Symptoms at admission to Altai coMra Center:

The patient - female, 63 - complained of:

• random oscillations of the glucose in the blood in the range from 5 to 19 mmol/L. A period of increase may at any time be followed by a sudden drop and consequent crisis;
• constant acute weakness due to these oscillations;
• moderate recurrent dull pain in the abdomen, more in the area of the right hypochondrium and navel;
• periodic constipation: one stool in 3-5 days;
• periodic numbness, burning and creeping in the upper and lower extremities, but recently mostly in the left hand;
• recurrent burning back pain, mostly in thoracic and lumbar regions;
• in the morning she measured at home 18 mmol/L glucose content in the blood.

History of the disease:

The patient suffers from this disease for more than 20 years.

She keeps Pevzner Diet No 9 only partially and from time to time.

She takes the medications prescribed to her (Metformin, Gliclazide, etc), but she would change the dosage during the day and jump from one medication to another, because she gauges her intake by her glucose level.

She was unable to fix steady dose with her endocrinologists. She is also not monitoring herself regularly with an endocrinologist.

She is not applying supplementary physio and phyto therapeutic methods.

By the time of admission she had not taken any medications for the last three days and recently she has been taking only Metformin: 1000 mg per day, but only if the glucose level is above 10 mmol/L.

Diagnosis:

The patient was admitted in good general condition and good mood.

However, she was overweight with morbid obesity with excess fatty tissue in the abdomen and thighs. (BMI = 41)

1. Main Diagnosis:

• Diabetes mellitus Type 2. The target blood glucose levels (up to 7 mmol/L at present) has not been achieved.
• Diabetic sensory neuropathy of the upper and lower extremities.
• 3^d degree morbid obesity. (BMI = 41)

2. Other Diseases:

• Polysegmental osteochondrosis of the spine; chronic, recurrent, in subremission. Myotonic syndrome.
• 2^nd degree chronic cerebrovascular insufficiency of complex genesis (atherosclerosis of the carotid arteries plus hypertension), in subremission. Cephalalgia.
• Ischemic heart disease: exertional angina pectoris 2^nd functional class. Left ventricular hypertrophy. Hypertension of 3^d degree. Chronic heart failure of 1^st degree, II functional class by NYHA scale.
• Kidney urolithiasis. Chronic pyelonephritis, without exacerbation.
• Polyosteoarthritis of small, medium and large joints of the upper and lower extremities. X-ray stage I,II. Joint dysfunction - 1.
• Varicose veins of the lower extremities. Chronic venous insufficiency - 1.
• Chronic gastritis, without exacerbation.
• Chronic cholecystitis, without exacerbation.

3. Rehabilitation Diagnosis:

• Constant functional limitation of the body as a result of the fixation of the chronic disease in the exacerbation or incomplete remission phase;
• various severe complications of the main disease dangerous for general health and life;
• periodic pain and neurosensory syndromes;
• aggravation of concomitant diseases due to this condition;
• restriction of social and work activity due to the general weakness, as well as due to the disharmonious work of the pancreas and intestines.

Treatment:

1. Treatment Goals:

First treatment course aimed at:

• Stabilization of daily glucose levels closer to the target level;
• normalization of the workings of pancreas: shifting the functioning of this gland from the threshold and critical modes to a balance of general energy and metabolic metabolism during the day and during the longer cycles according to the rhythm of the body;
• normalization of the secretion of the intestines and digestive glands;
• reduction of the pain in the abdomen and back;
• reduction of the numbness, burning and creeping in the extremities;
• partial restoration of the regenerative capabilities of the cells of the pancreas (in this course it is the restoration of the internal and external function of the cell, partial or complete replacement of structures and elements in the cell), after the prolonged inflammatory reaction and inhibition of cell functions;
• improving the quality of life and stabilizing concomitant diseases by reducing clinical manifestations;
• acquiring the habit of consicously caring for one's body by adjusting one's feeding behaviour and emotional breakdowns.

2. Treatment at Altai coMra Center:

The first coMra Therapy Treatment Course consisted of 21 treatment sessions, one session per day, for 21 days. Each treatment session consisted of:

• Endocrinology 1;
• Traumatology 1;
• Universal 3;
• Scanning of the left arm for 10 minutes at 1000 Hz.

3. Home Treatment:

During the treatment period the patient was educated and trained how to help herself in her daily life.

• She has been performing regular therapeutic and prophylactic exercises aimed at eliminating congestion in the abdominal cavity and pelvic organs, as well as at restoring the range of back movement;
• she was taught the principles of Pevzner Diet No 9 for pancreatic diseases, and how to adapt the latter to her lifestyle;
• She was taught how to calculate her carbo-units and how to adapt her medications intake and coMra procedures in accordance with those;
• she was taught how to design and implement fasting days;
• the patient decided to continue during the treatment with her method of taking drugs: 500-1000 mg metformin in case of blood sugar level above10 Mmol/L.

Results:

After the first Treatment Course the patient reported great improvement of her condition:

• The glucose in the blood normalised to 7-9 mmol/L without big jumps and drops during the day;
• the weakness reduced significantly by 4^th procedure and completely disappeared by the end of the treatment course;
• the abdominal and back pains were gone already by 4^th procedure;
• the stool recovered by 4^th procedure and completely normalised by 7^th procedure;
• after the treatment she took metformin only twice - 500 mg each time - and then stopped taking it;
• she learned the principles of her daily diet, but she did not follow it thoroughly. She also decided not to take any medications for now.

Conclusion: The goal of the first Treatment Course was almost fully achieved.

After the first Treatment Course the patient was advised to:

1. coMra Therapy:
   • Repeat this Treatment Course after 2 or 3 weeks;
   • ideally, do this Course at least quarterly for a year;
   • after achieving stable blood glucose levels on a prolonged period (no less than 5,6 months) the frequency of the Treatment Courses can be decreased, say once in six months.
2. Courses of general physiotherapy, no less than twice a year, as outpatient, under physiotherapist's supervision, consisting of:
   • Darsonvalization of the upper and lower extremities, 20-25 minutes per session;
   • electrophoresis with aloe of the pancreas and the liver, 15 minutes per session;
   • EHF Therapy in the area of the solar plexus, stomach and pancreas.
3. Maintaining an active lifestyle, alternating static loads during the day with walking, swimming, Nordic walking (with compression hosiery on the knee joints), exercises on an ellipsoid and on a fitball.
4. Reduction of excessive physical activity: excluding excessive axial and shock load on the spine and knee and hip joints (running, steps, jumping, exercises without fixation of the lumbar spine, exercises with a sharp bend and twisting of the lumbar spine and legs). She should not lift from squat more than 2.5 kg.
5. She should keep her legs elevated while resting.
6. She should wear comfortable shoes with heels up to 2-4 cm, and - if necessary - she could use elastic compression.
7. She should track her body weight and aim at reducing it by 5-7 kg during the next 3-6 months.
8. She should calculate correctly her carbo-units and strictly follow Diet No 9 and hypocholesterol diet.
9. She should include herbal medicine: herbal potions for the underlying disease, which should include: chicory rhizome, Rhodiola rosea, rose hips, dandelion leaves or flowers, etc. It is recommended to consult a phytotherapist for an individual and careful selection of herbs and preparation.
10. She should take her medications under the supervision of the attending physician and taking into account the test results (blood glucose, glycated hemoglobin, blood glucose profile during the day).Continuing with coMra Therapy, she should gradually decrease the dosage of drugs and eventually transition only to herbal medicine and diet therapy.
11. In a planned fashion she should examine:
    • UAC, OAM, urine for microalbumin, AST, ALT, bilirubins, urea, creatinine, lipid profile, blood sugar, glycated hemoglobin, sugar profile - in dynamics, control of GFR after 2.5-3 months;
    • Ultrasound or MRI of the knee joints;
    • Ultrasound of the pelvic organs;
    • Duplex scanning of the venous vessels of the lower extremities.
    She should adjust her coMra treatments according to the results of these tests.

Follow-up:

The effect of each treatment course carried over to the next 3-9 weeks with a gradual decrease. That is why the patient was advised to visit the center or perform coMra procedures at home in 2-3 weeks during the next 6-9 months. But she actually underwent only 2 more courses after 3 and 5 months, respectively.

Taking all of the above into account, we can conclude that:

• Stable and balanced long term remission was not achieved. Also, failure to start wholesome process of tissue regeneration of the pancreas. The reasons for this lack of full achievement are:
  • severity of the condition and already formed complications;
  • the patient did not follow the recommendations, especially those concerning her diet, physical activity and weight loss;
  • exhaustion low functional reserves of the pancreas;
  • non-regular application of coMra Therapy.
• What was achieved was:
  • quick therapeutic effect on the main disease after each treatment course and slow decrease of this effect over prolonged period of time: from 2 to 8 weeks and more;
  • preservation of the current volume of pancreatic function and general metabolism; retarding the pathological process.

It is important to realise that even in such a situation the body managed to stabilize a little, partially start regenerative processes and stop the rapid and strong development of the pathological process, which improved the overall prognosis for the quality of life and the course of the disease.

Case provided by: Dr Anna Surazakova, MD
Country: Altai, Russia