Diamino-diphenyl sulphone

[emotional leper]

Diamino-diphenyl sulphone (DDS) was the drug Covenant was taking for his Leprosy, right? That's one of the things it's noted for in its use.

One of the possible side effects of DDS is Peripheral Neuropathy -- one of the things Leprosy does to you.

How much would it suck to have the drug used to combat your disease cause one of the primary undesired symptoms of your disease?

Also, apparently, Thomas Covenant suffers from Paucibacillary Hansen's, which is, apparently, the best of the three presentations of Leprosy you could hope to have, since it's the least disfiguring and disabling.

[matrixman]

Thanks for the info! I didn't know about the side effects of that drug, but then I never researched leprosy beyond the Covenant books.

I'm guessing SRD didn't want to make Thomas Covenant too gruesome physically, so that's why the character had the "least disfiguring" kind of leprosy, as you say. Purely my speculation. If Covenant had resembled that grossly disfigured hermit in the leprosarium...then I guess the Chronicles would've been a very different kind of fantasy story.

[The Laughing Man]

yea, he would be half the man otherwise, and a very difficult character to flesh out.

TC: Have you seen my.....?

[drew]

-he wouldn't be allowed to play play, 'cause there'd always be a face-off in the corner.

[dlbpharmd]

Diamino-diphenyl sulphone (DDS) was the drug Covenant was taking for his Leprosy, right? That's one of the things it's noted for in its use.

One of the possible side effects of DDS is Peripheral Neuropathy -- one of the things Leprosy does to you.

How much would it suck to have the drug used to combat your disease cause one of the primary undesired symptoms of your disease?

Also, apparently, Thomas Covenant suffers from Paucibacillary Hansen's, which is, apparently, the best of the three presentations of Leprosy you could hope to have, since it's the least disfiguring and disabling.

DDS is marketed as Dapsone(R) - the most common use is as an antibiotic, particularly for brown recluse spider bites.

[danlo]

I wrote this way back in 2002:

Did Joan have an aggravated yeast infection? Did TC pet an armadillo? I know y'all are laughing your asses of right now, but the little research I did into leprosy and autism raises some interesting subjects, of course we also need a Dr. to help sort out my ignorance--amanibhavim are you out there? Aren't you a Dr.? Well we know how rare cases of leprosy are in the United States but my research indicates that the largest incidences found in the US occur in Texas and Louisiana. They have also found the same bacteria that causes Hansen's disease in armadillos! I'm not kidding...We also don't know the exact type of leprosy TC had--there are three types: Regular Hansen's causes dark hue pigmentosis, some loss of nerve feeling, severe dry skin and rashes. Tuberculoid leprosy causes nerve thickening and effects the eyes and worse. Lepomtous leprosy is the very worst and twists the body, digits and body parts fall off. In the varying degrees the worse the case the more the leper stinks and all cases can infect the brain. Right now they are being very sucessful in arresting and curing leprosy, if caught in the early stages, around the world. A large part of this is MDT (multidrug therapy) two of the major types of drugs used in this theraphy are antibiotics and DDS (diamino-diphenyl-sulfor). TC's Dr. at the leprosarim hinted that DDS and synthetic-antibiotics were being used in the attempt to arrest his leprosy. It seemed as if all of TC's treatments may have been going fine, he was doing his VSE, taking his medication and believed (from what we gather when he talks about it) he had the Tuberculoid form. Now let me pose this: remember TCTC was written in 76-78 and the MDT was very new back then...and not always successful, also now in the MDT regular antibiotics are being used, not synthetics. Also remember this: DDS was relatively new as well--DDS is only manufactured in China and it's original use was as a very strong accelerant for epoxy resins--for polymers. In other words in it's original form it is a carcinogenic, dangerous chemical used for making pipefitting glue stronger!!! I'm not proposing here that the Dr.s misdiagnosed TC's leprosy (tho of course anything's possible). But maybe TC had the lesser form of Hansen's disease and the dose of DDS was improperly formulated and it's mixture w/synthetic antibiotics was off balance, as well. Synthetic drugs in a wide application were also relatively new back then, as well. Some people, not many but some, can develope very serious allergic reations to any synthesized drug. Just as an example: before my hand surgery my Dr. perscribed Hydro-Codone--I got very irritable, had wicked headaches, vomited and had to leave work. Then we went on a camping trip and when I walked the dogs up a hill I really thought I was having a heart attack! When I got back I vomited every time I ate or drank anything and passed out for four hours at a time. When I stopped taking the drug-everything cleared up. Also, remember that TC suffered from vertigo as well and studies indicate that there is a link btween earlier synthetic based antibiotics administered in improper doses with the causation of vertigo like factors:

The aminoglycoside antibiotics are the first ototoxic agents which highlighted the problem of drug-induced hearing and vestibular loss. They are highly water soluble compounds and their charge prevents entry into cells via diffusion across the plasma membrane. The incidence of clinical and functional hearing loss due to aminoglycosides has been significantly diminished because some of the newer derivatives have lower ototoxic potential and perhaps efficient monitoring of serum levels of drugs have allowed for better dosing schedules. However, the problem is a significant one as they are still widely used in the treatment of serious gram-negative infections as pointed out by Schacht.69 The concentration of aminoglycoside in plasma produced by the initial or loading dose is dependent only on the volume of the distribution of the drug. Since the elimination of aminoglycosides is almost entirely dependent on the kidney, a linear relationship exists between the concentration of creatinine in plasma and the half-life of all aminoglycosides in patients with moderately compromised renal function. In anephric patients, the half-life varies from 20 to 40 times that determined in normal individuals. Because the incidence of nephrotoxicity and ototoxicity is related to the concentration to which an aminoglycoside accumulates, it is critical to reduce the maintenance dosage of these drugs in patients with impaired renal function.2
The mechanism of oto- and vestibular toxicity has been elusive. Mechanisms for acute and chronic toxicity may be different. It appears that there is an antagonistic relationship between aminoglycosides and calcium which can block the acute aminoglycoside-induced depression of microphonic potentials experimentally.70 A number of potential synaptic mechanisms are postulated.69 For example, streptomycin blocks the postsynaptic actions of excitatory amino acids on primary afferents in the vestibular system, blocks the glutamate-gated ionophore at the crayfish neuromuscular junction, and antagonizes quisqualate-induced excitation of cortical neurons. The chronic toxicity of aminoglycosides appears to target exclusively the kidney, cochlea, and the vestibular system. Aminoglycosides have been reported to affect a wide variety of intracellular reactions which are probably responsible for the permanent deficits of chronic toxicity. DNA, RNA, and protein synthesis, energy metabolism and ion transport are affected as well as synthesis or degredation of prostaglandins, gangliosides, mucopolysaccharides, and lipids. An important feature is the delayed onset of auditory and vestibular damage in almost all cases of chronic glycoside toxicity, both in experimental animals and as in patients. Early studies of aminoglycoside pharmacokinetics gave rise to the hypothesis that the toxicity of these drugs was based upon their Aaccumulation@ in inner ear fluids. This early hypothesis has been questioned.69,71 It may well be that a metabolite of the aminoglycoside is involved in the toxic action of such drugs. This hypothesis is reviewed in detail by Schacht.69 Drug metabolism may also explain the selective toxicity toward kidney and the inner ear as well as why some aminoglycosides preferentially damage the cochlea, and others the vestibular system. For example, although the vestibular system may have a preference to metabolize vestibulotoxic drugs, it may conversely have a greater capacity to detoxify those aminoglycosides that spare the vestibular system.-B. Todd Troost, MD

So you can see a possible connection between TC's medical therapy to treat his Hansen's disease and vertigo, not to mention the synaptic disfunction side effects--and there is no reason not to believe that these side effects could lead to an autistic-like condition. A prolonged, untreated yeast infection which can transmit the candida bateria can also disrupt brain function and lead to autism. This is only supposed to happen to children between birth and three years of age, but anything's possible.. But if Joan did have an infection and these antibiotics were running around like crazy in TC and his auto-immune system was compromised the transmission of this bacteria could have contributed even more to autistic like behavior:

They cite Japanese studies showing that candida is able to produce toxins which cause severe long-term disruption of the immune system and may also attack the brain. In extreme cases, they claim, severe disorders, totally resistant to conventional treatment, can occur as a result of candidiasis. These include depression, schizophrenia and, in some cases, autism.-Bernard Rimland, MD

Austistic children exibit anti-social behavior, have no interest in other people, perform ritualistic repetitive behaviors and tend to live in a "world of their own". Indeed many autistic children I have come in contact with draw amazing, sometimes unfathomable pictures of other worlds. TC's ingrained theraphy for coping with his leprosy: Knowing that he may face extended periods of being alone, to be distrutful and wary of society's reaction to his condition and his constant VSE (a ritualistic, repetitive behavior), do raise interesting parralells with autism. DDS's side effects may include: nausea, vomiting, headache, anorexia, nervousness, exfoliative dermititus, rash and proritus--which opens up the possibility that TC may have been totally misdiagnosed and the drugs were casusing leprosy-like symptoms--he definately had headaches, got sick in the Land and never ate anything. The Land was a pretty amazing "other world"...Of course, given this, we have to assume that Linden had autism as well and that they shared a common world or hallucination. On the other hand perhaps Linden never really entered the Land at all but was simply treating TC during a severe autistic episode and that he incorporated her into his vision. Thus by beginning to heal the Land she attempted to bring him back to reality and failed before she could could save his physical body on the altar...Anyway you can poke all sorts of holes in this, but you must admit it is some pretty interesting fft...

[amanibhavam]

It's not uncommon to see weird side effects listed on a drug leaflet, even ones like this which is seemingly just what the drug should alleviate in the first place.
However it has to be noted that the manufacturer/vendor has to list ALL side effects that ever occurred in the usually quite long clinical testing period (5-10 years) and which the clinical testers thought to have at least a tentative relationship to the treatment in question.

[emotional leper]

Danlo: Interesting read.

I'd note however, first, and quickly, that Autistic children are not Antisocial -- they're Asocial. There's a huge difference. Nitpicking, but, *shrug*.

I based my 'diagnosis' of Covenant off of Linden's overlook of him the first or second time she meets him, from The Wounded Land. Since he's lived with the Leprosy for over a decade, although I'm not a doctor, I feel that if he was exhibiting no outward symptoms of the two worse kinds of Leprosy, he probably did not have them. Also, he doesn't seem to have any vision problems (although I may be mistaken, but I don't remember him having any.)

I did think that Covenant was not on Multi-drug Therapy for his Leprosy, though. I was fairly sure that, atleast in the 1st Chronicles, all he was taking at the start of LFB was DDS.

[Menolly]

Danlo: Interesting read.

I'd note however, first, and quickly, that Autistic children are not Antisocial -- they're Asocial. There's a huge difference. Nitpicking, but, *shrug*.

From personal experience, I think I can agree with EL here.

*sigh*

[danlo]

Well I don't know if that's a condesending sigh or an experiential one, so I'm sorry for the misuse of that word. That's a very important difference so I thank you both for your correction. I have worked with autistic children for extented time frames and I think Fist and some others here have too...