The microbiome on my hand

After more than a year, I finally got back the results from the swab I sent to American Gut, a non-profit research group that studies people’s microbiomes—mostly the gut stuff. I’d swabbed my hand and sent the sample because I’d had an open wound on my finger that kept getting bigger instead of smaller—a situation that lasted about two months before it finally healed. Flesh eating bacteria, I was sure!

Anyhow, the results were not helpful, mostly because they didn’t identify the bacteria down to the species level. If you remember your biology, animal taxonomy goes in the following order: kingdom, phylum, class, order, family, genus, species. The lab results drilled down only as far as genera (the plural word for genus). I was astonished, though, that I had a list of over 170 different bacteria genera living on my hand—this would amount to thousands of different species. The genus staphylococcus was the tenth most abundant of my genera and was doubtless the cause of my problem. (As I said in an earlier blog staphylococcus epidermis is a common skin bacteria that normally causes no problems, but occasionally goes rogue and causes infection.)

Even though the results weren’t helpful, I did a little research on the skin microbiome and found some factoids based on studies of thousands of samples:

•  Your hand microbiome is in a state of constant flux and is affected by your age, handedness and gender, as well as by the products you use, your co-inhabitants and pets.
•  Women have a more diverse bacterial population than men; also, the bacterial composition of female hands is significantly more like their mobile phones than that of men.
• The bacterial composition on the hands of healthy people is different from those who are immune-compromised; oral antibiotics impact the hand microbiome.
•  As a rule, hand washing doesn’t change the microbial diversity on your hands.
•  Pet ownership increases the overall diversity of bacteria on your hands. Your hand microbiome is more like your own pet’s paws than that of a pet in another household.
• A home becomes colonized with its occupant’s microbiome, such that light switches, for example, harbor the same bacteria as your hands. Thus, objects can be identifiable to their owner—an alternative to human DNA in forensic analyses.

Get used to it. Your hands are loaded with thousands of bacteria and they leave tell-tale traces for forensic experts!

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Patient advocate extraordinaire

Many, if not most, of us have served as advocates when a loved one has become ill. We have searched for answers on the internet, questioned doctors, stayed by the bedside in the hospital, and did our best to make sure he or she is being cared for. I just finished a book recommended by my friend Laura called The Perfect Predator: A Scientist’s Race to Save Her Husband from a Deadly Superbug. Talk about being a patient advocate!

The author, an epidemiologist, and her husband are vacationing in Egypt. He becomes terribly ill and is taken by ambulance to a rather dingy clinic near Luxor where he is diagnosed with pancreatitis. From there, he’s airlifted to Germany and from there to their home-base hospital in San Diego. They find his body is infected with an antibiotic-resistant superbug (Acinetobacter baumannii). In fact, the bacteria have colonized his whole body. None of the 12 antibiotics they give him has any effect. The hospital is keeping him alive with all the equipment you can imagine. Months go by. His organs are shutting down and he’s near death.

His wife and author of the book, Steffanie Strathdee, begins searching the internet for anything that might save her husband and comes across a paper on phages—viruses that attack bacteria. (A single drop of water can harbor a trillion phages. They’re everywhere: in soil oceans, and our bodies.) In Europe and the US, a few labs are doing research on phages in anticipation of the time when more and more bacteria become resistant to antibiotics. The Navy’s lab is one of these. Steffanie begins contacting the labs and enlisting the help of the scientific community in San Diego. The labs are willing to help, but they must first find the specific phage that attacks her husband’s bacteria (sewage treatment plants are good sources).

In a nail-biting sequence of events that involve the labs, the hospital, the FDA, shipments of the patient’s bacteria, experimentation with different phages, couriers, and so forth, phages are shipped. Once the phages arrive in San Diego, the scientists must figure out where to administer them and at what dosage. To make a long story short, after nine months in the hospital, the phages did their job attacking the bacteria and the patient lived. Here are the phages attacking a bacterium.

Following the success of this experiment, the study of phages has been ramped up and the therapy has been used on a few other patients (Steffanie’s husband was the first in the US). Next time it could be you or me.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

A near death experience (not mine)

Every now and then I read about someone’s near death experience. I think they’re interesting. Those who have experienced such a thing seem to have a number of things in common: the sensation of floating over their bodies and viewing the scene around them; spending time in a beautiful, otherworldly realm; meeting spiritual beings and/or long-lost relatives and friends; recalling scenes from their lives; feeling a sense of connectedness to all creation as well as a sense of overwhelming, transcendent love; and finally being called, reluctantly, away from the magical realm and back into their own bodies. Most people are profoundly changed afterward and may have trouble fitting back into everyday life. 

I watched a TED talk given by Anita Moorjani, whose near death experience struck me as particularly interesting, mostly because of her recovery from her illness. She’d had lymphoma, which is cancer of the lymph system, and had tumors all over her body. Her organs were shutting down and she was hours away from death. She was in a coma. Her family was gathered around waiting for the end. On the verge of death, she had otherworldly experiences similar to those described above. She returned to life. Within five days, her tumors had shrunk 70%; after five weeks she went home, completely cured. She believes her cure was because of what she learned in the clutches of her near death experience:

• Love yourself; value yourself; don’t allow others to control you and don’t control others.
• Live life fearlessly.
• Incorporate plenty of humor in your life (see last week’s post!)
• Be aware that life is a gift and not a chore.
• Be yourself and embrace your uniqueness.

That advice isn’t particularly novel or earth shaking, but perhaps if you don’t value yourself, are afraid all the time, and so forth, such revelations can truly turn things around for you.

Scientists have tried investigating near death experiences—looking into the idea that a conscious mind can exist apart from a living body. While they’ve come up with a number of theories, such experiences remain a mystery as well as controversial, although many scientists, including Erwin Schrödinger, one of the fathers of quantum physics, believed such a thing. In the words of one scientist, “It’s a catalyst for growth on many different levels—psychologically, emotionally, maybe even physiologically.” Too bad that you have to be near death to reap such benefits. Maybe something to look forward to?

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Laughter as medicine

Remember Norman Cousins? He was a journalist, professor at UCLA, and author of many books, including Anatomy of an Illness as Perceived by the Patient: Reflections on Healing. This was a long time ago, but I just remembered it. In 1964 he was diagnosed with ankylosing spondylitis, a degenerative disease causing the breakdown of collagen. He was in constant pain and given the prognosis of only a few months to live.

As a professor, he had conducted research on the biochemistry of human emotions, which he believed were the keys to success in resisting and fighting illness. He decided to fight his disease with laughter (along with lots of vitamin C). For his laughter program, he’d watch the TV show Candid Camera and comic movies. "I made the joyous discovery that ten minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep," he reported.  He lived for 25 more years.

Laughter has since become a legitimate field of study (called gelotology). A related field, psychoneuroimmunology, examines the complex interactions between the nervous and immune system.  It is now well documented that human emotions interact with the mind and body in complex and powerful ways that impact our health. As far as laughter goes, it profoundly affects a number of physiological processes:

• Alters heart rate, blood pressure, sweating, and sleep patterns. including increasing blood flow.
• Decreases levels of stress hormones.
• Activates the brain's natural dopamine reward pathway in the brain.
• Increases the production of antibodies, which are important constituents of the immune system.
• Increases endorphins, the body’s natural painkillers. 

If only our orange clown would make us laugh instead of cry.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Withdrawing from painkillers

Travis Rider, a bioethicist at Johns Hopkins, was in a motorcycle accident that mangled his foot. To save it and make it semi-workable, he had six surgeries over a period of months. One of the surgeries consisted of removing flesh from his thigh to plug up a hole in his foot. As you can imagine, he was on lots of pain medicines—every type imaginable, but mostly opioids. 

After several weeks of being home, he wanted to get off the opioids and began calling various doctors about getting off them. They didn’t have a clue and didn’t want to be bothered by him. He called the pain management people at various hospitals with the same result. One doctor, off the top of his head, suggested that Travis cut his dose by quarter every week. Travis did this, and became horribly sick (nausea, sweating, chills, shaking, sleeplessness, depression) to the point of considering suicide. He says, “A whole slew of doctors gave me a medication that they weren’t willing to manage.” He stuck with the withdrawal for four weeks, after which he began to feel better, but “every moment in those four weeks was the worst moment of my life.”

Then he began doing research. Among other things, he learned that at most you shouldn’t taper off the meds faster than 10% a week and perhaps far less. He also learned that doctors receive little or no training in treatment of pain. Many doctors even lack the basic knowledge of when to prescribe opioids and have no idea how long it takes for a person to become dependent. (You can become dependent in as little as two weeks.) Many were taught to give opioids to anyone in pain. To make matters worse, doctors are motivated to keep patients pain free: they and their hospitals get higher ratings and they’re also financially rewarded by drug companies for prescribing pain meds. In his research, Travis also learned that opioids can increase sensitivity to pain, a condition called hyperalgesia.

He also says if he’d just been warned about the tortures of withdrawal he would have been prepared and been less despondent. Because his final surgery occurred after he’d gone through withdrawal, he was reluctant to take opioids for the pain, saying “I was more scared of withdrawal than I was of the pain.”

I think we've all experienced the ease with which doctors prescribe opioids. We had a bunch of unused opioids in our medicine cabinet until a neighborhood boy stole them. That's one solution, I guess.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.