Wednesday, September 26, 2012

Bugs, bowels and yoghurt!

Antibiotics have been with us for over half a century now - which is a relatively short time in the evolution of mankind - and we're still learning a lot about how they work and how bacteria work against them! One of the pitfalls of taking antibiotics is that often it leads to the patient developing Diorrhoea - which, if you're already feeling sick, is not something that you want to add to your list of woes! So it would be nice if there were something that we could do to lessen the impact of Antibiotic Associated Diorrhoea (AAD): which leads me onto "what on earth is living in our insides"?

In a previous Blog I have discussed that we are not exactly who we appear to be as much of us is made up of bacteria, fungi and viruses - the genus and function of which are still taxing the minds of some very intelligent scientists around the world. There are, in fact, many more Bacterial cells than human cells in our body: someone pointed out that one way to get an idea of the ratio of human cells to bacterial cells is to look at our bodies and realize that the area below the knee of one leg would represent the number of human cells and the rest of the body the number of bacterial cells! It has also been worked out that there is about 1Kg of bacteria living in our guts and they actually supply approximately 10% of our daily nutrition as well as vital vitamins and mineral. There is also developing evidence to link the bacteria that live in our gut with cell mediated immunity, so we need to think beyond the idea that they're "just friendly germs that live in our bowel", to the idea that they are an essential part of our makeup. So if we upset the balance of "Our" bacteria with inappropriate use of antibiotics, then we are doing harm to ourselves.

First golden rule of antibiotics: only use them when they will do you more good than harm.

But if there is a real need to take them, how can we protect ourselves from the downside of AAD?

Probiotic products are "foods" that contain bacteria, and which are thought to help restore the normal bacterial flora in the bowel - although it doesn't actually work that way. Firstly there are several different strains of bacteria that make up the "probiotic" group, and like different tools for different jobs, they are not a "one size fits all" panacea - they actually need to be matched to a particular condition. And not all gut based conditions will respond to probiotics at this stage, but AAD is one of those conditions that will often benefit from taking probiotics.

Crohns disease and Ulcerative Colitis are known as Inflammatory Bowel Diseases and in CD there is evidence of an exaggerated immune response to certain intestinal bacteria, more so than with UC:  but probiotics seem to have a slightly greater beneficial effect in UC than CD - such are the mysteries of medicine!

IBS or irritable bowel syndrome, is just what it appears to be ... irritable bowel without any definite diagnostic signs. There is no compelling evidence to show that probiotics work, but it's one of those areas where it is quite reasonable to "give it a go" for a period of time to see if there is any benefit.

The use of Probiotics is a very new field in Gastroenterolgy and there will be many discoveries made that I am sure will have an impact on areas of our bodies well away from our gut tube. For now, if you need to take an antibiotic, then a trip to the supermarket to get some Yoghurt containing Lactobacillus Bifidus will probably save you taking a trip to the smallest room in the  house! But for other inflammatory bowel diseases or IBS, you should discuss with your Specialist which Probiotic might be suitable - as they will know what is the latest and best in this fast changing field.

Ampersands & angle brackets need to be encoded.

Friday, September 21, 2012

Pain - it's not always as simple as you think.

I had a prolapsed disc in my lower back some years back that required surgery, and since then I have taken particular care to look after my spine - staying lean and fit, working on my core stabilizers and being careful about how I lift things. But the passage of time will often over-ride all our good habits and things still get "stiff and sore". Now I suspect, one of my facet joints is giving me some localized grief, and leaping out of bed in the morning has been replaced with a well thought out "log roll" onto my side, a steady lift to the vertical sitting position and then engaging the legs to lift me to my full 182cms in height! I have also decided to take an anti-inflammatory to get on top of the situation and to try and stop this from becoming a chronic situation.

All of this brings me on to what is pain and how do we treat it: and when does acute pain morph into chronic pain?

There's not enough room in one- or indeed several blogs - to cover the subject of Pain. For a start, one persons pain is another persons discomfort: and what type of pain do we mean - aches, shooting pains, pins and needles, burning pain - the list is enormous! And methods of treatment vary from local ice or heat: simple pain-killers to long acting Opiates: acupuncture to surgery and all stops in between, so you begin to get the idea that this is not a simple subject, so please do not think that there is a "one size fits all" solution to managing pain - like a good fitting suit, the treatment has to be tailored to the individual in order to maximize a successful outcome.

A very simplistic way to understand pain is to divide it into Acute and Chronic pain. Obviously Chronic pain lasts longer - it's usually been around for 6 months in order to be classified as such - and by that stage it's not the local problem - the arthritic knee, the neuralgia caused by that bout of Shingles that you had, or the trauma sustained in the MVA - that is the area that needs sole attention: rather it's the way the brain has taken over your perception of pain and how your brain now influences all things to do with "that pain" and which is affecting your whole life. So in chronic pain it is so important to look at the whole person and not just the injured part, and to focus the treatment more on the brain than on the injury - and that will often mean the use of a completely different set of "tools" in order to be successful.

Management of Chronic pain is a challenging subject but is one where, with the correct approach and the involvement of a whole team of people -Doctors, dieticians, psychologists, physical therapists, occupational therapists etc, and which also vitally includes the patient and his/her family - then there is a real hope that lives can be radically altered and individuals can return to a normal life which is not dominated by pain or pain-killers.

The message: If your pain is not responding to simple solutions - get professional advice. If you've been in pain for more than 6 months then you need the help of a team of Pain Experts. And remember to be patient if you don't want to remain a patient!

Ampersands & angle brackets need to be encoded.

Monday, September 10, 2012

A special time.

Sometimes things happen in life which cause us to pause from the normal routine of things and reflect on the "bigger issues". My dear ole Dad died just over a week ago - yes he was a great age - but it still came as a shock. Although his mind was dimming, he was still physically pretty active for a nono-genarian and he still delighted in his greenhouse and garden.

When most of us fast forward to those last years of life we like to think that we'll "slip off the twig" in our sleep after the golden glow of a long and happy life, but for more and more people Dementia and strokes seem to blight those final years of life. So I thought I'd write down a few suggestions for how I like to be treated should I start to go Bonkers or, even worse, have a debilitating stroke or disease.

PLEASE DO NOT sit me in front of a TV from early morning! Over the years I have visited many nursing home and seen so many frail people planted in from of early morning TV with inane programs or cartoons! I would hate that even if I was mad! Find a window where I can see the world, or even better sit me in a garden where I can feel the breeze and let the flies tickle my face. If it rains, even better to feel the drops of water on my body: and does it really matter if I get a cold or pneumonia afterwards?

I've always loved trying different things so take me out to the beach, or lower me into a swimming pool: push my wheelchair to the edge of a cliff so that I can experience danger - even if it kills me! And don't worry about me being comfortable in a car - when you were kids we strapped you into seats and I'm sure you filled your nappy too on many a long trip.

Stick some ear phones on my head with music that you think I might like, pod-casts that may interest me, or just the sounds of nature on a cold and wet day. I may appear distant and dribble, but it's what happens deep inside that really counts now - and everything you do with love will be heard in the depths of my soul.

Let the little people near me - they have enormous, yet beautiful energy - and their vision often extends far beyond that of we myopic parents. If they tip me out of a chair or spill something on me - who cares - every blot will be a badge that I can marvel at, every bruise a vivid memory

Dare to believe that you can still connect with me because when I'm no longer here, I still want you to be able to maintain that connection - not for me, but for you because you will miss me just as I will be missing you.
Ampersands & angle brackets need to be encoded.