G. J.

Sioux Falls, South Dakota

Clostridium difficile, a toxin-producing bacterium, spreads easily on the hands of caregivers and on hard surfaces such as bed rails, stethoscopes, and toilets. About 3 million people are diagnosed with it each year, and studies show that nearly one-fourth of them experience lingering or recurrent diarrhea, abdominal cramping, and fever.

Most infections occur during or after antibiotic therapy, which disrupts the normal balance of bacteria in the gut and allows C. difficile to take hold.

Patient safety researcher and advocate Dr. Peter Pronovost, a critical care specialist at Johns Hopkins Hospital in Baltimore, Maryland, explains:

“C. difficile (C. diff) can colonize the gastrointestinal tract as well as infect it. As a result, the presence of the organism in the gut is not a problem unless the person has diarrhea and other symptoms. Recurrent C. diff diarrhea is fairly common and requires retreatment with oral metronidazole (Flagyl) or oral vancomycin (Vancocin). When possible, it’s important to get off of any other antibiotics that can trigger the disease. Talk to your doctor.”

Handwashing, thorough cleaning, and avoiding unnecessary use of antibiotics are the best ways to prevent 
the spread of C. difficile in homes and hospitals.

Lingering GI Tract Infection The Saturday Evening Post

Dorrie

St. Augustine, Florida

Rest easy. Your body is able to turn the prescription drug Synthroid into the T3 hormone that you need.

A healthy thyroid gland produces the right amount of T3 (triiodothyronine) and T4 (thyroxine or tetraiodothyronine) to control the body’s rate of energy use. Doctors prescribe a synthetic version of T4 called levothyroxine (Synthroid, Levoxyl) when the gland is underactive or removed because of thyroid cancer or Graves’ disease, the most common cause of hyperthyroidism in the United States.

“The body converts, or makes, T3 from T4,” explains Dr. Jeffrey Garber, chief of endocrinology at Harvard Vanguard Medical Associates. “In fact, a 2008 study from Georgetown University Medical Center in Washington, D.C., reports normal T3 levels in those taking levothyroxine therapy.”

Thyroid Pills The Saturday Evening Post

Although anyone can get meningitis, preteens and teens are at higher risk of its most dangerous form than other age groups—and more likely to die from it, too. 

Meningitis caused by meninogococcal bacteria can take the life of an otherwise healthy young person in a single day. Fortunately, a simple shot is available to protect against the serious infection. 

The Centers for Disease Control and Prevention (CDC) recommend a vaccine to prevent four common types of bacterial meningitis for youngsters 11 to 18 years of age and college freshmen living in dormitories, as well as individuals with weakened immune systems, military recruits, and some overseas travelers. 

Meningitis occurs when the fluid-filled membranes (meninges, men-IN-geez) that cover the brain and spinal cord become infected and swollen. Viral meningitis usually resolves in two weeks with little treatment. However, bacterial meningitis is extremely serious and requires immediate treatment at a hospital with antibiotics and medicines to prevent amputation of arms, legs, fingers, and toes; brain damage; hearing loss; or kidney damage. 

Symptoms of the two types are similar, which is why anyone with a high fever, headache, and stiff neck should seek medical help right away. Other warning signs of the disease are nausea, sensitivity to light, confusion, and sleepiness. 

“I lost both of my legs, my kidney, my spleen, half my hearing, and almost my life to meningitis. And I’m one of the lucky ones,” recalls Amy Purdy, who contracted meningococcal disease when she was 19. 

Amy Purdy
Credit: Paul Smith Photography, courtesy of the Voices of Meningitis campaign

Safe and effective vaccines are available for people ages 2 through 55 who want to protect themselves from meningitis. Less than half of children age 11 to 18 have been immunized, however, placing millions at risk for the rare but potentially devastating disease. 

Remarkably, Purdy not only survived but later won medals in the USA Snowboard Association’s snowboarding competition and competed in the ESPN Extremity Games. Today, she is a motivational speaker and also works as a model, actress, and make-up artist. 

“If I knew about meningococcal disease, including meningitis, and that a vaccine existed to help prevent it, I would have made it a priority to get vaccinated,” she says. “I know firsthand how serious it can be, and I want to help raise awareness about meningococcal meningitis and encourage preteens and teens to get vaccinated.” 

Click here http://www.voicesofmeningitis.org/get-the-facts-the-basics.html for more about Purdy’s story, and additional information about meningitis from the National Association of School Nurses. 

Click here http://www.cdc.gov/meningitis/vaccine-info.html for details on the CDC’s meningitis vaccine recommendations.

Act Now to Stop Meningitis The Saturday Evening Post

Margaret
South Carolina

Chances are good that you won’t catch it again because most people develop an immunity to the bacteria or viruses that caused their illness. Spinal meningitis occurs when the fluid-filled membranes (meninges, men-IN-geez) that cover the brain and spinal cord become infected and swollen. Viral meningitis usually resolves in two weeks with little treatment. However, bacterial meningitis is extremely serious and requires immediate treatment at a hospital with antibiotics and medicines to prevent brain damage, hearing loss, or learning disabilities. Symptoms of the two types are similar, which is why anyone with high fever, headache, and stiff neck should seek medical help right away. Other warning signs of the disease are nausea, sensitivity to light, confusion, and sleepiness.

Some forms of bacterial meningitis are mildly contagious, especially among those living in crowded conditions. Experts say, however, that talking to someone with the illness or breathing the same air is not dangerous. A vaccine to prevent four common types of bacterial meningitis is recommended for high-risk groups including infants, children, freshmen college students living in dormitories, individuals with weakened immune systems, military recruits, and some overseas travelers.

Washing hands before eating, and after changing diapers or going to the restroom, reduces the spread of many types of germs, including ones that cause potentially deadly infections such as bacterial meningitis. Make it a habit.

Spinal Meningitis The Saturday Evening Post

Gut Reactions

Kupper’s condition turned out to be an autoimmune disorder known as celiac disease, a severe reaction to gluten, the protein in many grains, including wheat, rye, and barley.

When the immune system launches an attack against gluten, the result isn’t merely irritation of the gut (though there’s plenty of that, too, chronic diarrhea being a major symptom). The repeated attacks also end up flattening the finger-like projections in the small intestine through which nutrients are absorbed into the bloodstream. The resulting nutrient deficiencies can lead to a number of problems, from anemia to osteoporosis (caused, respectively, by a lack of iron and calcium). In children, celiac disease can lead to short stature and a general “failure to thrive.”

But celiac disease is more complicated than a digestive complaint or food allergy. As part of the immune system’s assault on gluten, the body generates antibodies to one of its own enzymes called tTG (tissue transglutaminase). This enzyme is an innocent bystander that only gets targeted because it binds to gluten in the lining of the intestines. If tTG were found only in the gut, there would be damage enough. But tTG is also found in the skin, heart, thyroid, bones, and nervous system. Antibodies against tTG can direct fire at any of these organs, too. The results may range from blistering, itchy rashes to thyroid disorders and neurological problems. “Name an organ, and it can be affected,” says Dr. Peter Green, director of the Celiac Disease Center at Columbia University’s College of Physicians and Surgeons.

As recently as a decade ago, celiac disease was considered rare. Now almost everyone seems to know someone who has it. That’s not just the result of better diagnosis, which today involves blood testing and confirmatory intestinal biopsy. Recent studies suggest that celiac disease is becoming more common. One 2009 study in the journal Gastroenterology compared banked blood samples from the early 1950s with recent samples and, using the blood tests for celiac disease, found a fourfold increase in the last 50 years.

Celiac disease is now thought to affect one in 100 people of all ages and races. Unfortunately, it often takes years before the disease is correctly identified, according to the National Institutes of Health.

Search for the Cause

Gluten was first identified as the trigger in celiac disease after a Dutch doctor noted the precipitous drop in cases during the bread shortages of World War II—and the rebound of the disease once bread became available again.

But scientists believe that it’s more than just bread, crackers, cookies, pasta, and other wheat-filled foods that are responsible for the increase in celiac disease. In order to develop the ailment, a person must eat gluten, and also carry genes that predispose her to gluten sensitivity. “But our genes haven’t changed in the last 50 years,” points out Dr. Green. He cites a Finnish study that compared a high-celiac population in Finland to those across the border in Russian Karelia with low rates of the disease. “The two have similar genes. That means there must be some other environmental factor that helps initiate the immune response.”

Life is easier for Cynthia Kupper, who feels "much, much better" after going gluten free.
Photo by Duane Hamamura

One possible explanation focuses on the “hygiene hypothesis,” already suspect in the rising tide of allergies and asthma. According to this theory, humans today grow up in more sterile environments than our ancestors did. When infants and young children fail to encounter historic levels of household and farm germs, their immune systems—which evolved to fight these bugs—go looking for other foreign invaders. They end up targeting things like pollen, peanuts, or gluten. Perhaps Grandma was right when she advised, “You have to eat a peck of dirt before you die.”

Improved hygiene, however, is not the only shift in Western society. Researchers are investigating the potential impact of a half-century of changes in how we live, what we eat, and how medications affect the workings of the gut. We take different drugs and more of them, from potent antibiotics to acid blockers. These pills affect the populations of bacteria that naturally inhabit the gut. Some researchers suggest that dietary changes, too—including more fiber-poor, sugar-rich foods, and consumption of sulfites found in cooked and processed foods as well as in wine and beer—can affect intestinal flora. Exactly how these might contribute to celiac disease is unclear, but one possibility might be increasing the permeability of the gut, which disrupts the way the digestive system functions. “When the tight junctions between cells in the intestinal lining come apart, gluten seeps into the underlying tissue and incites the immune system,” says Dr. Alessio Fasano, director of the Center for Celiac Research at the University of Maryland School of Medicine.

Meeting the Need

Whatever the fundamental cause, the solution is simple in concept, if difficult in practice—eliminate gluten from the diet. Fortunately, 
food manufacturers accepted the challenge of providing gluten-free fare (though not cheaply), and pharmaceutical companies are exploring potential drug treatments.

They can hardly come too soon. A decade ago, there were few gluten-free baked goods, and those products “tasted like cardboard-Styrofoam combinations,” says Kupper, who now enjoys renewed energy and good health after embracing the gluten-free life, adding, “I’m really doing well.”

Today, celiac sufferers can find a burgeoning array of gluten-free offerings that are actually tasty, even if pricey. The Celiac Disease Center at Columbia University found that the cost tends to run twice as high for gluten-free products as for normal versions of bread, pasta, cookies, cakes, and crackers. (A cheaper and super-healthy approach is to eat a diet that’s naturally free of gluten—including vegetables, fruits, fish, nuts, lean meat, rice, and potatoes.)

Experts advise celiac consumers to carefully examine food labels for hidden gluten: Its presence is not always obvious. For example, frozen or canned fruits and vegetables, processed cheese spreads, and flavored yogurts, even lotion, toothpaste, and shampoo, may contain gluten.

Drugs are still years away. But Alvine Pharmaceuticals in California is conducting a trial testing digestive enzymes for gluten. These would help break down indigestible gluten fragments into individual amino acids that the immune system would not recognize as threatening. Another company in Australia is working on a vaccine. Also in Australia, a third group has launched a clinical trial giving participants hookworm infections, which appear to alter the immune response of celiac patients in beneficial ways.

With all these lines of research, it seems likely that at least one of these approaches to drug therapy will eventually pan out. When that day comes, scientists will be able to boast that, for the first time, celiac sufferers can have their gluten-laden cake. And eat it, too.

Celiac Disease: The Great Pretender The Saturday Evening Post