Archive for the ‘Lung Cancer’ Category

Stop Smoking by 30 to Erase Increased Risk of Death

Friday, August 22nd, 2014

I may not be 30, but I’m 30-something and after 20 years of smoking I finally quit more than six months ago. The road was long and hard, but according to a recent medical study of more than one million women, it was the perfect time to quit. Smoking increases a woman’s risk of death dramatically – cutting up to 10 years off her life in the end – but quitting early could help you add those 10 years back in no time.

The Lungs and Heart of the Matter

The Lancet published the most recent study into the long-term effects of quitting smoking by age 30. According to the study of more than one million women, smoking can reduce lifespan by 10 years if continued into the 50s, 60s, 70s and beyond. Many female smokers die of lung disease, stroke or heart disease related to smoking, but that doesn’t have to be your fate or mine. Researchers found that women who quit smoking by 30 were able to reduce increased risk of death by 97%. Even waiting as many as 10 more years and quitting before 40 reduced increased risk of death by 90% – so now is the time to quit, but how?

The CDC and Smoking Cessation Resources

The Centers for Disease Control and Prevention (CDC) has been a strong partner in smoking cessation campaigns for years. There is a long list of links to websites where smokers can learn more about smoking cessation programs like Smokefree Woman, but traditional smoking cessation programs are not for everyone; they weren’t for me either, so where can women turn who just don’t know how to quit?

E-Cigarettes: A Viable Option?

I chose to quit using electronic cigarettes. My first purchase was a cheap disposable product from a convenience store. That was the last day I smoked a cigarette. The e-cigarette allowed me to get the nicotine my body craved and go through the motions of smoking. The habit of smoking was more difficult for me to break than the addiction to nicotine. Over time, I reduced the amount of nicotine I consumed and the number of times I “smoked” my e-cigarette each day. I’m still working on quitting 100%, but I’m close than I’ve ever been and I left traditional cigarettes behind in my 30s, so I’m already gaining back years of my life.

Proactive Cancer Protection Tips to Help Stay Cancer Free

Friday, August 22nd, 2014

To stack the odds against getting cancer in your favor, there are several things that can be done. Quit smoking, wear sunscreen and stay active are three well known, proactive measures to avoiding certain types of cancers. Here are some lesser known proactive cancer protection measures that are effective in the battle to stay cancer free.

Protect Against Colon Cancer With Eggs

If you don’t like fatty seafood like salmon or sardines, and the after taste of fish oil capsules disgusts you, get the omega-3 cancer protection your body needs from eggs.

Research has shown that omega-3’s inhibit the inflammatory compounds that contribute to growth of cancerous polyps in the colon. Eggs are rich in omega-3’s and two eggs will provide as much colon cancer protection as a salmon fillet.

Red Sauce Protects Against Lung Cancer

The colorful pigment that makes tomatoes red, lycopene, significantly reduces the risk of lung cancer. The most proactive cancer protection comes from cooked tomatoes, like those found in red sauces; spaghetti sauce, salsa and canned tomato products. The body absorbs the lycopene easier when the tomato product is cooked.

Garlic Reduces Risk Of Bladder Cancer

Studies have shown that the more garlic you eat, the more resistant your bladder is against cancer. Many processed foods, like lunch meats, hot dogs and bacon, contain nitrates, those nitrates are converted by our body into cancer causing nitrites, which can lodge in the bladder. Garlic helps prevent the nitrates in processed food from converting into nitrites. Eating one clove of garlic per day, raw or cooked, is a proactive step towards preventing bladder cancer. Keeping the bladder flushed out with six glass of water or other water based beverage (tea, coffee, diluted fruit juices) is also a proactive cancer protection step.

Wear Colorful Clothing

Colorful clothing provides more proactive protection against skin cancer than white clothing. Brightly colored clothing reflects away more of the sun’s cancer causing UV rays than pale pastels or white clothing. Dry clothing offers twice the proactive protection from UV rays than wet clothing, so bring an extra T-shirt to change into at the beach or lake.

Aspirin Protects Against Ovarian Cancer

Aspirin lowers the levels of estrogen in the bloodstream. Estrogen fuels cancer cells in the ovaries, taking an aspirin a day or reaching for aspirin instead of acetaminophen or NSAID pain relievers lowers the estrogen level and protects against ovarian cancer.

Two Supplements Protect Against Breast Cancer

The combination of a multi-vitamin and a calcium supplement is powerful in the proactive fight against breast cancer. The two supplements, taken together, help speed up the repair of damaged DNA in the breast before breast cells can turn cancerous.

How to Naturally Repair Lung Damage Caused by Smoking

Thursday, August 21st, 2014

You finally quit smoking. Congratulations! For some people, this is one of their most challenging achievements of their life. Once smoking is stopped, the lungs will slowly begin the process of repair, but it can take years to undo the harmful effects of cigarette smoking. Keep in mind that it took time to get cigarette lung damage in the first place and the changes can’t be reversed overnight.

The reality is that even after you quit smoking, your risk of lung cancer will never be as low as someone who never smoked; although ten years down the road, your risk of lung cancer will be substantially reduced. Because your lung cancer risk will always be higher than that of a non-smoker, it’s important to do everything you can from a dietary standpoint to reduce the lung damage caused by smoking. Fortunately, human and animal studies show that diet can make a difference when it comes to repairing cigarette lung damage. What are some dietary changes you can make to improve the health of your lungs?

To Repair Cigarette Lung Damage Eat More Tomato Sauce

Tomato sauce and other processed tomato products are a good source of lycopenes. Lycopenes are nutrients in the carotenoid family that hold some promise for lung cancer prevention. One study showed that mice given tomato lycopenes had a lower risk of developing lung tumors. Lycopenes are abundant in tomatoes that have been cooked with much lower levels found in raw tomatoes. Tomato juice, tomato sauce, and ketchup are good sources. Try to fit more of these lycopene-rich foods into your diet.

To Repair Cigarette Lung Damage Drink Green Tea

Green tea is a good source of polyphenols – natural chemicals that have antioxidant properties. A recent study showed that mice exposed to cigarette smoke and subsequently given green tea extract developed less lung damage than those exposed to cigarettes without the benefit of green tea. Although studies haven’t been conducted on green tea and lung damage in humans, it would make sense that it could have benefits in humans as well. To get these benefits, you would probably need to drink five cups or more a day or take a green tea extract.

To Repair Cigarette Lung Damage Eat More Vegetables

A Chinese study showed that smokers and non-smokers who ate the highest quantities of vegetables lowered their risk of lung cancer by sixty percent compared to those who ate the least. Fruits also reduced the risk, but not as dramatically as vegetables did. To repair lung damage caused by smoking, find more ways to add vegetables to your diet – particularly cruciferous vegetables such as broccoli and cabbage.

Eating more of these healthy foods and limiting processed, packaged foods may be a simple way to reduce the harmful effects of cigarette lung damage. You’ve taken the most important step by kicking the habit. The diet part should be a cinch!

References:

http://www.ncbi.nlm.nih.gov/pubmed/11237207
http://www.foodnavigator.com/Financial-Industry/Green-tea-extracts-may-slow-smokers-lung-damage
Annals of Oncology. 2007; 18: 388-392.

Atelectasis of the Lung: Who’s at Risk?

Sunday, August 10th, 2014

What Is Atelectasis?

Atelectasis of the lung is a medical condition in which a part or all of a lung contracts and is airless; it can be acute or chronic. Acute atelectasis involves the recent collapse of a lung; the only immediate symptom is often airlessness. If you have a stethoscope you can actually listen to see if you hear breath sounds. Diminished or a total lack of breath sounds is cause for great concern. Keep in mind that you might not hear breath sounds if you haven’t been trained in listening to them and are unfamiliar with the different spots on the chest, back and sides on which to place the stethoscope. In any case, unless you are a medical doctor, you should never determine whether you or someone else has atelectasis based on listening to lung sounds at home.

Chronic atelectasis of the lung involves not only airlessness, but can also involve widening, scarring, and infection of the bronchi, known as bronchiectasis. “Bronchi” is the plural form of the word “bronchus.” There are two bronchi or main branches of the trachea (windpipe) that lead directly down into the lungs; they branch off forming what looks like an upside down letter “Y.”

What Causes Atelectasis of the Lung?

This lung disorder is usually brought on by an obstruction of some type of one of the bronchi. A tumor, an inhaled object or mucus can cause the blockage. Things and conditions outside of the lungs can also cause a blockage–enlarged lymph nodes and pneumothorax (air in the pleural space surrounding the lungs) are examples; these, however, are not the only causes. Acute atelectasis can develop after surgery, particularly after abdominal or chest surgery and can occur as a result of an injury sustained in an auto accident, a stabbing or shooting.

Prevention, Signs and Symptoms, Diagnosis, Treatment, and Risk Factors

High doses of certain drugs such as sedatives and opioids, tight and restricting bandages, distention (abdominal swelling), and immobility following surgery can contribute to the development of acute atelectasis. Neurologic health problems and deformities of the chest can also lead to shallow breathing, which in turn leads to the development of other problems that bring on atelectasis of the lung.

The severity of symptoms depends on many factors such as the degree and length of time of the blockage, what brought on the obstruction in the first place, the presence of any infection, and the amount of lung affected. Shortness of breath is almost always present; there might also be an increase in the heart rate and the person might begin to turn bluish (become cyanotic). If these signs and symptoms are present, medical help should be summoned without delay.

Doctors will usually order a chest x-ray which might or might not appear normal. However, if he or she suspects atelectasis of the lung, a computed tomography (CT) and/or a bronchoscopy test might be ordered. Treatment is based on the cause of the obstruction. For example, a tumor might be treated with surgery, laser, chemo, or radiation therapies, and suctioning might be performed to remove a foreign object causing the blockage. Antibiotics to help fight infection are almost always prescribed.

Prevention of atelectasis of the lung is closely connected to risk factors. When risk factors that can be removed are removed, prevention “moves” in automatically. Accidents will happen; sometimes they are serious and cause extensive damage to the chest increasing the risk of the development of atelectasis. However, the unintelligent and health-destroying habit of smoking endangers not only the health of the smoker, but also the health of everyone around him or her who cannot enjoy the right to breath clean air being exposed to second and even third-hand smoke; yes, there is third-hand smoke. Smoking and exposure to smoke significantly increase the risk of developing the miserable condition of atelectasis.

Sources:

The Merck Manual of Medical Information (second home edition) by Merck Research Laboraties
My EMT training/experience (state licensed and NREMT certification)

Chronic Obstructive Lung Disease: My Story

Sunday, August 10th, 2014

I was doing just fine in life, just as I had before. Working as a secretary in New York City and earning a good salary made life more bearable and social amenities accessible. Sometimes walking up and down six stair cases with no chest or breathing problems. On the subway going to work one day, I saw large, white spots and my ears were ringing. I felt light-headed but I slowly made it to the office.

Diagnosis
I lay down on the carpet in my boss’s office, hoping it would go away. Since It did not, they were forced to drive me to hospital. In the ER I was given some kind of smoking pipe to breathe through. That meant I had a breathing problem. I could easily relate this to my smoking. After regaining consciousnesses, the news was broken down to me: I had COPD. A few weeks later, it happened again, and I had the same response. All this time, I had no idea what COPD was, even though they said it meant Chronic Obstructive Pulmonary Disease. I actually puffed a cigarette on my way home from hospital. I still had no clue! What a dummy.

Treatment
At one time, I was admitted me to the hospital, where I spent a week on oxygen. I had to be given nicotine patches because of my addiction to cigarettes which was taking toil on me. That is when it was explained to me. It took 4 months’ of nicotine patches to quit smoking altogether. And a year later I was put on oxygen 24/7. I was very weak because I still couldn’t breathe. I had to be sent to pulmonary rehab to get some of my strength back. I heard about lung volume reduction surgery and switched hospitals to try and access the surgery which am happy am happy to say was successful.

I still attend pulmonary rehab twice a week on a maintenance program. This seems to be my biggest struggle. I was given another chance at life and thank God all the time for that. I also can not fail to hail all the relentless efforts of the medical practitioners who employed their skills to see me through this journey.

Conclusion

Today the smell of tobacco nauseates me. I really hope and pray that my experience, full of pain, tears and despair can be used to empathize with COPD patients to make them realize it is not a death sentence and also alluded to when cautioning masses of the effects of over indulgence in cigarette smoking.

American Lung Association Grades the Government

Sunday, August 10th, 2014

On January 10 2008, The American Medical Association released a tobacco product report by the American Lung Association . This report, “State of Tobacco Control” applied a grading system for the year 2007 at both a federal and state level. The report, with new topics entering the close Presidential race, is finally coming to light. The ALA hopes the results will spark debate and leadership in the current Presidential Candidates. Though their has been a slight progress in change since the original report 6 years ago, the Lung Association urges consumers and governments agencies to do more. With an annual death rate of more than 450,000 Americans, from tobacco related cancers, the agency sees an immediate need for accelerated adherence to the necessary roles of the U.S. government to protect its citizens.

The American Lung Associations report on tobacco grades at both a federal and state level. The Federal Level is graded in four areas; cigarette taxes, regulation of tobacco products by the U.S. Food and Drug Administration (FDA), cessation and the Framework Convention on Tobacco Control, and on (FCTC)-the international tobacco control. The states are graded on the four areas of taxation, control and prevention, smoke free air, and youth prevention/control. The Association has specific criteria the federal government and each state must meet to pass or fail their testing areas. Among the tested states, only 10 were considered to have fully passed. In the area of cessation, which the ALA considered a top and proven priority, only six states passed. The American Lung Association is urging consumers to work with their government agencies to bring about change. They also encourage the state and federal governments to strive for A’s across the board in the coming years.

The American Lung Association awarded point values for specific tobacco related tasks in the federal and state governments. As well, points are awarded based on the governments’ attempts to comply with recommendations, specifications, and researched reports. Bonus points are awarded in many areas and most evaluations are balanced on a sliding scale.

THE FEDERAL GOVERNMENTS TABACCO REPORT CARD

Cigarette Tax (Grade: F)
A states average excise tax on cigarettes was taken into account for this portion of the grading system.
The Excise Tax grades break down as follows:
A = $2.21 and over
B = $1.66 to $2.209
C = $1.11 to $1.659
D = $0.555 to $1.109
F = Under $0.555

Food and Drug Regulation of Tobacco (Grade: F)
The ALA used the criteria set forth in their developed guidelines, “Essential Elements of FDA Regulation” and can be further explored with the document “Critical Elements of Any legislation to Grant FDA Authority to Regulate Tobacco Products” (refer to link at article end). This report has long been provided to the U.S. government.
A = Meets target
F = does not meet target

Framework Convention on Tobacco Control (Grade: D)
The Framework Convention on Tobacco Control (FCTC) is a set of standards for the United States and other countries to address and control addition to tobacco products and to control initial use.
A = Ratification by the S. Senate.
B = FCTC approved by the Senate Foreign Relations Committee.
C = President sends FCTC to Senate for ratification.
D = President signs FCTC.
F = No action on FCTC.

Cessation (Grade: F)
The American Lung Association used the criteria set forth by the Secretary of Health in 2002. The Secretary demanded bold and scientific based initiatives. Initiatives the federal government could adopt to lower the use of tobacco products nationally. Some of the initiatives set out in the final report by the Secretaries sub-committee later formed the American Lung Association State of Tobacco Control 2007
A = 18 to 20
B = 16 to 17
C = 14 to 15
D = 12 to 13
F = under 12

STATE GOVERNMENT REPORT CARD

Tobacco Prevention and Control Spending:
A small amount of states received good or middle ground grades in the category of control and prevention. Among the (A) states were Alaska, .Delaware, Wyoming, Colorado, and Arkansas. A great many states failed the prevention and spending criteria, greatly frustrating the American Lung Association. Among the failing (F) states were Tennessee, Utah, Nebraska, Wisconsin, Nevada, and Illinois.
The CDC (Center for Disease Control) in 1999 developed a set of nine categories that would best allow states to control tobacco use among its citizens. The report “”Best Practices for Comprehensive Tobacco Control Programs” and its minimum requirement is what the ALA used as a percentage calculator in grading each state.
A = 90 percent or more of the CDC lower estimate
B = 80 percent to 89 percent
C = 70 percent to 79 percent
D = 60 percent to 69 percent
F = 59 percent or less

State Cigarette Excise Tax:
The only states to receive an (A) in taxation were New Jersey and Rhode Island. Some states fell in between in the grading system. However many states received poor grades in this category. The failing grade of (F) included Florida, Utah, Louisiana, Virginia, and Kentucky.
Grading on the tax, the ALA had to take into account inflation and fluctuating prices on tobacco per state. The American Lung Association strongly believes high taxes can discourage youth smoking. They also believe the taxes can provide cessation encouragement nationally.
A = $2.21 and over
B = $1.66 to $2.209
C = $1.11 to $1.659
D= $0.555 to $1.109
F = under $0.555

Smoke free Air Laws:
Among the (A) grade of states in the smoke free air categories were Arizona, Nevada, Ohio, Delaware, California, and New Mexico. Receiving a failing grade of (F) were states including Pennsylvania, Iowa, Alabama, Texas, and Kentucky.
A study by the National Cancer Institute presented in the article Application of a Rating System to State Clean Indoor Air Laws, outlined nine categories to look in studying Smoke Free Air. The ALA used the number 36 as the common denominator for their study.
A final score of Zero (0) was attributed to any states that required smoking to be permitted or had laws without and restrictions.
A= 33 to 36
B = 29 to 32
C = 26 to 28
D = 22 to 25
F = 21 and below

Youth Access Laws:
The access of youth to tobacco products is a leading concern for associations and governments. The American Lung Association was especially disappointed in this categories grade. Some of the states who scored high with an (A) average were Vermont, Hawaii, Alaska, Idaho, and Connecticut. Among the states returning a failing grade of (F) were Ohio, Colorado, Maryland, Michigan, and North Dakota.
The youth access grading system relies on a paper published by the American Cancer institute called “State Laws on Youth Access to Tobacco in the United States: Measuring Their Extensiveness with a New Rating System,” the paper looked at nine areas including sampling, law enforcements, and photo Id requirements. The ALA used a point system that took into account the 9-category list in the Cancer Institute paper and awarded points. For example, 4 points were available for states that had an entire ban on vending machines that allowed the sale of tobacco products.
A = 26 to 24
B = 21 to 23
C = 19 and 20
D = 16 to 18
F = 15 and below

The American Lung Association admits that specific laws or programs may have been established since their original 2007 study changing the degree of their grading system. As well, the study does not take all areas of state and federal programs, compliance, and statistics into account. Therefore, a state that scored very high may very well be weak in a number of other important areas pertaining to tobacco. A state scoring very low may have data, which could make it more to the center within the grading scale. Most middle grades in the report would most likely not sway dramatically either way.

To see your states grade, link to The American Medical Association’s website.

The American Lung Association refers those interested in making a difference to educated themselves on the facts. They also urge those interested in change to write letters to their public officials and representatives in Washington.

For further reading, or to read the reports and documents referred to in this news article, choose a link below.

CDC “Best Practices For Comprehensive Tobacco Control”

“Critical Elements of Any legislation to Grant FDA Authority to Regulate Tobacco Products”

“Application of a Rating System to State Clean Indoor Air Laws”

The Framework Convention on Tobacco Control

Double Lung Transplant – General Information

Sunday, August 10th, 2014

A double lung transplant is a surgical procedure where both lungs are replaced with lungs from a donor. This method is normally used when an individual has such severe lung damage that only a replacement of both lungs can allow for survival. In many cases, transplant both lungs allows for a better survival rate than simply replacing one, which has caused some doctors to consider using this method even when transplantation of only one lung would be sufficient. This is a very involved operation that can potentially take up to 12 hours, but normally takes approximately eight.

The actual procedure for a double lung transplant is different from the method used in single lung transplants. For one thing, doctors have to hook the patient up to a machine that can pump the blood and keep it oxygenated during the operation. The lungs are normally replaced one at a time, and the actual process is straightforward but not necessarily simple. Doctors open up a person’s chest, take out one lung, disconnecting all the blood vessels that run to it, and install the new lung. After this, the process is repeated. A single lung transplant will often take about half the time and patients will usually recover more quickly.

Doctors have found that donor compatibility is very important for any kind of lung transplant operation. Most deaths after these operations happen because of eventual organ rejection. People are often able to delay this by taking immune suppressant drugs, but it is somewhat rare for individuals to live over 10 years after having the operation. Doctors have also discovered that a double lung operation has a longer survival rate than single lung operations. The reasons for this aren’t absolutely clear, but doctors think it has something to do with compatibility between the two lungs, and unrecognized problems in the remaining lung when single lung operations are performed.

Originally, double lung transplants where only used for cases where both lungs were severely diseased. Single lung transplants were generally preferred, especially in the case of elderly patients because of the belief that they were less damaging to patients, and easier for people to adjust to. Discoveries about possible long-term benefits of these transplants has the potential to change the conventional wisdom in this area, although some people feel that there aren’t enough organ donors to handle the load if two lung transplants become the norm.

Ex Penn State Football Coach Joe Paterno Dies of Lung Cancer

Sunday, August 10th, 2014

Joe Paterno had a rough and scandalous year. Unfortunately, old age, lung cancer, and a broken pelvis took its toll, and according to BusinessWeek, Paterno died yesterday at 9:25am surrounded by family at the Mount Nittany Medical Center in State College, PA. Before cancer ate away at his body, Joe Paterno helped to build Penn State into one of the finest football programs in the country. ESPN reported that he spent 61 years with the team, and 46 seasons as the head football coach. His career came to an end when he was terminated due to a cover up involving his assistant coach, and Paterno found out about his cancer diagnosis just days afterwards.

Joe Paterno made headlines last November for his possible knowledge of his former defensive coordinator Jerry Sandusky allegedly abusing a young boy in the Penn State showers in 2002. ESPN reports that when confronted about the instance, Paterno replied “I didn’t know exactly how to handle it and I was afraid to do something that might jeopardize what the university procedure was. So I backed away and turned it over to some other people, people I thought would have a little more expertise than I did. It didn’t work out that way.” Vicky Triponey told USA today that when investigations began, Paterno told his players not to cooperate with the school’s office of student conduct. Controversy surrounds his actions, or lack thereof. Did Paterno turn a blind eye? Paterno had a responsibility as a member of Penn State’s staff to report these occurrences.

Despite the controversy surrounding his name, people flocked to mourn his death. CBS reports that students, alumni, and the community were met with grief and disappointment at the death of Joe Paterno. Ed Hill of Altoona, a 35 year season ticket holder, told CNN “His legacy is without question as far as I’m concerned, the Board of Trustees threw him to the wolves. I think Joe was a scapegoat nationally. … I’m heartbroken.” Sunday evening thousands of people, mostly students, stood outside Penn State’s administration building participating in a candlelight vigil. Many kind words have been passed on to his family, and it is obvious his memory will not be forgotten.

Erik Matuszewski, “Joe Paterno, Penn State’s Fallen Coaching Legend, Dies at 85”, Business Week
Gene Wojciechowski, “Ignorance No Excuse For Joe Paterno”, ESPN “Paterno’s Death Met With Grief in State College”, CBS News

Recurrent Ear and Lung Infections in Children

Sunday, August 10th, 2014

Never let your physician fool you into thinking that he or she has all of the answers. Medicine is a complex field and no one has all of the answers. In fact, no one has even a small portion of the answers. Just this past week I learned about a whole spectrum of disorders when a family member called to tell me that a new physician had finally been able to offer some insight into her daughter’s recurrent lung infections. Medicine is complicated and even four years of school is not enough to cover a fraction of the diseases that are known, let alone the multitude that are poorly understood. If you suspect that something is wrong and you are not getting the answers you think you need, don’t be afraid to ask for a second opinion. You are in charge, not your doctor. Of course, we don’t help the situation because when we are sick we are looking for and willing to believe in the all-knowing doctor who makes no mistakes because it is comforting. As comforting as the thought may be, the reality is that even the very best physicians can’t possibly know everything and they should admit that to you and to themselves. If you are looking for a good physician, look for the one who admits that he or she does not know everything, the one who is willing to learn, the one who can look past his or her ego to the bigger picture that is your health. Now, let us discuss selective antipolysaccharide antibody deficiencies or SPADs.

BACTERIA OVERVIEW

Before we discuss, SPADs, we should take a brief look at bacteria and their anatomy in order to better understand how our body fights infection. Bacteria are living organisms that differ from us in several ways. Bacteria live as ingle cells without nuclear membranes. That is to say, one cell is the whole creature (unlike our roughly one trillion cells) and the DNA is not contained in a special compartment but is free to float about inside the cell. Now, there are other criteria that make bacteria their own grouping, but those criteria are not important for us. What is important for us to know is that within the large, general group referred to as bacteria, there are many, many different species. Just like thje primate group is a large group but there are all different kinds of primates such as gorillas, baboons, chimps, and humans, the “bacteria group” contains a multitude of different bacteria.

Bacteria can be categorized in a variety of different ways. For our purposes we will only be focusing on human pathogenic bacteria. That is to say, we will only be looking at those bacteria that cause disease in humans. Within this group, there is still incredible diversity and the members can be further divided into groups based on their structure, genetic make-up, method of producing energy and so on. For our purposes we are going to focus on structure. All bacteria have a plasma membrane. The plasma membrane is like a balloon in that it is flexible, but contains everything within the cell necessary for living and reproduction. Because it is flexible, the plasma membrane can rupture and easily be invaded by other cells, such as the cells of the human immune system. Outside of the plasma membrane, some bacteria have a “cell wall” or capsule. The cell wall is a tough structure made of special proteins and sugars that offers protection from invasion and from other environmental hazards such as drying out when there is too little water. Some bacteria actually go on to add another plasma membrane outside of the cell wall. These are referred to as gram negative bacteria because they do not take up Gram’s stain when viewed under a microscope.

The bacteria that have a cell wall on the outside and do not add the extra plasma membrane are referred to as gram positive bacteria. It is this group that we will focus on, even though both groups have a cell wall or capsule.

Within the gram positive group are bacteria such as Streptococcus (Strep throat, skin infections, pneumonia), Staphylococcus (skin infections, pneumonia), Meningococcus (meningitis), and many others. Their outer cell wall is exposed to their surroundings and is referred to as a capsule. The capsule of a bacterium is made of sugars called polysaccharides (in most, but not all cases). The purpose of the capsule is to protect the bacterium, particularly from cells in the human immune system called macrophages. Macrophages roam around the body ingesting and killing anything that they recognize as foreign. The polysaccharide capsule of certain bacteria prevents them from being recognized by the macrophage as foreign. Over the years, the body evolved a second line of defense to deal with the problem of polysaccharide capsules. B-cells, another type of cell in the immune system are responsible for making antibodies that help to rid the body of invading pathogens. The B-cells are able to recognize small bits and pieces of the polysaccharide capsule as foreign and then produce antibodies against these pieces. The antibodies circulate in the blood and throughout the body, binding to the polysaccharide capsules of these bacteria. Once the antibodies are bound, the macrophage is able to recognize the bacteria and eliminate it from the body.

The immune system function and Immunodeficiency

Like any system in the body, the immune system can become disordered to acquired or inherited disease. In some instances, such as HIV, an acquired disease damages the immune system and leaves the body vulnerable to infection. In fact, HIV alone does not kill but rather damages the immune system to such a degree that the person is unable to fight off infection and dies do to another disease referred to as a opportunistic pathogen (i.e. it takes the opportunity of a weakened immune system to create damage that is could not if the immune system were properly functioning.

Genetic or inherited disorders of the immune system mean that a person was born with a disordered immune system. Granted, some of these syndromes do not manifest until adulthood, but the genetic programming was there from birth. Inherited immune syndromes cover a spectrum from severe and life-threatening to so mild that the affected individual may never know he or she has an immunodeficiency syndrome. Genetic diseases of the immune system include such things as severe combined immunodeficiency syndrome (SCIDs), chronic granumlomatous disease, IgA deficiency, common variable immune deficiency syndrome (CVIDs), and many others. We are going to discuss a specific and less well known syndrome referred to as selective antipolysaccharide antibody deficiency (SPAD).

SPAD is a disorder of B-cells, those cells we discussed above that are responsible for producing antibodies against invading pathogens. B-cells come in many varieties and have many different jobs. Because there are so many different types of B-cells, it is possible for most of them to be perfectly healthy while only a few are dysfunctional. This is exactly what happens in SPAD. Let us take a closer look.

The first thing we need to discuss is B-cells and the antibodies that they produce. It turns out that antibodies come in different shapes and sizes and can be broken down into five distinct classes. The classes are as follows: IgA, IgD, IgM, IgG, and IgE. The “Ig” stands for immunoglobulin, which is another name for antibody. Each of these classes has a different function in the body. For instance, IgA antibodies are secreted into the intestine and lungs where they help to prevent invading pathogens from ever entering the body. IgG can cross the placenta and help to protect unborn babies while in the mother’s womb before they start to make their own antibodies.

Each of these classes can be further divided into subclasses. For IgG, there are four subclasses referred to as IgG1, IgG2, IgG3, and IgG4. The IgG class, and IgG2 in particular, is important because it confers long-term resistance against polysaccharide bacteria. IgG can be thought of as the long-term antibody. That is to say, IgG stays in the blood from years after an infection is cleared as keeps up a constant surveillance in case the same pathogen should return. If the same pathogen does invade again, the IgG is already present and the body is able to rapidly mount an immune response to prevent the infection from taking hold and abort the illness before it ever begins.

In general, IgM is the first antibody produced when a new infection is encountered. B-cells begin by producing IgM, which allows macrophages to recognize the invading pathogen and clear it from the body. At some point in the immune response, the B-cells that are making IgM against a given bacteria switch to making other classes, such as IgA and IgG. The first time the body encounters a specific bacteria, it can take days for the immune system to fully respond, which means the individual will feel sick for a week or more. The second time that the same bacteria invades the body, the person may not even notice the illness as the immune response reaches full scale in a matter of hours before the infection can take hold.

IgG is responsible for long-term immunity and is the antibody that is missing in individuals with SPAD. Thus, when a person with SPAD encounters and polysaccharide bacteria, such as Strep, they will mount and IgM response to clear the infection, but this will take several days. What makes these individuals susceptible again is that they do not go on to produce IgG against polysaccharides from the bacteria capsule. Without IgG, each time the individual encounters the infection it is as if he or she is seeing it for the first time with the result being a slow immune response and prolonged illness. This is significant because the highest risk of complication from an infection occurs in the initial slow-response, whereas there is almost no risk from pathogens to which IgG has been formed. The slow response of the initial immune response opens the individual up to the complications of infection such as dehydration, delirium, and death. In fact, some bacteria are so virulent (causing disease) that they kill a significant portion of those that they infect before the body has a chance to develop IgG. Infection such as H. influenzae and Meningococcus fall into this group. Modern medicine deals with such pathogens through routine vaccination.

The formation of IgG is the principle on which vaccination is based. By giving a person a weakened or killed form of a pathogen, the body is able to produce an immune response as if the pathogen were alive, but without the associated complications of infection. The formation of IgG ensures that long-term protection is acquired without ever having to be sick. Vaccination of this type is responsible for the eradication of small pox and for the dramatic decrease in cases of H. influenzae (a deadly infection that can lead to swelling of the epiglottis, which covers the breathing tube (trachea), and eventually suffocation).

Oddly, it turns out that most people with and inability to form IgG in the face of an infection are able to do so when provided a vaccine for the same pathogen. This forms the basis for treatment of this particular immune deficiency.

SELECTIVE ANTIPOLYSACCHARIDE ANTIBODY DEFICIENCY (SPAD)

SPAD is a very specific form of IgG deficiency. As we have discussed, some bacteria are able to avoid detection by macrophages through the use of a polysaccharide capsular coat. The body responds to this threat by producing antibodies that help the macrophages do their job. In SPAD, the IgG form of the antibody is never produced, meaning people are susceptible to reinfection by the same pathogen with all of the inherent risks of a first-time infection.

Bacteria that have a polysaccharide capsule are as follows:

1. Streptococcus pneumoniae: causes pneumonia, ear infections (otitis media), and meningitis

2. Hemophilus influenza: causes pneumonia, ear infections, and meningitis

3. Nisseria meninigitidus: causes meningitis

As it turns out, S. pneumonia (a.k.a. pneumococcus) is usually the culprit in patients with SPAD. Thus, it may be more accurate to refer to the disorder as anti-pneumococcal antibody deficiency and save SPAD for those people who truly don’t form antibodies to any of the polysaccharide capsules. Despite slightly different connotations, these two terms are used interchangeably and thus we will use SPAD simply to keep typing to a minimum.

Pneumococcus is most commonly responsible for ear infections and pneumonia in those ranging from infants to the elderly. In addition, pneumococcus is also responsible for meningitis in the very young and the very old.

In patients with recurrent ear infections and recurrent pneumonia (more than once in a year for those without any comorbid disease such as COPD or cystic fibrosis), SPAD should be suspected at tested for. The testing is relatively simple. The levels of all five immunoglobulins (A,D,E,M, and G) are measured as well as the specific level of IgG against pneumococcus. If the overall levels of antibodies are normal, but the anti-pneumococcal IgG is low, a diagnosis of SPAD is made.

SPAD most commonly presents as recurrent otitis media (ear infection) or recurrent pneumonia in young children. It is often missed for a variety of reasons, including inconsistent laboratory testing, differing physicians with each hospital admission, and failure of many physicians to recognize this particular disease. Any child that experiences pneumonia more than once in a given year or suffers from frequent ear infections should be tested for SPAD.

TREATMENT

There is no clear treatment for SPAD as the disorder has only recently been well-recognized. The approach to treatment generally flows as follows.

First, a vaccination against pneumococcus will be given. Today, all children are vaccinated using the Prevnar vaccination against pneumococcus. This vaccination is designed to protect against the seven most common antigens (things the antibodies react with) found on different strains of pneumococcus. As an aside, pneumococcus is not just one strain of bacteria, but many different strains. You can think of it like race. Whether, White, Asian, African, etc., we are all human but there are subtle differences. The same is true for pneumococcus. There are subtle differences between the many strains that allow them to evade the immune system. Thus, Prevnar vaccinates against the seven most common strains.

Another vaccination against pneumococcus is referred to as Pneumovax and protects against 23 different antigens. This vaccination is often given to those who are prone to developing pneumonia, such as those with COPD, cystic fibrosis, or HIV. This vaccination is given to those diagnosed with SPAD as well.

Approximately six weeks after Pneumovax is given, blood will be drawn to determine if there is an increase in the levels of IgG2 against pneumococcus. If there is, the vaccination may be all that is required. If levels do not improve, then other steps may be necessary.

One of the other steps involves the administration of Intravenous Immunoglobulin (IVIG). In other words, antibodies will be supplied directly to the blood stream. This is not a common practice in SPAD because it generally is not effective and is rather expensive. To determine if an individual will benefit from IVIG, an immunologist (an immune system specialist) will perform a variety of tests.

The final approach to treatment of SPAD is prevention and rapid response. Prevention takes the form of careful hygiene and being aware of how pneumococcus is spread. Generally, pneumococcus is spread through respiratory droplets when a person coughs and through contact when a person touches a surface or other person and picks up the bacteria. Careful attention to cleanliness should include frequent hand washing, sanitation of surfaces, avoidance of nose-picking, and perhaps simple hospital masks when a person is known to have pneumococcus.

Quick response to infection in these individuals can also help decrease morbidity and improve quality of life. The first signs of infection should be immediately treated with antibiotics with known antipneumococcal activity. Doxycycline and levoquin are suitable choices. It is important to note that some resistance is developing in pneumococcus against penicillin-based antibiotics. As such, it may be worthwhile to culture those individuals with SPAD and recurrent pneumococcus infections in order to document sensitivities of the bacteria to various antibiotics and thus empirically direct treatment. Given the need to for rapid response to infection, it may be beneficial to have antibiotics on hand, the pill-in-the pocket approach, that an individual with SPAD can take at the first sign of infection.

REFERENCES

Balmer P, Cant AJ, Borrow R. Anti-pneumococcal antibody titre measurement – what useful information does it yield? J. Clin. Path.2007;60:345-35. First published online:1 Sept 2006. http://jcp.bmjjournals.com/cgi/content/abstract/jcp.2006.041210v1

Dhooge IJ, van Kempen MJP, Sanders LAM, Rijkers GT. Deficient IgA and IgG2 anti-pneumococcal antibody levels and response to vaccination in otitis prone children. International Journal of Pediatric Otorhinolaryngology. 2002;64(12);133-141. http://www.ijporlonline.com/article/S0165-5876(02)00068-X/abstract

Treatment of Deficient Subclass or Anti-Polysaccharide Antibody Response (Subklasse). On: Clinicaltrial.gov. Updated: 2/28/2008. Accessed: 4/14/2009. http://clinicaltrials.gov/ct2/show/NCT00522821

Lung Failure in Cystic Fibrosis Patients: Prevention, Therapy and Medication

Sunday, August 10th, 2014

Preventing Lung Failure in Cystic Fibrosis Patients

Cysticfibrosis (CF) is a hereditary disease, which there is no cure for. CF is a chronic disease that affects the lungs and digestive system. Cystic fibrosis stems from a faulty gene, and its protein causes the body to produce thick mucus that is sticky and clogs up the lungs, which causes life-threatening lung infections.

This mucus also blocks the pancreas from working properly, and the natural enzymes are not able to break down and absorb food like they do when a healthy person eats.

Respiratory failure is the most common cause of death for cystic fibrosis carriers. However, some cystic fibrosis carriers die due to liver disease, heart failure, internal bleeding or complications from surgery. While the disease itself cannot be cured, there are options to try to prolong life.

The average life span is about 30 years for a person with cystic fibrosis. With new technology, added research and experimental medications, the life span of cystic fibrosis patients is increasing.

Respiratory Therapy

There are special devices that help with breathing and also vests that cause compression. Various body positions will aid in drainage, chest vibrations and deliberate coughing, which are some of the methods of respiratory therapy.

Prescription Medication

There are a variety of prescription medications that help to thin the mucus in the lungs, making it a bit easier to cough up.

Anti-inflammatory drugs are used at times to aid the lungs in their function.

It is not uncommon for cystic fibrosis patients to have chronic lung infections. Antibiotics are routinely given to control the infections.

Lung Transplant

Lung transplantation is typically a last resort for patients with cystic fibrosis.

Typically lung transplant surgery is performed only in patients that have very serious forms of cystic fibrosis. Patients with mild or moderate cystic fibrosis would not be the best candidates, because the risk of the surgery is greater than the benefits.

The decision for a cystic fibrosis patient to have a lung transplant is a decision that the individual person needs to make for themselves. A cystic fibrosis patient can listen to all the advice they choose to from medical field personnel, family and friends. What it comes down to it, any organ transplant situation is one in which the organ receiver needs to believe in their heart and soul that they are making the right decision for themselves

While it is not easy for a person with cystic fibrosis, there are options available to help make the disease more manageable and prolong life as long as possible.