Walt Whitley: Hey, everybody. Thank you for tuning into another episode for DryEyeCoach podcast. Today is going to be a very exciting and interesting topic where we’re going to talk with Dr. Diana Driscoll, who practices out of Colleyville, Texas. She is the clinical director for POTS Care. She’s also the founder and director for TJ Nutrition and the president of Genetic Disease Investigators. Welcome, Diana.

Diana Driscoll: Thank you, all, and it’s such an honor to be here. I’m so grateful to you.

Walt Whitley: Yeah. Today we’re going to talk about things that you are super passionate about and things that I am excited to learn more about. You and I we’ve had several different discussions over the last several weeks, and you’ve told me a little bit about what you do, and I’m excited for our listeners to hear as well.

Walt Whitley: So you’re in research and you have a medical clinic, but you’re an optometrist now working in a neurological dry eye. How did you end up doing this?

Diana Driscoll: It’s a very unusual story, isn’t it, and you’re right. I’m very passionate about it because it was such a long journey.

Diana Driscoll: It was, gosh, almost 15 years ago. I went on a mission trip to Costa Rica and got a virus, and all of us got the same virus, I can’t blame the virus. But I ended up not recovering, and I was the only one who didn’t recover.

Diana Driscoll: But months later, I was diagnosed with POTS, Postural Orthostatic Tachycardia Syndrome, which is basically a breakdown of the autonomic nervous system and unable to get help basically anywhere. We traveled the country and, oh, that was so hard because I was just rather immediately disabled by it. I couldn’t even finish my last two patients the day I was hit and I can work through quite a bit.

Diana Driscoll: But eventually about a year, year and a half later, my kids got sick, and we were quite the mess. So we needed answers, and we couldn’t get any. No one understood the condition. It was extraordinarily frustrating.

Diana Driscoll: So I set up a corporation, Genetic Disease Investigators, and started to do some research. I started by looking in the eyes, imagine that, right?

Walt Whitley: Yeah, that was weird when you’re an optometrist, huh? [crosstalk 00:02:25]

Diana Driscoll: Yeah, I know. It turns out to be pretty handy.

Walt Whitley: Yeah, exactly. And one of the reasons why I was so interested, you just mentioned POTS and we’re going to talk more about that, but one of the things I shared with you is one of my friends and colleagues, she ended up develop or getting the same condition and so I didn’t know what it was at first. So when you and I started talking, I just wanted to know more. So can you tell us what is POTS?

Diana Driscoll: Right. Absolutely. It’s so misunderstood. Just the name implies that when someone gets vertical, their heart rate goes up. But I remember telling the doctors, “That’s the least of my worries. That’s what you guys can see. But I am sick from head to toe and the heart problems is fairly minor.” But it’s where the autonomic nervous system, the system of the body we really shouldn’t have to think about, no longer works well. So you can’t control heart rate, blood pressure, digestion, the blood doesn’t circulate properly.

Diana Driscoll: Then symptoms started to multiply and every month it seemed like it was different and more disabling. So trying to figure out in each case what happened and what can we do to pick up the pieces is extraordinarily complex, extraordinarily complex. But I had to take a deep dive into the autonomic nervous system, something I never anticipated doing.

Walt Whitley: Well, but doing so, now you have some of the answers or many of the answers. So what breakthroughs did you have?

Diana Driscoll: Yeah, I had a few, and it came in layers. The first layer I was able to figure out was there was a propensity for high intercranial pressure. It was interesting because as eye doctors we’re used to looking for papilledema in that case, but the majority of patients didn’t have true papilledema. So we really had to dig deep on that one, spend a few years on that.

Diana Driscoll: Then the next layer was more, I suspected, the vagus nerve getting caught up in all this. One reason I thought about that was the heart rate was just racing oftentimes, the gut wasn’t working, it was starting to shut down. I thought, “What would tie both of those things together,” and that would be a vagus nerve. So I started to dig into “Is that why my GI tract was shutting down, my gallbladder stopped working, I horrible constipation?” Then it went on to full-blown gastroparesis. Nothing was moving, and I was in a world of hurt.

Walt Whitley: So there was a nicotine patch that you remember from school. Can you talk about that?

Diana Driscoll: Sure will. Yeah, apparently no one ever thought about doing this. When I had that horrible gastroparesis, my doctors didn’t know what to do. We tried everything. I had this pain in my lower right-hand quadrant, and I was starting to suspect maybe the valve between the large and small intestine, the ileocecal valve might not be opening. Maybe something was wrong with it, and my doctor sent me to a urologist. She said, “Well, maybe that pain is a kidney stone.” I thought, “I don’t think so, but okay,” and I saw this doctor. He was so nice, and I told him what I suspected. He thought that was fascinating. Meanwhile, he checked for kidney stones. He gave me this dye to drink and, ugh, and he scanned. He said, “There’s no stones.” He sent me to a surgeon to see if they could open that valve if that was right, and the surgeon said, “No, don’t do that. Don’t have abdominal surgery unless it’s life-threatening.”

Diana Driscoll: So I went home and still had no answers. And three days later, wow, it was so weird, I got a kidney stone, and the only thing I can think of was divine intervention. What are the chances? So I called the urologist and I said, “I do understand that I didn’t have a stone three days ago, but I do now.” And he met me at the hospital. Sure enough, I had a kidney stone, he removed it. When I woke up, he was just real close to me and he said, “Diana, you’re right.” I said, “What?” He said, “It’s your ileocecal valve.” I said, “Well, how do you know that?” He said, “That dye I gave you three days ago to drink is still in you. It’s just all crammed up against that valve.” I felt like then, well, I had some verification that I was on the right track. I asked him what to do. He said, “Oh, I don’t know. I’m here to remove your stone.”

Diana Driscoll: So I was on my own yet again, but I felt like I had something to work with. So I started to think back to the lectures in school. I don’t know how I remember these things, but I thought we learned that there’s two parts to the vagus nerve. There’s the preganglionic that goes from the brain down into the chest and abdomen, there’s a gap or synapse, and then there’s the postganglionic vagus nerve. And I remember the instructors saying the postganglionic vagus nerve is so small it’s almost a part of the organ itself. I thought, “I think I still have that. Is there any way I could trigger that?”

Diana Driscoll: So I started to think about the neuro-transmitters. I thought, “Well, that’s acetylcholine, but that’s not a drug. So could I use an imitator of that drug, which is called an agonist?” I thought, “Okay, what’s the agonist for that nerve?” I thought, “Oh, well that one, I remember. This is the only nicotinic acetylcholinergic nerve in the body.” So I got a nicotine patch and, well, I put it on my abdomen not knowing if I was going to make any difference. But it took about an hour and the valve open, I had a normal bowel movement and kept using it for a few days, did fine. Called other patients with the same condition, they did fine, too. Thought, “Okay, we’re onto something.” We can’t keep using nicotine because it was actually activating more inflammation, but it set me on the right track, understanding the receptors were still working. Whether or not the nerve was affected, I didn’t know, but I had still a target.

Diana Driscoll: Then I thought, “Can I come up with a oral way of doing this, mix supplements in a way that it can have that same response and yet not use nicotine?” So that was the goal.

Walt Whitley: Yeah. Well, that’s definitely your breakthrough, but since this is DryEyeCoach, can you tell us how people notice about dry eyes and the relief they got?

Diana Driscoll: Yeah, absolutely. I did so many studies on this and I was looking at bowel movement, vagus nerve, gallbladder function, all that to make sure I got it. It wasn’t until the end of the studies I realized that dry eye cases were clearing up, but okay, I have to back up and figure out why did that happen. The lacrimal nerve, of course, uses acetylcholine as its neurotransmitter. The receptors are different, though. They’re basically muscarinic, not nicotinic. So I wanted to figure out how that happened, how to improve on it.

Diana Driscoll: Then I started to think, “Well, how many chronic dry eye patients are dealing with something in the same family of conditions where acetylcholine is getting blocked, it’s not getting released properly?” They don’t have to be sick like I was sick, but you start to look for symptoms of kind of like anticholinergic poisoning, but turned way down. So look for things like brain fog, large pupils, tendency for constipation or fatigue, those sorts of symptoms that we oftentimes blame on just getting old or being stressed out or something. I found in the dry eye population that was super common.

Diana Driscoll: So approaching dry eye from both a systemic viewpoint of supporting this neurotransmitter for more than just the lacrimal nerve turned out to be this wonderful combination, not only for the dry eye, but the overall wellness, and I figured out that that was really a new approach. No one had ever looked at that before, and I’ve gotten some patents today, which was very validating, very validating.

Walt Whitley: Yeah. So I mean, that’s a critical connection that you made there. So you identified that connection, so then what? What did you do next?

Diana Driscoll: Right. I basically sat in my kitchen. I used my old organic chemistry knowledge, but I don’t even want to tell you how old that is. And I was working in genetics at the time, thinking that we had some genetic problems what are the chances both my kids and I could end up with this with no genes involved and tried to figure out a way to put together ingredients to support acetylcholine, work around all genetic defects in that pathway, include nutrients that are in the pathway of making acetylcholine and yet to be real careful not to overstimulate the receptors so that tolerance builded up. Then I wanted to make sure it crosses the blood-brain barrier because there were so many symptoms that the central nervous system was affected, the brain fog, short-term memory problems, et cetera.

Diana Driscoll: So my goals are very lofty, but I sat there and just made it and then just kept tweaking it for about three, three and a half years, gave it to my son and I, my son had developed severe osteoporosis it was really frightening, to make sure he had it right and then started to study. So it ended up with the oral over-the-counter supplement mix to do this and it worked.

Walt Whitley: So you have the Parasym Plus Eyes. How is this product different than other dry eyes supplements?

Diana Driscoll: Right. It’s a completely different approach, and it really took a mind shift for this to think in terms of dry eye is not necessarily always being an eye problem. If the eye problem, if you will, is secondary to a systemic problem, then oftentimes you can see it manifest in other ways, like the fatigue or tendency for constipation, or inflammation oftentimes will block acetylcholine and the same inflammation can cause other symptoms. So we look for some of that and I found it to be very common. So approach it from more of a systemic point, approach it from the autonomic nervous system and get the muscarinic receptors and the nicotinic all in one fell swoop.

Diana Driscoll: But as it turned out, this chronic inflammation that’s blocking acetylcholine is something that’s usually not diagnosed. We’re familiar with something like Sjogren’s syndrome where we clearly understand the inflammatory component, but the inflammatory cytokines and chemokines I was finding weren’t measured by the traditional markers, CRP, sed rate. We had to go to cytokines and, as practitioners, we can’t really do that. So even normal aging is an inflammatory process. Strong athletes tend to be inflammatory. So there’s a huge population, I think, that gets overlooked in this state and dry eyes is just one consequence of that chronic problem with inflammation blocking that neurotransmitter. And I love the fact that it was over-the-counter. I thought, “I can’t wait for a drug to be developed so we’ve got to get this out and ready for my family right now.”

Diana Driscoll: So it is different. It’s completely different approach, and it’s something doctors can roll into their current paradigm. So it’s not going to replace if there’s structural damage or the meibomian glands are bust or what have you, you’ve got to support the neurology, though, to get the best outcome for the patient. So it is a different approach.

Walt Whitley: Yeah, it’s definitely working on it from the systemic aspect, as you just mentioned. So have you looked much into the OC-01 varenicline that’s going to be intra-nasal, potentially intra-nasal [crosstalk 00:14:45].

Diana Driscoll: You know it.

Walt Whitley: So what are your thoughts on that? Because that’s something that many are so excited. You looked at one approach, this is another approach, but it’s both doing the same thing, looking at the selective nicotinic acetylcholine receptor agonist. So what are your thoughts?

Diana Driscoll: Yeah, I have a couple of thoughts and I think, one, it is awesome that someone is finally looking at the autonomic nervous system and kudos to them. I think that is great.

Diana Driscoll: This is a nicotinic agonist, their product is a nicotinic [inaudible 00:15:18] so it works on the nicotinic receptors. But it looks like with research we’re finding that most of the receptors for the lacrimal functional unit are actually muscarinic so for that, it won’t be as effective. But it’s still a localized drug. It’s treating dry eye as a local problem, as opposed to a systemic problem. So it’s not going to increase acetylcholine, say, to cross the blood-brain barrier to support the vagus nerve.

Diana Driscoll: I also wonder it stimulates the trigeminal nerve, but the way I think of it is the trigeminal nerve is an autonomic nerve. It should work all by itself, right, we don’t have to think about tear production. So if it’s broken, if it’s not working and drives result, then stimulating that nerve is not going to be effective. You can’t stimulate a broken nerve and have it work. But if it’s autonomic, why isn’t it automatic? Why are we having to stimulate something? I think we need to think deeper about more systemic effects. I like the fact that we don’t have to sneeze [inaudible 00:16:37] take a pill to. I’m hoping that won’t be a real issue for them, but I have no doubt [crosstalk 00:16:41].

Walt Whitley: That’s right. Well, now, I’ve been excited to learn more about OC-O1 and since we’re on this topic, I definitely had to bring it up. I mean, looking at the data, we know that we should hear in the next month or so whether or not that’s going to be approved, but so far the data signs and symptoms for dry eye disease, it’s been impressive.

Walt Whitley: But then also now hearing about you and things that you’ve been working on from the systemic aspect, I mean, this is great because you and I both talked about there’s so much when it comes to dry eye and what is the underlying issue. So, I mean, it’s exciting to hear more learning from you. Do you have any closing words or anything you’d like to add before we wrap up this podcast?

Diana Driscoll: Right. It’s such an exciting time, isn’t it? And I love when new things are coming out and I love people who think deeper and to help patients. It’s all about helping the patients.

Diana Driscoll: But I’ve got to tell you, I’ve got to pinch myself sometimes, well, because I was disabled for over a decade and having to be forced out of eyecare and going this long circuitous route around, I circled back into eye care and having something to contribute to the profession is amazing. I’m so grateful for the education I received and that I’m in this profession. I don’t think I could have gotten the answers I got for my own health and for others had I not had that background.

Diana Driscoll: So I don’t know that eye doctors get enough kudos for looking at systemic illness and I understand. We’re eye doctors, right? But the eye is that window to the rest of the body and we can learn so much by looking at the eye. And I think dry eye disease is just one thing that might be telling us a systemic story that we can’t miss. But I’m so happy to be here and it’s a second chance a lot of people don’t have, and I’m so grateful to you for letting me tell my story.

Walt Whitley: Oh, well, hey, thank you so much for spending time with us today there, Diane, and it’s been great to learn so much more about this and look forward to our continued conversations.

Walt Whitley: And for everyone that’s on this podcast, thank you so much for spending time with us and looking forward to the next one. Have a great day.