition to lipid storage diseases, other lysosomal storage diseases include the mucolipidoses, in which excessive amounts of lipids with attached sugar molecules are stored in the cells and tissues, and the mucopolysaccharidoses, in which excessive amounts of large, complicated sugar molecules are stored.

How are lipid storage diseases inherited?

Lipid storage diseases are inherited from one or both parents who carry a defective gene that regulates a particular lipid-metabolizing enzyme in a class of the body’s cells.  They can be inherited two ways:

• Autosomal recessive inheritance occurs when both parents carry and pass on a copy of the faulty gene, but neither parent is affected by the disorder.  Each child born to these parents has a 25 percent chance of inheriting both copies of the defective gene, a 50 percent chance of being a carrier like the parents, and a 25 percent chance of not inheriting either copy of the defective gene.  Children of either gender can be affected by an autosomal recessive pattern of inheritance.
• X-linked (or sex-linked) recessive inheritance occurs when the mother carries the affected gene on the X chromosome.  The X and Y chromosomes are involved in gender determination.  Females have two X chromosomes and males have one X chromosome and one Y chromosome.  Sons of female carriers have a 50 percent chance of inheriting and being affected with the disorder, as the sons receive one X chromosome from the mother and a Y chromosome from the father.  Daughters have a 50 percent chance of inheriting the affected X chromosome from the mother and are carriers or mildly affected.  Affected men do not pass the disorder to their sons but their daughters will be carriers for the disorder.

What are the types of lipid storage disease?

Gaucher disease is caused by a deficiency of the enzyme glucocerebrosidase.  Fatty material can collect in the brain, spleen, liver, kidneys, lungs, and bone marrow.  Symptoms may include brain damage, enlarged spleen and liver, liver malfunction, skeletal disorders and bone lesions that may cause pain and fractures, swelling of lymph nodes and (occasionally) adjacent joints, distended abdomen, a brownish tint to the skin, anemia, low blood platelets, and yellow spots in the eyes.  Individuals affected most seriously may also be more susceptible to infection.  The disease affects males and females equally.

Gaucher disease has three common clinical subtypes:

• Type 1 (or nonneuronopathic type) is the most common form of the disease in the U.S. and Europe.  The brain is not affected, but there may be lung and, rarely, kidney impairment.  Symptoms may begin early in life or in adulthood and include enlarged liver and grossly enlarged spleen, which can rupture and cause additional complications.  Skeletal weakness and bone disease may be extensive.  People in this group usually bruise easily due to low blood platelet count.  They may also experience fatigue due to anemia.  Depending on disease onset and severity, individuals with type 1 may live well into adulthood.  Many affected individuals have a mild form of the disease or may not show any symptoms.  Although Gaucher type 1 occurs often among persons of Ashkenazi Jewish heritage, it can affect individuals of any ethnic background.
• Type 2 (or acute infantile neuropathic Gaucher disease) typically begins within 3 months of birth.  Symptoms include extensive and progressive brain damage, spasticity, seizures, limb rigidity, enlarged liver and spleen, abnormal eye movement, and a poor ability to suck and swallow.  Affected children usually die before age 2.
• Type 3 (the chronic neuronopathic form) can begin at any time in childhood or even in adulthood.  It is characterized by slowly progressive but milder neurologic symptoms compared to the acute or type 2 Gaucher disease.  Major symptoms include eye movement disorders, cognitive deficit, poor coordination, seizures, an enlarged spleen and/or liver, skeletal irregularities, blood disorders including anemia, and respiratory problems.  Nearly everyone with type 3 Gaucher disease who receives enzyme replacement therapy will reach adulthood.

For type 1 and most type 3 individuals, enzyme replacement treatment given intravenously every two weeks can dramatically decrease liver and spleen size, reduce skeletal abnormalities, and reverse other manifestations.  Successful bone marrow transplantation cures the non-neurological manifestations of the disease.  However, this procedure carries significant risk and is rarely performed in individuals with Gaucher disease.  Surgery to remove all or part of the spleen may be required on rare occasions (if the person has very low platelet counts or when the enlarged organ severely affects the person’s comfort).  

Blood transfusion may benefit some anemic individuals.  Others may require joint replacement surgery to improve mobility and quality of life.  There is currently no effective treatment for the brain damage that may occur in people with types 2 and 3 Gaucher disease.

Niemann-Pick disease is a group of autosomal recessive disorders caused by an accumulation of fat and cholesterol in cells of the liver, spleen, bone marrow, lungs, and, in some instances, brain.  Neurological complications may include ataxia (lack of muscle coordination that can affect walking steadily, writing, and eating, among other functions), eye paralysis, brain degeneration, learning problems, spasticity, feeding and swallowing difficulties, slurred speech, loss of muscle tone, hypersensitivity to touch, and some clouding of the cornea due to excess buildup of materials.  A characteristic cherry-red halo that can be seen by a physician using a special tool develops around the center of the retina in 50 percent of affected individuals.

Niemann-Pick disease is subdivided into three categories:

• Type A, the most severe form, begins in early infancy. Infants appear normal at birth but develop profound brain damage by 6 months of age, an enlarged liver and spleen, swollen lymph nodes, and nodes under the skin (xanthomas). The spleen may enlarge to as great as 10 times its normal size and can rupture, causing bleeding. These children become progressively weaker, lose motor function, may become anemic, and are susceptible to recurring infection. They rarely live beyond 18 months. This form of the disease occurs most often in Jewish families.
• Type B (or juvenile onset) does not generally affect the brain but most children develop ataxia, damage to nerves exiting from the spinal cord (peripheral neuropathy), and pulmonary difficulties that progress with age. Enlargement of the liver and spleen characteristically occurs in the pre-teen years. Individuals with type B may live a comparatively long time but many require supplemental oxygen because of lung involvement. Niemann-Pick types A and B result from accumulation of the fatty substance called sphingomyelin, due to deficiency of an enzyme called sphingomyelinase.
• Type C may appear early in life or develop in the teen or even adult years.  Niemann-Pick disease type C is not caused by a deficiency of sphlingomyelinase but by a lack of the NPC1 or NPC2 proteins.  As a result, various lipids and particularly cholesterol accumulate inside nerve cells and cause them to malfunction.  Brain involvement may be extensive, leading to inability to look up and down, difficulty in walking and swallowing, progressive loss of hearing, and progressive dementia.  People with type C have only moderate enlargement of their spleens and livers.  Those individuals with Niemann-Pick type C who share a common ancestral background in Nova Scotia were previously referred to as type D.  The life expectancies of people with type C vary considerably.  Some individuals die in childhood while others who appear to be less severely affected can live into adulthood.

There is currently no cure for Niemann-Pick disease.  Treatment is supportive.  Children usually die from infection or progressive neurological loss.  Bone marrow transplantation has been attempted in a few individuals with type B with mixed results.

Fabry disease, also known as alpha-galactosidase-A deficiency, causes a buildup of fatty material in the autonomic nervous system (the part of the nervous system that controls involuntary functions such as breathing and heart beat), eyes, kidneys, and cardiovascular system.  Fabry disease is the only X-linked lipid storage disease.  Males are primarily affected, although a milder and more variable form is common in females.  

Occasionally, affected females have severe manifestations similar to those seen in males with the disorder.  Onset of symptoms is usually during childhood or adolescence.  Neurological signs include burning pain in the arms and legs, which worsens in hot weather or following exercise, and the buildup of excess material in the clear layers of the cornea (resulting in clouding but no change in vision).  

Fatty storage in blood vessel walls may impair circulation, putting the person at risk for stroke or heart attack.  Other symptoms include heart enlargement, progressive kidney impairment leading to renal failure, gastrointestinal difficulties, decreased sweating, and fever.  Angiokeratomas (small, non-cancerous, reddish-purple elevated spots on the skin) may develop on the lower part of the trunk of the body and become more numerous with age.

People with Fabry disease often die prematurely of complications from heart disease, renal failure, or stroke.  Drugs such as phenytoin and carbamazepine are often prescribed to treat pain that accompanies Fabry disease but do not treat the disease.  Metoclopramide or Lipisorb (a nutritional supplement) can ease gastrointestinal distress that often occurs in people with Fabry disease, and some individuals may require kidney transplant or dialysis.  Enzyme replacement can reduce storage, ease pain, and preserve organ function in some people with Fabry disease.

Farber’s disease, also known as Farber’s lipogranulomatosis, describes a group of rare autosomal recessive disorders that cause an accumulation of fatty material in the joints, tissues, and central nervous system.  It affects both males and females.  Disease onset is typically in early infancy but may occur later in life.  Children who have the classic form of Farber’s disease develop neurological symptoms within the first few weeks of life that may include increased lethargy and sleepiness, and problems with swallowing.  The liver, heart, and kidneys may also be affected.  Other symptoms may include joint contractures (chronic shortening of muscles or tendons around joints), vomiting, arthritis, swollen lymph nodes, swollen joints, hoarseness, and nodes under the skin which thicken around joints as the disease progresses.  Affected individuals with breathing difficulty may require a breathing tube.  Most children with the disease die by age 2, usually from lung disease.  In one of the most severe forms of the disease, an enlarged liver and spleen can be diagnosed soon after birth.  Children born with this form of the disease usually die within 6 months.

Farber’s disease is caused by a deficiency of the enzyme called ceramidase.  Currently there is no specific treatment for Farber’s disease.  Corticosteroids may be prescribed to relieve pain.  Bone marrow transplants may improve granulomas (small masses of inflamed tissue) on people with little or no lung or nervous system complications.  Older persons may have granulomas surgically reduced or removed.

The gangliosidoses are comprised of two distinct groups of genetic diseases.  Both are autosomal recessive and affect males and females equally.

GM1 gangliosidoses

The GM1 gangliosidoses are caused by a deficiency of the enzyme beta-galactosidase, resulting in abnormal storage of acidic lipid materials particularly in the nerve cells in the central and peripheral nervous systems.  GM1 gangliosidosis has three clinical presentations:

• GM1 (the most severe subtype, with onset shortly after birth) may include neurodegeneration, seizures, liver and spleen enlargement, coarsening of facial features, skeletal irregularities, joint stiffness, distended abdomen, muscle weakness, exaggerated startle response, and problems with gait.  About half of affected individuals develop cherry-red spots in the eye.  Children may be deaf and blind by age 1 and often die by age 3 from either cardiac complications or pneumonia.
• Late infantile GM1 gangliosidosis typically begins between ages 1 and 3 years.  Neurological symptoms include ataxia, seizures, dementia, and difficulties with speech.
• GM1 gangliosidosis develops between ages 3 and 30.  Symptoms include decreased muscle mass (muscle atrophy), neurological complications that are less severe and progress at a slower rate than in other forms of the disorder, corneal clouding in some people, and sustained muscle contractions that cause twisting and repetitive movements or abnormal postures (dystonia).  Angiokeratomas may develop on the lower part of the trunk of the body.  The size of the liver and spleen in most affected individuals is normal.

GM2 gangliosidoses

The GM2 gangliosidoses also cause the body to store excess acidic fatty materials in tissues and cells, most notably in nerve cells.  These disorders result from a deficiency of the enzyme beta-hexosaminidase.  The GM2 disorders include:

• Tay-Sachs disease (also known as GM2 gangliosidosis-variant B) and its variant forms are caused by a deficiency in the enzyme hexosaminidase A.  The incidence has been particularly high among Eastern European and Ashkenazi Jewish populations, as well as certain French Canadians and Louisianan Cajuns.  Affected children appear to develop normally for the first few months of life.  Symptoms begin by 6 months of age and include progressive loss of mental ability, dementia, decreased eye contact, increased startle response to noise, progressive loss of hearing leading to deafness, difficulty in swallowing, blindness, cherry-red spots in the retina, and some paralysis.  Seizures may begin in the child’s second year.  Children may eventually need a feeding tube and they often die by age 4 from recurring infection.  No specific treatment is available.  Anticonvulsant medications may initially control seizures.  Other supportive treatment includes proper nutrition and hydration and techniques to keep the airway open.  A rare form of the disorder, called late-onset Tay-Sachs disease, occurs in people in their 20s and early 30s and is characterized by unsteadiness of gait and progressive neurological deterioration.
• Sandhoff disease (variant AB) is a severe form of Tay-Sachs disease.  Onset usually occurs at the age of 6 months and is not limited to any ethnic group.  Neurological signs may include progressive deterioration of the central nervous system, motor weakness, early blindness, marked startle response to sound, spasticity, shock-like or jerking of a muscle (myoclonus), seizures, abnormally enlarged head (macrocephaly), and cherry-red spots in the eye.  Other symptoms may include frequent respiratory infections, heart murmurs, doll-like facial features, and an enlarged liver and spleen.  There is no specific treatment for Sandhoff disease.  As with Tay-Sachs disease, supportive treatment includes keeping the airway open and proper nutrition and hydration.  Anti-seizure medications may initially control seizures.  Children generally die by age 3 from respiratory infections.

Krabbe disease (also known as globoid cell leukodystrophy and galactosylceramide lipidosis) is an autosomal recessive disorder caused by deficiency of the enzyme galactocerebrosidase.  The disease most often affects infants, with onset before age 6 months, but can occur in adolescence or adulthood.  The buildup of undigested fats affects the growth of the nerve’s protective insulating sheath (myelin sheath) and causes severe deterioration of mental and motor skills.  Other symptoms include muscle weakness, reduced ability of a muscle to stretch (hypertonia), muscle stiffening (spasticity), sudden shock-like or jerking of the limbs (myoclonic seizures), irritability, unexplained fever, deafness, blindness, paralysis, and difficulty when swallowing.  Prolonged weight loss may also occur.  The disease may be diagnosed by enzyme testing and by identification of its characteristic grouping of cells into globoid bodies in the white matter of the brain, demyelination of nerves and degeneration, and destruction of brain cells.  In infants, the disease is generally fatal before age 2.  Individuals with a later onset form of the disease have a milder course of the disease and live significantly longer.  No specific treatment for Krabbe disease has been developed, although early bone marrow transplantation may help some people.

Metachromatic leukodystrophy, or MLD, is a group of disorders marked by storage buildup in the white matter of the central nervous system and in the peripheral nerves and to some extent in the kidneys.  Similar to Krabbe disease, MLD affects the myelin that covers and protects the nerves.  This autosomal recessive disorder is caused by a deficiency of the enzyme arylsulfatase A.  Both males and females are affected by this disorder.

MLD has three characteristic forms: late infantile, juvenile, and adult.

• Late infantile MLD typically begins between 12 and 20 months following birth.  Infants may appear normal at first but develop difficulty in walking and a tendency to fall, followed by intermittent pain in the arms and legs, progressive loss of vision leading to blindness, developmental delays and loss of previously acquired milestones, impaired swallowing, convulsions, and dementia before age 2.  Children also develop gradual muscle wasting and weakness and eventually lose the ability to walk.  Most children with this form of the disorder die by age 5.
• Juvenile MLD typically begins between ages 3 and 10. Symptoms include impaired school performance, mental deterioration, ataxia, seizures, and dementia. Symptoms are progressive with death occurring 10 to 20 years following onset.
• Adult symptoms begin after age 16 and may include ataxia, seizures, abnormal shaking of the limbs (tremor), impaired concentration, depression, psychiatric disturbances and dementia. Death generally occurs within 6 to 14 years after onset of symptoms.

There is no cure for MLD.  Treatment is symptomatic and supportive.  Bone marrow transplantation may delay progression of the disease in some cases.  Considerable progress has been made with regard to gene therapies in animal models of MLD and in clinical trials.

Wolman’s disease, also known as acid lipase deficiency, is a severe lipid storage disorder that is usually fatal by age 1.  This autosomal recessive disorder is marked by accumulation of cholesteryl esters (normally a transport form of cholesterol) and triglycerides (a chemical form in which fats exist in the body) that can build up significantly and cause damage in the cells and tissues.  Both males and females are affected by this disorder.  Infants are normal and active at birth but quickly develop progressive mental deterioration, enlarged liver and grossly enlarged spleen, distended abdomen, gastrointestinal problems, jaundice, anemia, vomiting, and calcium deposits in the adrenal glands, causing them to harden.

Another type of acid lipase deficiency is cholesteryl ester storage disease.  This extremely rare disorder results from storage of cholesteryl esters and triglycerides in cells in the blood and lymph and lymphoid tissue.  Children develop an enlarged liver leading to cirrhosis and chronic liver failure before adulthood.  Children may also have calcium deposits in the adrenal glands and may develop jaundice late in the disorder.

Enzyme replacement for both Wolman’s disease and cholesteryl ester storage disease is currently under active investigation.

How are these disorders diagnosed?

In some states, some of these disorders (most notably and controversially Krabbe disease) are screened for at birth.

In older children, diagnosis is made through clinical examination, enzyme assays (laboratory tests that measure enzyme activity), genetic testing, biopsy, and molecular analysis of cells or tissues.  In some forms of the disorder, urine analysis can identify the presence of stored material.  In others, the abnormality in enzyme activity can be detected in white blood cells without tissue biopsy.  Some tests can also determine if a person carries the defective gene that can be passed on to her or his children.  This process is known as genotyping.

Biopsy for lipid storage disease involves removing a small sample of the liver or other tissue and studying it under a microscope.  In this procedure, a physician will administer a local anesthetic and then remove a small piece of tissue either surgically or by needle biopsy (a small piece of tissue is removed by inserting a thin, hollow needle through the skin).  

Genetic testing can help individuals who have a family history of lipid storage disease determine if they are carrying a mutated gene that causes the disorder.  Other genetic tests can determine if a fetus has the disorder or is a carrier of the defective gene.  Prenatal testing is usually done by chorionic villus sampling, in which a very small sample of the placenta is removed and tested during early pregnancy.  The sample, which contains the same DNA as the fetus, is removed by catheter inserted through the cervix or by a fine needle inserted through the abdomen.  Results are usually available within 2-4 weeks.

How are these disorders treated?

Currently there is no specific treatment available for most of the lipid storage disorders but highly effective enzyme replacement therapy is available for type 1 and type 3 Gaucher disease.  Enzyme replacement therapy is also available for Fabry disease, although it is not as effective as for Gaucher disease.  However, anti-platelet medications can help prevent strokes and medications that lower blood pressure can slow the decline of kidney function in people with Fabry disease.  

The U.S.Food and Drug Administration has approved the drug migalastat (Galafold) as an oral medication for adults with Fabry disease who have a certain genetic mutation.  Eligustat tartrate, an oral drug approved for Gaucher treatment, works by administering small molecules that reduce the action of the enzyme that catalyzes glucose to ceramide.   Medications such as gabapentin and carbamazepine may be prescribed to help treat pain (including bone pain).  Restricting one’s diet does not prevent lipid buildup in cells and tissues.

Where can I get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
800-352-9424

Information also is available from the following organizations:

Ara Parseghian Medical Research Foundation [For Niemann-Pick Type C Disease]
3530 East Campo Abierto
Suite 105
Tucson, AZ 85718-3327
victory@parseghian.org
Tel: 520-577-5106
Fax: 520-577-5212

Children’s Gaucher Research Fund
P.O. Box 2123
Granite Bay, CA 95746-2123
research@childrensgaucher.org
Tel: 916-797-3700
Fax: 916-797-3707

Fabry Support & Information Group
108 NE 2nd Street, Ste. C
P.O. Box 510
Concordia, MO 64020-0510
info@fabry.org
Tel: 660-463-1355
Fax: 660-463-1356

Hide and Seek Foundation for Lysosomal Storage Disease Research
6475 East Pacific Coast Highway
Suite 466
Long Beach, CA 90803
info@hideandseek.org
Tel: 877-621-1122
Fax: 818-762-2502

Hunter’s Hope Foundation (Krabbe Disease)
P.O. Box 643
6368 West Quaker Street
Orchard Park, NY 14127
Tel: 716-667-1200

ISMRD-International Advocate For Glycoprotein Storage Diseases
20880 Canyon View Drive
Saratoga, CA 95070
info@ismrd.org
Tel: 734-449-1190
Fax: 734-449-9038

March of Dimes
1275 Mamaroneck Avenue
White Plains, NY 10605
askus@marchofdimes.com
Tel: 914-997-4488; 888-MODIMES (663-4637)
Fax: 914-428-8203

MLD Foundation (Metachromatic Leukodystrophy)
21345 Miles Drive
West Linn, OR 97038
503-656-4808
800-617-8387

National Fabry Disease Foundation
4301 Connecticut Avenue, NW
Suite 404
Washington, DC 20008-2369
info@fabrydisease.org
Tel: 800-651-9131
Fax: 800-651-9135

National Gaucher Foundation, Inc.
5410 Edson Lane, Suite 220
Rockville, MD 20852
ngf@gaucherdisease.org
Tel: 800-504-3189
Fax: 770-934-2911

National Niemann-Pick Disease Foundation, Inc.
P.O. Box 49
401 Madison Avenue, Suite B
Ft. Atkinson, WI 53538
nnpdf@nnpdf.org
Tel: 920-563-0930; 877-CURE-NPC (287-3672)
Fax: 920-563-0931

National Organization for Rare Disorders (NORD)
55 Kenosia Avenue
Danbury, CT 06810
orphan@rarediseases.org 
Tel: 203-744-0100; Voice Mail: 800-999-NORD (6673)
Fax: 203-798-2291

National Tay-Sachs and Allied Diseases Association
2001 Beacon Street
Suite 204
Boston, MA 02135
info@ntsad.org
Tel: 800-90-NTSAD (906-8723)
Fax: 617-277-0134

United Leukodystrophy Foundation
224 North 2nd Street, Suite 2
DeKalb, IL 60115
office@ulf.org
Tel: 815-748-3211; 800-728-5483
Fax: 815-748-0844

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