Tag Archives: toxins

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The Colour of my Baby

What a great idea: a bandage that tells you when what it is hiding, is itself hiding something –an infection.  http://www.bbc.com/news/health-34808273

I suppose it was an idea looking for a platform. When bacteria are growing, they often invent ways to keep doing just that. Sometimes they overwhelm by sheer numbers to defeat the body’s defences, at other times it’s toxins that break down tissues and help them invade. The body, for it’s part, has its own bag of tricks. In the end, infections are often simply a kind of parry and thrust contest –a fencing match, if you will.

Most bodies are not unduly challenged by wounds, however –keep them clean and cover them with some sort of dressing, and they heal. Antibiotics are seldom required. The problem, of course, is that sometimes the foes are not evenly matched. People on immune suppressants (transplant patients), or those with already compromised immune systems –whether from disease or immaturity (babies, for example)- may not be able to mount a suitable response to bacteria in a wound and are at risk of severe infections. These are the ones in whom a timely and appropriate antibiotic would be prudent.

Sometimes, though, antibiotics are used like soap: if it looks dirty, or if it might turn out to be dirty, why not use an antibiotic? Just in case. Well, the simple answer is that the body is usually pretty good at dealing with bacteria. After all, we are all exposed to bacteria from day zero. It starts with the journey down the obviously non-sterile birth canal, and progresses to crawling along things, tasting things… none of which could be said to be free of bacteria of some sort or other. Bacteria are what we do, where we live… Bacteria live in our mouths, in our bowels, on our skin. There are more bacteria in our intestines than cells in our bodies; we simply cannot get rid of them all.

Nor should we. I’ve written before about the benefit of these usually commensal creatures and the benefits they provide both for continuing health and development: https://musingsonwomenshealth.wordpress.com/2014/05/15/the-human-microbiome/

But let’s not be naïve about bacteria –they don’t give a fig about us -they are amoral. A bacterium prefers to live with others –family. They grow and prosper with no regard for boundaries or house rules. Without suitable checks and balances they would take over. Like pouring water in a cup -too much and it merely overflows the constraints and moves on. That’s an infection. That’s when the body may need some help.

The trick is obviously intervening when it is necessary, but monitoring when it is not. Why? Well, treating every wound, say, with an antibiotic might get rid of the truly sensitive bacteria, but leave behind those that don’t respond quite as easily or quickly. The result of the treatment may therefore be to select for those bacteria that don’t mind the antibiotic –the resistant organisms. That’s how it happens.

So in those people who may not be able to deal with bacteria efficiently, it would be helpful to know when –or if– to intervene. That’s where the bandage that changes colour when bacteria in wounds begin to proliferate and infect would be helpful. There are other ways, of course: the old Latin aphorism I was taught in medical school, for example: Tumor, Dolor, Rubor, Calor – Swelling, Pain, Redness (inflammation), Warmth (infection). But sometimes it’s nice to have another tool in the kit that may detect a problem earlier -before these signs are present. Or, in the case of a body incapable of even producing the signs- when an infection would be catastrophic.

Clearly a lot of work needs to be done to detect the mischief of different types of bacteria –they don’t all produce toxins, and even if they did, there would likely be differences in their structures that would have to be accounted for in the detection mechanism. But this may be the bandage of the future –a Facebook band aid that is constantly posting. Almost like refrigerators that tell you what you need, or coffee pots that turn on when they hear the toilet flush in the morning. A brave new world.

It is ‘a hit’, as Osric, a courtier, says of Hamlet’s thrust as he is dueling with Laertes, ‘a very palpable hit.’ Let us hope so.

 

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Staying in Touch

In the endless dark of night, belief that there will be a morning is sometimes all that sustains us. Hope springs eternal in the human breast, as Alexander Pope declared in one of his essays -and that is occasionally all there is. When Medicine fails, the understandable temptation is to turn to alternatives; when inductive reasoning seems insufficient (compilation and collation of observations to arrive at a tentative conclusion) then perhaps the converse might be helpful: deductive reasoning (start with a conclusion and then look around for supporting evidence). The Scientific Method tends to use more of the former than the latter to test hypotheses, although to be honest, it is often a melange. But to start with a conclusion and then to attempt to prove it can be a recipe for failure –or worse, deceit.

Alternative Medicine appears to be guilty of the latter -although whether by intent or naivete can be argued, I suppose- but it does seem to attract a certain edge of the population. I, for one, am not a believer, but to set the stage, perhaps a definition of alternative medicine would be helpful. The description in Wikepedia (sorry!) is as good as any I’ve seen: ‘Alternative medicine is any practice that is perceived by its users to have the healing effects of medicine, but does not originate from evidence gathered using the scientific method, is not part of biomedicine, or is contradicted by scientific evidence or established science. It consists of a wide range of healthcare practices, products and therapies, ranging from being biologically plausible but not well tested, to being directly contradicted by evidence and science, or even harmful or toxic.’

In this essay, I don’t intend to debate the merits or harms of alternative strategies for health, but merely to illustrate the pitfalls that can result when they are espoused too vigorously -when hope triumphs over experience. When, to paraphrase Macbeth, Physic is thrown to the dogs.

*

I really liked Loretta; I could tell that as soon as I saw her in the waiting room chatting to her neighbours. A slender young woman barely grazing her twenties, she had short brown hair and was dressed in jeans and a yellow tank-top. Her face was all smile –or, rather, all teeth and tongue, with large, brown eyes occasionally mobilized to emphasize some point or other. The whole room seemed alive with laughter and focussed on her every word, her every gesture –and there were a lot of those. Her body was in constant motion, sometimes pointing with a ring-laden hand, then gesticulating with her arms as her bracelets clinked and ran up and down her forearms like beads on an abacus; even her legs were integral as she swung them back and forth to illustrate a point with her dainty sandal-clad feet – an actress playing to an adoring audience. I almost felt embarrassed as I crossed the room to lead her offstage. She actually waved to them as she left; I half expected her to blow kisses.

She sat on the edge of her chair in my office clutching a backpack in one hand and a phone in the other as if to relax was anathema to her. “You seemed quite popular out there,” I said, nodding towards the corridor that led to the waiting room.

Her smile broadened at the compliment. “I like to stay in touch with everybody… and everything,” she added, as if it were a necessary addendum, then filled the time between our words with safaris into the uncharted depths of her pack. “I’ve come here for a pap smear,” she said as she saw me scrolling on the computer. “That’s what my GP says, but it’s really because he doesn’t know what to do with me…” She let the sentence dribble to a close without a firm indication she was finished with it. Like it was still a work in progress. So I waited. A text arrived on her phone and she blinked at me and proceeded to thumb a rapid, practiced reply almost as if she was scratching her leg without thinking about it.

Still she said nothing, but instead inspected the room, starting with the pictures on the wall and then progressing to the the plants on my desk, inspecting them one by one, perhaps thinking I was going to quiz her about the office. “What is it that concerns your GP, Loretta?” I felt I had to say something.

She shrugged goodnaturedly and her eyes migrated to my face. “I suspect she thinks I’m too self aware…” She giggled at the thought, then noticed the puzzled expression that I had tried to disguise. “I like to be on top of things…” She immediately blushed and corrected herself. “You know, like my health and stuff.”

I smiled to encourage her to explain.

“Like, you have to be careful about what you put in your body. I mean they’re putting additives in everything. Bodies need help getting rid of all the toxins that build up: detox regimes.” I grimaced inwardly, but maybe she saw the shadows. “My GP said that was nonsense, too, but I know I feel better after a cleanse,” she said, momentarily dropping the smile and folding her arms across her chest with the bracelets following close behind for emphasis.

I tried to disguise a deep breath. “I see…” –but actually I didn’t– “Is there any reason he felt that a gynaecologist could be of some help?”

“Help?” she said with a sharp intake of breath, as if I had really not understood a word of what she’d been telling me.

“You know,” I quickly added, “Help with something that you’ve been unable to deal with using your…” I hurriedly rummaged around in my head for an appropriate word –one that wouldn’t seem to insult her, yet wouldn’t suggest acquiescence either. “…Your strategies.” I thought that sounded neutral and not overly critical. I wanted to keep her on my side to see if there really was anything I could do to help. She could sort out the knowledge base for herself later.

Before she could respond, another text arrived, prompting yet another seemingly mindless flurry of thumbs to resolve the issue. She didn’t apologize and I realized that this was just part of the background in her life -like traffic noise, or maybe someone bumping into her in a crowd. She found time to shrug at me again, but whether to acknowledge the text she had just answered or as a way of answering my question was hard to tell. “I’ve been getting a lot of yeast infections lately, so I tried another cleanse.”

Her eyes jumped onto mine to see if I needed any clarification, and rested there when my face didn’t light up sufficiently with comprehension. We live in different worlds they said.

“Toxins,” she added, like she was talking about the elephant in the room. “The bowel walls get encrusted with stuff and overgrowth of candida is one of the crusts.” She smiled innocently, almost as if she was going to admit to sneaking a cookie between meals. “I tried dietary modifications for months: fruit fasts, fiber-only diets… but no matter, I still got itching down there. So I tried a coffee enema once a week for a month. Then a probiotic one for almost three months.” She jangled her bracelets again as she thrust her arms upwards to suggest what else could she do. “Nothing worked, so finally I tried an enema using an antifungal solution that my girlfriend told me about. Jeez, try to keep one of those puppies inside for 15 minutes! I only managed 8…” She noticed the horrified expression that I’d tried desperately, but unsuccessfully to camouflage. “Eight minutes, doctor –not eight enemas!” She shrugged again –it was another form of speech for her, evidently. A sort of body text, I suppose. “But when I told my GP about it, he got really mad. “Of course there’s yeast in the bowel; we all have yeast in our bowels, he said… No he yelled that at me,” she added after thinking about it for a second.

“So I told him about the enemas they’re using nowadays for –I forget the infection…”

“Clostridium difficile,” I added helpfully, and also to show that I was still listening.

“Those are special fecal enemas, he yelled back at me, and only for a special problem!  Anyway, you can’t get rid of vaginal yeast with those silly health-product enemas, he added. Not even the probiotic ones. He said ‘probiotic’ more softly, though, as if maybe he wasn’t so sure about that one.” Her face perked up again as the indignation faded and the verbal catharsis revived her spirits. “The yeast down below isn’t so bad right now –it seems to come and go. But no thanks to him -none of his prescriptions helped…” She shrugged a text at me. “That’s why I tried colonics dead last. I mean I believe in probiotics, and I hate enemas.” She studied my face for a moment. “Hey, I was desperate.” Another jingle from her arms. “There’s gotta be another way to go. Despite what all my friends say, I still think enemas are unnatural, don’t you?”|

I have to say it was hard not to roll my eyes. I realized I had a chance to convert her to our side of the fence if I was careful. And tactful. “I agree with you about probiotics, Loretta.” She smiled and nodded her head at my unexpected response. “The idea, of course, is to adjust the biota –the bacterial flora of whatever organ- to be able to suppress other unwanted organisms. But you can’t just use off-the-health-food-shelf probiotics –one type doesn’t do all jobs, just like one antibiotic doesn’t fit every occasion.” I glanced at her face to see if she was listening or playing with her phone again. She was listening. Staring at me in disbelief, actually. But in this Google age, I knew I had to be careful -I could only remember one article I’d read and that might already be outdated. For that matter, I couldn’t even recall where or when I’d seen it –the Canadian Medical Association Journal, maybe. But then again, she probably didn’t really have a yeast infection anyway…

“And the other thing is that good studies in this field are hard to find.” I hesitated a moment for effect -timing is everything. “I seem to remember there are a couple of probiotic regimes that have undergone scientific investigations. They were published a few years ago in…Ahh, the Canadian Medical Association Journal. You can look it up, I imagine.” The long-winded, but welcome news had forced her back into the chair, her phone into her pack, and the pack onto the floor. Then a look of concern replaced the incredulous rictus. “But how are the new bacteria going to be able to compete with all that toxic stuff in the area now? It might poison them, or overwhelm them before they even get a chance to set up a new colony.”

It was my turn to look concerned –well, at least curious. I’ve never understood the toxin theory promulgated by many of the alternative medicine practitioners. “How do you know there are toxins, or whatever, in the area, Loretta?” I sat back in my chair, convincing myself I had her.

Her eyes rolled as her hands reached into the pack at her feet in response to a muffled text. I assumed she was reacting to the disturbance, but suddenly realized it was me they couldn’t believe. She closed them slowly, patiently, in a slow motion blink and then opened them again, this time filled with all the sure and certain knowledge of youth. Her body texted me before any words left her mouth. “How do I know there’s still stuff living there now after months of using my colonic ‘strategies’ as you put it? Ever had a retention enema, doctor?”

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The Cleanse

Sometimes, if I have the chance, I like to review the list of referral letters before I see any patients for the day. It tells me what to expect; how to allocate the time for the consultations; whether any of them might be particularly interesting. Surprises happen. The other day, one letter about a patient caught my attention. It was short and to the point: Chronic yeast infection. Tried everything. Nothing worked!

Great. I noticed she was booked for the end of the day so there was always the chance that she wouldn’t show up. The thought sustained me all that morning.

But of course, she did.

Quite an confident looking young woman in her early thirties walked into the office accompanied by her partner. Tight jeans and a bulky grey tee shirt announced her presence on the chair, a too-loud voice from an un-makeupped face made it echo around the room.

“I’ve just done a cleanse, but I thought I’d keep the appointment anyway,” she shouted defiantly. I suppose it wasn’t technically a shout, but it made my ears vibrate nonetheless. She glanced at her partner to underline the proof of the assertion, and then they both glared at me, in case I dared to disagree.

I’d never actually knowingly talked with anybody who’d confessed to a cleanse, and to tell the truth, I was a little vague on what it entailed. I thought I’d ignore the gap, and ran my eyes over the referral paper to make sure I had the correct patient. “So…” I said, noisily unfolding the referral letter on my desk -I often start this way, to demonstrate beyond a doubt that I am in possession of their doctor’s opinion- “Your doctor tells me you’ve had a yeast inf…”

Both their eyebrows shot up in unified derision of whatever it was that the letter contained. “Oh, don’t listen to her!” the partner interrupted in a softer, angrier voice. “She had no idea what was going on with Marcie…”

“Was..?” There was hope in my tone.

“I told you I did a cleanse!” Marcie said, almost reverently. And slowly, as if she were spelling the word out in her head.

I must have looked puzzled, because she produced an overly-tolerant look on her face, and smiled at me, the only slow one in the room.

“Cleanse!” She said it so slowly she seemed to caress the sound on the way through her lips. “It’s a way of ridding your body of its built-up toxins.” When my expression didn’t change, she continued after a maudlin sigh that her partner obediantly repeated. “The colon contains all sorts of toxins that build up over the years and stop the body from fighting off things like yeasts…” She rolled her eyes at the need to explain it to a specialist like me.

“So it worked?” I had meant it as a tentative acceptance of her information at first, but by the time the sound made it out of my mouth it had turned upwards into a question.

Her partner, Grace, seemed offended. “Of course it worked!” she said indignantly. “We both tried it,” she added proudly and smiled broadly at Marcie.

“The theory makes sense, when you think about it,” Marcie bellowed at the picture on the wall behind me. I could almost feel it rattle.

“Oh? Why’s that?” I was trying to be polite –there’s absolutely no evidence for its benefit in the standard medical literature. In fact the fecal microbiome is important for proper immune functioning- but I’m afraid that, once again, my words came out suggesting I was doubtful at best.

Her eyes narrowed and her face tightened –both faces tightened, actually- and she straightened her tee shirt as shocked as if I had sworn in church.

“There’s evidence,” she said and crossed her arms defiantly, satisfied that she had bested me.

I tried to look neutral –neither judging, nor rejecting her statement. “I…” It was all I could get out before she launched into a tirade.

“You doctors,” she roared, somehow managing to make ‘doctors’ sound like a disease. “You restrict your information to narrow little unreadable journals. You never read anything that disagrees with what you already think you know… Or, if you happen on it, you never read the whole thing…” I used the opportunity between her breaths to think about that one. Maybe she had something there… Confirmation bias is something we all struggle with.

She quickly turned to Grace who nodded in support. “There was a website I saw just last week that proves it…” She hesitated momentarily when I picked up a pen to write it down. In fact, she lowered her voice to encourage me.  It’s  http://www.tylervigen.com/

And then she laboriously spelled out each letter, including the forward slashes -in case I got them backwards, I suppose. “I just looked at a couple of them, but they were stuff you’d never find in your medical journals –and all statistically proven.”

I must have raised my eyebrows, because she quoted an example. “Did you know, for example, that the per capita consumption of chicken in the USA is correlated with the total USA crude oil imports? Don’t you find that strange? I mean stuff like that is proven, but they don’t want us to know about it.” She crossed her arms again.

I just concentrated on keeping my expression neutral, all the while trying to figure out how oil imports had anything to do with cleansing.

“And what about the margarine one, Marcie?” Grace added to overwhelm me with evidence.

Marcie nodded, somewhat annoyed she had chosen the chicken example, I thought. “Anyway, I’m betting it’s the same with colon toxins!”

And with that, they both rose in unison and thanked me for listening, all the while glancing furtively at each other. “We’ll come back if it doesn’t work out, though,” Marcie added as a sop to my dignity as she left the room.

As for my part, I felt disappointment at my inability to defend myself. Sometimes naivete is attractive, but usually it is just annoying. Incapacitating…

Out of curiosity, I looked up the website that night. Marcie must have skipped over the title, though -it was called Spurious Correlations. Or maybe she read it as ‘Curious’ Correlations… Anyway, I managed to find an article on it in the BBC News Magazine  http://www.bbc.co.uk/news/magazine-27537142

Somehow, I think they both missed the point of the website -written by a student at Harvard- that correlation does not equal causation. But maybe it wouldn’t have mattered: I didn’t read the whole thing…

 

 

 

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