Not A Post For The Faint of Heart

Image found here.

Have you noticed that with autoimmune disease, your GI tract is, um, how should I say, more gaseous than previously? Well, mine is. I'm blaming my flatulence on Sjogren's - that's my story and I'm sticking to it. And this has caused me more red-faced incidents than I care to remember. I also want to make note than on those occasions, my decreased acuity in sense of smell has distinct advantages. Come to think of it, with brain fog, I probably don't even remember how many times this has happened. Handy. 

I will write another post detailing a more scientific explanation for changes in the gastro-intestinal tract in response to autoimmune disease when I am in a much less silly mood. 

So with gas on the brain, when I read this from VooDoo Medicine Man, I laughed until I cried, and, you guessed it.......whew. 

BUT - before you zip over to his site, be warned that he uses language that I don't. Physicians. Tsk. 

Recently, I was flying home on a two-hour American Airlines flight. A middle-aged woman dressed professionally in a gray pinstriped pants suit sat in the window seat to my left. We made the usual small talk about how tired we are of flying and how ***** American Airlines has become. Then, as the flight was preparing to leave, we did the Blackberry ritual of checking our emails and then prepared for the flight. After the plane had reached a comfortable cruising altitude, I heard a strange noise that seemingly came from the business woman. I thought to myself, "That was a fart." I know a fart when I hear it for I have been on both the donor and recipient end of the fart spectrum. Unsure whether it was really a fart or some weird noise coming from the aging MD-80, I sniffed like a puppy looking for a dog treat. It was a fart for sure. I am not sure what this woman ate, but something crawled up inside of her and died. But, then I started to smile. the smile turned to a laugh and the laugh almost became uncontrollable. I looked at the woman who was sleeping soundly and she let another one rip. I was trying to cover my mouth to keep people from seeing me laugh and my nose to keep from smelling the weapons-grade gas this attractive woman was eliminating. 

I am a physician. I understand the pathophysiology of flatulence. But, a fart is still a funny thing. Have we come to the point in society where a fart is not funny anymore? In Geoffrey Chaucer's The Canterbury Tales (written in the fourteenth century) he details the story of a miller trying to trick another man by farting on his face. In high school, we used to have farting contests. In medical school I farted just as four of us were getting out of the car at a restaurant. When we returned later, the fart was still in the car and we had to open the windows and doors for 5 minutes before we got in (the fart later became one of the great legends of our medical school class). Everybody farts. Farts are funny (especially in a bath tub).

...........But, have we come to a point in our politically correct society where we can't laugh at a fart? Will the PC police ban "whoopee cushions"? Farting can be an art form. I used to work with a friend who could fart the first 8-10 bars of the southern hymn "Dixie". Racist, probably not as my friend was black. I am not sure I want to live in a country where a fart is no longer considered funny. How about you? 

Sjogren's vs Saliva

The dimly lit auditorium is crowded, boisterously loud, and smoke-filled. The raucous crowd focuses on the boxing ring brightly lit in the center of the room. An official stands in the spotlight and grabs the overhead microphone.

"Ladies and Gentlemen! In this corner, the heavyweight champion - Rock 'em Sock 'em Sjogren's Syndrome!"

The crowd cheers wildly.

"In this corner, the lightweight contender - Spittin' Sammy salivary gland!"

The platinum blonde next to you adjusts her mink wrap as the crowd jeers. She stops chewing her wad of gum long enough to lean over and comment, "Awww. Poor little guy don't have a chance.."

Unfortunately, Blondie is right. Anyone who deals with the heavyweight champ Sjogren's Syndrome knows that our saliva glands don't last long in the ring before a KO punch puts them down for the count.

Why is that? And what's so important about a salivary gland, anyway?

(Julia rolls out an overhead projector and dims the lights.)

Image found here.

Everyone has three sets of salivary glands - the parotid in front of your ear, the submandibular under your jaw, and the sublingual under your tongue. These glands are responsible for secreting saliva, a very complex liquid that has several properties:

Table found here.

Gosh, and I used to think that saliva was mostly good for making spit balls. To smack Scott Hendrickson with. Because he tied my hair to my chair in fourth period homeroom once. Ah, the good old days.... but Sjogren's Syndrome has made my spit ball expertise a thing of the past.

In Sjogren's Syndrome, autoimmunity triggers destruction of cells which secrete fluids. This cell destruction, which also occurs elsewhere in the body, can create a multitude of problems, one of which is the significant decrease of saliva produced.

If you have Sjogren's, and don't have a copy of The New Sjogren's Syndrome Handbook edited by Steven Carsons, MD, and Elaine K. Harris, consider picking up a copy. It contains detailed information about decreased saliva production and all the other effects that SjS may have on your body. This post will focus on the dry mouth issues from Sjogren's.

The following information has been paraphrased from the Handbook:

Normal saliva has five major functions:

1. Coating and lubricating the mucous membranes inside the mouth.
2. Act as a cleansing mechanism to remove food remnants and potentially harmful bacteria from the teeth and soft tissues.
3. Maintaining a chemically neutral pH balance in the oral cavity.
4. Balance the calcium and phosphate in the teeth and decrease susceptibility of tooth decay and erosion.
5. Protect oral cavity from bacterial infections and yeast (Candida) infections by utilizing salivary proteins which inhibit bacterial, yeast, and viral growth.

What seems to be the quickest and easiest solution when faced with decreased saliva production - to guzzle large amounts of water - isn't the best choice.

Plain water lacks components such as mucins (lubricating agents), buffering substances, calcium and phosphate salts, antibodies (secretory IgA), and salivary proteins.

Besides lacking important components, water, when drunk in large amounts, will not overcome mouth dryness, and may remove any remaining mucous on the lining of the mouth and further increase the symptoms of dryness. Frequent small sips of water during the day is more beneficial, and reduces the need to make trips to the bathroom during the night.

There are other treatment options for Sjogren's dry mouth.

Medications are available which stimulate salivary flow, but only in those patients who have some function remaining in their salivary glands. These drugs must be prescribed by your doctor, and may have side effects. Pilocarpine and cevimeline HCL are examples of these types of medications.

Saliva substitutes are also available, and are especially useful for those who wear dentures. These work best when used at bedtime, while talking, or traveling. They work for a limited amount of time because eventually they are swallowed, and take their beneficial properties with them.

Some patients benefit from chewing sugarless gums or letting sugarless hard candies dissolve in their mouth. Care should be taken to avoid candy and gum containing sugar, however, since sugar will promote tooth decay, a significant problem when facing a decrease in saliva.

Which brings up an important issue - prevention of caries, or cavities. For all the reasons described above, meticulous care of your teeth is vital. Good oral hygiene (there's that word again - see a previous post) such as twice daily tooth brushing with a flouride-containing toothpaste, daily use of dental floss, and avoiding sugar in the diet is a good place to start.

Unfortunately, once Spittin' Sammy the saliva gland loses his fight to Sjogren's, the cells destroyed can't be replaced. Research someday - and I hope soon - will provide a something to deliver a knock out punch to Sjogren's.

Go, You Chicken Fat, Go!

OK, folks - how many of you are willing to admit having to exercise along with this 45 record during gym class?



Jazzercize? Pssshhhaaawww. Johnny-Come-Lately.

Busy Fat Cells

photo by luci
I know, I know. I promised that I would not make any New Years resolutions, and I didn't. Really.

But in the process of getting my daily fix of reading autoimmune-related studies, I am seeing more and more evidence that adipose tissue - meaning fat - is a major contributor to the inflammation that arises from autoimmune disorders.

I am learning more about my belly that jiggles like a bowlful of jelly, or white adipose tissue. I had always been under the impression that fat cells are merely reservoirs of that extra piece of pecan pie or the large order of McDonald's fries.

Not so.

Ever since 1994 when scientists discovered that fat cells create a substance called leptin, researchers are finding that fat cells are busy busy busy. This illustration from Medscape shows how busy those cells are:


Take this article from Boston University , for instance. This study found that fat cells produce two proteins with different properties:

Fat produces both pro-inflammatory and anti-inflammatory proteins. The right amount of fat protects the body from starvation and infection, but too much fat produces excessive pro-inflammatory proteins. These can induce inflammation that can lead to diabetes, heart disease and autoimmune disorders, according to Walsh. “The fat from lean, healthy people makes large amounts of protective anti-inflammatory proteins such as adiponectin.” “When you’re too fat, the pro-inflammatory proteins win out,’’ he said. “You make lower amounts of adiponectin.’’

How does this relate to my New Years resolution, you ask? Well, I did resolve not to make a resolution. But I also promised to be kind to myself this year. Perhaps being kind to myself should include making a serious attempt to eat foods and incorporating exercise habits that will make me healthier.

Play It Again, Sam

Picture found here.
Terese is baby-sitting a baby grand piano, lucky thing. It's a magnificent piece of furniture but even better, it's a wonderful musical instrument. It survived being tipped on it's side, it's legs removed, and a lengthy trip in a truck without a scratch and remained relatively in tune.

She hosted a party a few days ago. All of us gathered around the piano as it seemed to draw us close and elicit some kind of reaction from each of us. Magic fingers Terese effortlessly ripped out several beautiful pieces which showcased the piano's classic grand piano sound quality.

Rick, usually so dignified, morphed into a smarmy lounge lizard character as he leaned into the curved side of the piano, Bill Murray-esque oily smile plastered on his face.

Cheryl was transported back to her childhood piano recitals, in which she refused to play. She beamed and posed for pictures at the keyboard but her fingers never actually touched the keys.

The girls, meaning all of our daughters, took turns actually playing the piano. They approached the piano almost reverently and carefully made some of the most beautiful music heard that night. The piano seemed to inspire them to revisit their old lesson books. Ah, to be young and gifted....

Greg and John would not get within ten feet of the piano, even when Terese enticingly began several of their favorite country-western tunes. Their excuses for not singing along included a lack of adult beverages and some skepticism of their wives intentions, having been recorded previously without their consent.

Terese and I were shocked, yes, shocked at their suspicions.

As for me, the piano seemed to bring out my hammier side. I paged through a book of corny love songs and plunked out one of the corniest, ending with a contrived flourish. As everyone rolled their eyes, I took several bows.

"They laughed, they cried..." began Terese,

"they barfed..." I finished.

I'm not so sure that this round of shenanigans qualified as music therapy - an alternative medicine modality that some practitioners claim helps reduce symptoms of autoimmune disease. You can read more about music therapy and autoimmune disease here.

Personally, this approach is a little woo-woo for my taste. However, if some find benefit in this therapy, I'd say go for it.

Autoimmunity Inheritance

Image found here.
A few days ago, John's nephew and his wife had a beautiful baby boy. John and I were tickled pink to be asked to be the little guy's godparents. I held this precious bundle and counted his fingers and toes and smooched his silky smooth cheeks. What a blessing.

His parents were uber prepared for this little boy's arrival. They thoroughly researched everything from car seats and good/bad plastic products and vaccinations. His parents also did some research into our family's health history. They found several significant histories of diabetes, heart disease, SIDs, allergies and such, but didn't discuss autoimmune disease.

Can autoimmune disease be inherited? This is a very good question to ask when considering family health history.

The short answer to this question is No. And Yes.

Sigh. Nothing is simple in autoimmune disease, is it? It seems that the tendency to acquire an autoimmune disease is more likely in close family members. So, no, these diseases are not directly inherited. But the possibility of acquiring an AD is higher especially when combined with some environmental trigger.

From Lab Tests Online, this very good general article discusses autoimmunity:

The cause of autoimmune diseases is unknown, but it appears that there is an inherited predisposition to develop autoimmune disease in many cases.

This from Frequently Asked Questions from Johns Hopkins:

Q: Are autoimmune diseases inherited? A: Clinical and epidemiologic evidence as well as data from experimental animals demonstrate that a tendency to develop autoimmune disease is inherited. This tendency may be large or small depending on the disease but, in general, close relatives are more likely to develop the same or a related autoimmune disease. A number or genes have been implicated in causing autoimmune disease, primarily genes related to the human major histocompatibility complex called HLA.
Q: If autoimmune diseases are not primarily inherited, what causes them? A: It seems likely that environmental factors acting with the genetic predisposition of the patient are responsible for triggering autoimmune disease. A few such triggers have been identified, including a number of drugs that are associated with some forms of lupus, thrombocytopenia, hemolytic anemia and other autoimmune disorders. Infections can be followed by an autoimmune disease in a few instances such as rheumatic fever followed by a streptococcal infection and Guillain-Barre` syndrome caused by chlamydia. A great deal of circumstantial evidence suggests that viruses may play a role in initiating some autoimmune diseases. A number of nutrients have been studied including iodine which contribute to the onset of autoimmune thyroid disease. In most cases, however, we do not have clear evidence of a particular environmental trigger of autoimmune disease.

Since Baby Boy is not a blood relative, I know that along with the toys and clothes and flowers and balloons and hugs and kisses, my autoimmune disease is not included in my gifts to him.

I now know that I have given this tendency to my children and future grandchildren, however.

Let's hope that this gift remains unwrapped.

Ahhhh............

I'm back. It's good to be online again. Did I miss anything while I was disconnected?

Technology Troubles

Our internet provider has been having problems. I'll be back as soon as we can get this figured out.

Inspector Number Nine

Image found here.

Remember when your mom would buy your underpants in those plastic packages containing at least three pair? Or at Christmastime when your Aunt Zelda would give you the underwear jackpot - seven pairs of day of the week underwear? When you would rip open the package, a little tag would drop out. The tag was a small white slip of paper that simply said: inspected by number nine. Or seven, or twelve, or whatever.

And yes, to publicly admit my weirdness, as a child I used to envision a giant number nine critically examining underpants one by one all day long. He had long black plastic arms and Mickey Mouse style white gloves. He would snap that waistband and tug at the seams. Imperfect panties were tossed into a garbage bin, never to be seen again.

Come to think of it, as a child, Inspector Number Nine seemed huge and the underpants very small in my imagination. Now, as an adult, the imaginary underpants have gotten considerably larger, and good old Inspector Number Nine seems much smaller in comparison.

Hm. Not going there. Back to reality:

I thought about my Inspector when I read a summary of a recent study completed and published by the Oklahoma Medical Research Foundation. Their research found that even in healthy individuals, potential autoimmunity-inducing cells can be found:

As antibody-producing B cells develop in the bone marrow, the body tests them to determine whether their antigen receptors are apt to confuse self tissues for intruders. If so, their receptors are either rearranged to make new, non-autoreactive versions-a process called 'receptor editing'-or the cells are killed off while still in the bone marrow. Yet a minority manages to escape, slipping into the body as mature B cells with a propensity for self-attack.

What does this mean for autoimmune patients? Probably that a great deal more research is needed to explain why our bodies' testing mechanism allows far more flawed B cells to escape detection than those people without autoiummune disease.

Personally, I think that our bodies need Inspector Number Nine checking out those antigen receptors.

Yet Another Non-Sjogren's Post

Here's one to file under the "Wow, man......" category:

A brain cell totally looks like the universe. 

see famous look-a-like faces

Enjoy

..........Joshua Bell performing the Ave Maria.

I don't think I'm ready to give up the holiday season yet. 

I've Had Some Requests

......to deliver on all promises made last year in this blog. I'll try to remember what they were, and follow through. 

OK. Promise #1: A picture of the finished  wedding cake that I made for our friend's wedding:

Promise #2:  A picture of the  finished gingerbread church made for the same wedding:

Promise #3: A reader asked for my peach pie recipe: 

Crisco Pie Crust Recipe:

2 2/3 cups all purpose flour

1 tsp. salt

1 C. chilled Crisco shortening

6 - 10 Tbsp. cold water

Blend flour and salt in mixing bowl. Cut chilled shortening in 1/2 inch cubes. Cut shortening cubes into flour and salt mixture using a pastry blender until mixture is coarse crumbs with a few pea-sized pieces remaining. Sprinkle 5 Tbs. water over the mixture and mix with a fork. Continue adding water one Tbs. at a time until dough is moist enough to hold together. Divide dough in half and shape each into a ball. Wrap balls in plastic wrap and chill for 30 minutes. This recipe makes 2 crusts for a deep dish pie. 

Peach Pie Filling:

6 Cups peeled, sliced, fresh peaches

1 Cup sugar

1/4 Cup plus 2 Tbsp. minute tapioca

1 Tbsp. lemon juice

1/2 tsp. cinnamon

Mix together and let stand for 15 minutes. 

Roll pie crusts and place one in a deep dish pie pan. Fill with peach mixture and dot with 1 Tbsp. butter. Cover with remaining crust. Seal and flute edges. Cut slits in top crust to allow steam to escape. 

Whisk one egg yolk with 2 Tbsp. milk. Using a pastry brush, brush egg mixture over top of pie. Sprinkle generously with sugar. 

Bake at 400 degrees F. for 50 - 55 minutes, or until juices form bubbles that burst slowly. 

Enjoy!