My aunt has recently been diagnosed as having pernicious anemia. What is this problem, and what is the cause?
Pernicious anemia is a condition in which there are inadequate red blood cells. This is because of a deficiency of an essential substance called vitamin B12, or cobalamin. This vitamin compound is very important in the formation of red blood cells. It also plays a vital role in the building of DNA, which is present in all cells. Red blood cells and nerve cells are especially dependent on vitamin B12 in order for them to function normally. As discussed in the November issue of Adventist World, anemia is the condition in which insufficient red blood cells (hemoglobin) exist to carry oxygen to the body for all its needs (energy production, metabolism, and simply staying alive optimally). This places a strain on the heart and many other organs.
In the case of pernicious anemia, associated symptoms and signs of nerve dysfunction are often exhibited. These can include the loss of ability to feel vibration in the limbs and the position of the toes in relation to the feet. This dysfunction usually starts in the legs but then later affects the arms. This is because of spinal cord damage. There may be progression to psychiatric disorders and dementia (loss of ability to think and reason). The tongue is also affected in the advanced stage of the disease and becomes inflamed with a red “beefy” appearance. Ulcers on the tongue may also appear.
Pernicious anemia may be associated with autoimmune diseases such as those that affect the thyroid, adrenal glands, skin, ovaries, or pancreas. Other causes of poor absorption of B12 include stomach and/or bowel surgery, certain cancers, and bacterial infections.
Pernicious anemia is one of a group of anemias called megaloblastic (or large cell) anemias. These anemias may have a variety of causes, including nutritional vitamin B12 deficiency, folic acid deficiency, parasitic infestations, chemotherapy, certain medications, and alcohol.
What is the treatment for this kind of anemia? Pernicious anemia results from the inability of the body to absorb vitamin B12 taken in food or any oral form. It is therefore necessary to give vitamin B12 injections on a regular basis for life. These injections are given into the muscle.
If the anemia is caused by a nutritional lack of B12 in the diet (and there is no absorption problem from the bowel), adding the appropriate foods and/or vitamin B12 supplements by mouth is usually sufficient. The treatment needs to be monitored to ensure an adequate response. This is shown by a return of the red cells to their normal size and function.
Pernicious anemia is a disease condition that needs to be diagnosed and treated in good time. When treated appropriately and in time, not only does the anemia reverse but the damage to the nervous and other systems resolves. If the condition is neglected, permanent damage and even death can occur.
What are the sources of vitamin B12? Vitamin B12 is produced only by microorganisms, and humans receive vitamin B12 only from the diet. It is present only in foods of animal origin (including milk and eggs). Some claim that vitamin B12 can be obtained from vegetables; this is from bacterial contamination and manure in which the plants are grown and is both unhygienic and insufficient. Well-planned ovolactovegetarian diets (plant-based with eggs and dairy products) usually supply adequate amounts of vitamin B12. If one chooses to eat a total vegetarian diet, it is essential to supplement the intake of vitamin B12 in tablet or syrup form. Failure to do so sets one on a sure course for health problems.
The body has stores of vitamin B12 that last up to four years; it may take 5 to 10 years for the deficiency to show in a clinical form. The message is that the diet must be well planned and, if necessary, supplemental B12 should be taken.
I had an ultrasound, and my not-yet-born baby is a boy. My husband and I are discussing circumcision. What do you advise? Circumcision of a boy is not the same operation as female circumcision or as what is often referred to as “female genital mutilation.” This is where unqualified persons (using unsterilized knives, glass, and the like) may actually remove the labia minora and clitoris in a horrendous procedure. Nevertheless, male circumcision is not without its own risks. These include bleeding and infection, and several studies have shown changes in pain tolerance among those circumcised, compared to those uncircumcised. Phimosis, which is a narrowed or tight foreskin, may cause problems in older boys, but is relatively rare and not sufficient reason to circumcise all males.
The American Pediatric Society does not recommend circumcision; but recently, studies in Kenya and Uganda have shown that, as in South Africa, there is about a 60 percent reduction in the transmission of HIV in those circumcised. Clearly, because it is a difficult matter to get people to alter “at-risk” behavior patterns, and in a place such as Africa where risk is so high, it might make sense to recommend circumcision.
As for you and your new baby, you will have to make your own decision as you carefully weigh the pros and cons.
My daughter lives in Brazil, and she tells me it is fashionable to have cesarean section rather than natural childbirth. What do you say? We are men, so we could get into deep trouble on this one. Those “funny” letters behind our names are Canadian and South African qualifications, and the ones behind Handysides (FRCSC and FACOG) mean Fellow of the Royal College of Surgeons of Canada and Fellow of the American College of Obstetricians and Gynecologists. Nevertheless, we hereby give notice that we will not enter into a lengthy correspondence on this issue.
Childbirth is painful. How do we know? Well, my wife [Mrs. Handysides] has the pain tolerance of a horse, but she says it hurts and I believe her. So it’s natural that if a procedure could be done under anesthesia with lesser pain (albeit drawn out over a longer period), some may choose it.
There! Did we ever rile up some of our readers!
But to be more serious, some of the risks associated with cesarean section (C-section) are declining with the improvements in anesthesia and, consequently, older arguments against C-section are often less valid (though many are still true). Most complications are maternal and, consequently, better tolerated andless likely to lead to litigation than is damage to a baby. This means difficult forceps, breech deliveries, or any other threat to the baby whatsoever in labor is taken very seriously, and a C-section is often selected.
Though normal delivery is beautiful and a “fantastic” experience for most (many mothers have told me [Allan] this—I’ve delivered literally thousands of babies), it can have complications. The stretching and tears that on occasion occur may lead to problems.
An example was shown in a recent Oregon study of 8,700 women. Only 40 percent, unfortunately, completed the survey, but 27 percent of those responding reported fecal incontinence in the 3 to 6 months post-delivery. After adjusting for the number of children a woman had given birth to, the study found obesity, duration of pushing, lacerations, and smoking habits were all related to the particular problem. Many women do not talk about such difficulties, so the extent of the problem is probably underestimated. Fecal incontinence is not likely a long-standing problem for the majority, but such factors may influence choices about cesarean section.
When I (Allan) was in Brazil, I discussed with some of the doctors there the high C-section rates in that country, which are at least double those in the United States. They felt the outcomes justified the rates.
What more do we say? We have said enough to get us into deep trouble already from folk on both sides of this debate.
I am concerned about the way HIV becomes resistant to drugs. How long can an individual expect to be treated before resistance develops? We have written about HIV before, but your question throws light on a very important area of concern. HIV is one of those viruses that constantly varies and, consequently, shows multiple genetic expressions of itself. This process, called mutation, allows for changes in sensitivity to the agents used in its control.
Up to now two main groups of agents have been used against the virus. These agents were developed to act at key spots in the process of virus multiplication. HIV does many things in its entrance to the special lymphocytes, called CD4 cells, that it targets. First, it binds to the CD4 cell. Then it enters the cell. Then its RNA (ribonucleic acid) is “written” into the DNA (deoxyribonucleic acid) by an enzyme called “reverse transcriptase.” Once the DNA mirror of the RNA has been written, it has to be “integrated” into the nucleus. The altered nucleus now begins to produce messenger RNA, which goes to a subunit in the cell, which makes a stream of new HIV in a long strand. The strand is cut into individual virus particles by an enzyme called “protease.”
The reason we give you this complex trail is so you can appreciate how tailor-made the medicines are.
The two current groups of anti-HIV medications have been agents that block either the reverse transcription or the protease enzymes. The medications are used at least three at a time. This is so they can, hopefully, combat a given strain of HIV even should it develop resistance to one of the medications. Of course, the medications have to be taken faithfully, at the times and in the combinations ordered. To fail to do this results in the virus escaping from control and developing resistance. Persons who take medicine as directed have been seeing great success in their treatment, and many are living more than 20 years without developing AIDS.
Why don’t they treat a person with HIV with the medications as soon as they are diagnosed? A person may successfully withstand HIV for many years, using their natural immunity. Because HIV is so readily able to develop resistance, holding medication until the person really needs it means that several years go by without the virus having a chance to develop resistance. When the antivirals are started, they are given in combinations, and actually are so effective they sometimes lower the viral load to scarcely detectable levels.
Is there any new hope for people who are on antiviral treatment and starting to have problems with viral resistance? Actually, although two main groups of antiretrovirals exist (the reverse transcriptase inhibitors and the protease inhibitors), two classes of medications make up each group. Resistance is usually not to the whole group, but to individual medications.
Then, too, research is ongoing. An article in The Journal of the American Medical Association (April 11, 2007, vol. 297, No. 14, pp. 1535, 1536) by Joan Stephenson, reports on new HIV drugs currently being tested. These medications differ from the drugs in the other two groups and classes, and actually represent breakthroughs. They are being tested in large studies, and represent two new strategies. The one medication aims at blocking an enzyme called “integrase,” which plugs the viral DNA into the cell’s DNA. By doing this, the DNA made from viral RNA does not get incorporated into the cell nucleus.
The second group of drugs is called “entry inhibitors.” They act like “locks” on the cell “doors” through which the virus enters the lymphocytes. By doing this, the drug acts to reduce the number of infected cells. So far, the results are very encouraging, though—once again—these medications do not stop the process completely, and are not by any means a cure. The more sites at which the virus can be attacked, the less powerful its assault—but so far the battle promises to be a lifelong process.
My doctor has been investigating my chronic anemia and tells me I have celiac disease. She found this through a blood test and says it causes food malabsorption. But I am not underweight; in fact, I am what my husband calls pleasantly plump. The diet the doctor wants me on is gluten-free, and that is not going to be fun. Do you think she could be mistaken?
Celiac disease is a very interesting disorder that is becoming more frequently diagnosed because there are blood tests that detect specific antibodies that mark the disease. Celiac disease is unique in that it is an autoimmune disease (i.e., the body makes antibodies that damage its own tissues) where the reaction is triggered by a substance called gluten.
Well-nourished men and women become wasted shadows of their former selves.
Most Adventists know gluten as the rubbery meat substitute made from gluten flour. Gluten is a protein complex found chiefly in wheat, but it is also present in barley and rye. It is rich in the amino acids glutamine and proline. There is a component of gluten that is soluble in alcohol called gliadin; this is not easily broken down, and small amounts of it may be absorbed. It is possible that the process is aided if there should be an infection of the bowel. It is against these gliadin fractions that the antibodies are made, resulting in inflammation. The antibody is directed against the gliadin, but because the gliadin is bound by cells in the intestinal wall, these cells get damaged by the inflammation process that ensues. People who get celiac disease have a genetic predisposition to the disorder.
When one has this problem, food and nutrients may be poorly absorbed, and iron deficiency may show itself. There can be a wide range of severity in this condition. Some children can have serious problems with symptoms such as diarrhea, “pot bellies,” wasted buttocks, sometimes swollen ankles, and irritability. Their stool may have a lot of unabsorbed fat and smell extra unpleasant. Children like this do not grow properly and are said to be failing to thrive. Adults too may suddenly develop these symptoms, perhaps following a bout of gastroenteritis, and we have seen well-nourished men and women become wasted shadows of their former selves.
Fortunately, not all cases are this dramatic, and you seem to have a milder form of the disorder. But the cure is the same for all: avoid wheat, rye, and barley products.
This sounds easy, but it is not. You will need to study to find out just what you can and cannot eat. Today the condition is well recognized, and many commercial foods are produced gluten-free. Failure to completely rid the diet of gluten results in less than optimal results. In children this can have effects on the growth of the child.
The diagnosis is completed by the taking of a duodenal biopsy. If you have not had this done, your doctor can easily arrange it. It is not painful.
Because there is the genetic component to the disease, family members who have signs of slow growth, failure to thrive, or anemia like you did, or even with vague intestinal upset, are candidates for the screening.
I am a 68-year-old woman with some pain in my knees when I walk. The doctor told me it is osteoarthritis and that I should take an over-the-counter painkiller and lose weight. Would you please write more about what osteoarthritis is, and what I should do?
Osteoarthritis is the most common form of arthritis, and it occurs in people as they age. Arthritis is inflammation of a joint. The joints are the interfaces of bones, where the bone is covered with a smooth cartilage and encapsulated in a fibrous sac. The lining of the sac is called synovium, and it secretes synovial fluid—a joint lubricant.
In rheumatoid arthritis, the synovium is inflamed because it is targeted by the body’s immune system as though it were foreign tissue. This misguided immune response causes inflammation, and the inflammatory secretions damage the cartilage and joint, leading to deformity. Why the body attacks its own membranes has not been fully clarified.
Other forms of arthritis may be associated with infection, tumors, or even gout. In the latter condition, crystals of uric acid precipitate into the joint and cause inflammation.
Osteoarthritis is not associated with infection, tumors, crystals, or autoantibodies, but seems to occur in people who have a family predisposition, persons who have seriously overworked their joints, or even those who have suffered a trauma. In osteoarthritis, the cartilage over the end of the bone degenerates, for reasons that are not completely clear, and mild to moderate inflammation is set up in the joint. The bone underlying the damaged cartilage becomes increasingly dense, and bony outgrowths at the edges of the joint cause nobby-looking joints.
When this process involves joints such as knees or hips, it can cause difficulty in walking. If it causes small joint arthritis, as in the hands, it results in a loss of dexterity and weakness.
Exercise can be damaging to osteoarthritic joints, but aquatic exercise that is, swimming—has been shown to be very helpful and is the exercise of choice. It also helps to lose weight, especially if the joints involved are knee or hip joints. Dietary changes are not particularly useful in helping osteoarthritis, though a reduced acid load may help rheumatoid arthritis, hence the benefit of a vegetarian diet in that condition.
Some have touted the use of chondroitin sulfate and glucosamine, but a large controlled study sponsored by the National Institutes of Health found them not superior to placebo* (the proverbial “sugar pill”). Limited data support the use of injected hyaluronic acid into the joint, and much of the treatment revolves around pain relief. Acupuncture has been shown to improve the pain in some, but most use acetaminophen (Tylenol). The nonsteroidal antiinflammatories such as Naproxen may be tried in the lowest effective dose in cases in which Tylenol is not helping, but they have side effects on the stomach.
For many, a surgical joint replacement is very helpful, and where we used to delay this as long as possible, some studies suggest earlier replacement may prevent muscle weakness and debility and actually be associated with a more productive lifestyle.
Clearly, this is scanty coverage of this topic, and your doctors will give you more specific advice for your individualized need.
We hope you can obtain sufficient relief so you may enjoy your life.
*Clegg, D. et al., The New England Journal of Medicine, 2006, 354, pp. 794-808.
My wife is 80 years old and has had back pain for years. We recently heard of a book that talks of living pain-free for life. I think it deals with a kind of “mind cure.” What is the Adventist Church’s stance on “mind cure”? Ellen White was very adamant about never giving our mind over to the control or suggestions of another, as occurs in hypnotherapy. She was also very positive about the effects of willpower correctly directed. We believe strongly that the mind controls a great deal of our health and our response to disease. We do not believe, however, that all disease comes from the mind. It is folly to think one can “will away” a cancer, a raging pneumonia, a case of malaria, or fix a bone without it being properly aligned and splinted.
But pain is an entirely different thing. Pain is not disease; it is a symptom. Pain serves us well. It causes us to pull our hand from a burning hot stove or to withdraw from a sharp object. Pain, therefore, is essential to our proper survival. Chronic pain is different, however; it indicates some nerve irritation, and in some ways can become self-perpetuating by its continued presence.
Our brains have a set of pathways that stimulate the production of endorphins. These are chemicals that function as opiates. Opiates are heroin, morphine, and codeine―derivatives of plants such as the poppy. Perhaps it would be wiser to say, opiates mimic the endorphins.
Failure to have a serious organic problem diagnosed could have disastrous consequences. There are chemicals that block the actions of opiates, and these medications also have been shown to block the action of the endorphins.
Researchers into the placebo effect,―which is the process by which inert substances will produce relief in approximately 35 percent of people,―have shown the effect to be mediated through the endorphin system. The opiate blockers also block the placebo effect. It is through the power of suggestion that placebos work, so we have here a mechanism through which our brains can suppress pain. But remember, placebo effects work in only 35 percent of people. Consequently, to achieve success, one would have to have a powerful turn-on of the endorphins. Then, too, the pain relief experienced is seldom 100 percent. Of course, when it comes to pain, a reduction of any magnitude will be very welcome.
Studies have shown that the recall of pain relief tends to be exaggerated in the mind of the one for whom some relief was obtained, leading to their recounting greater relief than was actually experienced at the time. Skepticism itself may be counterproductive to the working of such endorphin-activated mechanisms, but we would be less than truthful if we did not express that we doubt 100 percent relief will be obtained for pain that is based in significant pathology. We are also nervous that people might ignore the cause of the pain while pursuing the relief of the pain. Diagnosis should always precede therapy, even if the therapy is going to be a “mind” process. Failure to have a serious organic problem diagnosed could have disastrous consequences.
Your wife, who may have a degenerative condition of her spine for which conventional doctors have little significant curative measures, may well find benefit from mental adaptation to the pain. Remember, too, that prayer, with its casting of the care upon the Lord, may also remove those elements of anxiety that so heighten pain.
I read recently that pregnant women have now been advised to eat fish. I had thought that the mercury content of fish made it dangerous to eat. Do you think fish should now be part of a health-conscious person’s diet? Your question is one that is very topical and of great interest to vegetarians. As you no doubt know, many “vegetarians” include fish as part of their diet. Fish was eaten by Ellen White instead of “flesh meat,” and she considered it a better food than flesh of animals. She cautioned about fish from polluted rivers, and that is very much the situation today where fish from the inland and coastal waters of many countries are polluted with contaminants such as mercury, pesticides, and dioxins. The mercury content of fish was what prompted the withdrawal of fish from the diet of pregnant women. The reversal of this recommendation was based on factors other than the mercury content, which has not changed.
A person’s cell walls require Omega-3 fatty acids for their proper function, and two very important types are the eicosapentaenoic acid (EPA) and the docosahexaenoic acid (DHA). Fish oil is rich in these two important fatty acids, and concerns for the development of the unborn baby’s brain led to the reversal of the advice to pregnant mothers. Underlying this recommendation is a belief that Omega-3 fatty acids derived from plant sources are not easily metabolized to the EPA and DHA varieties of Omega-3 fatty acids.
At the Fifth International Congress on Vegetarian Nutrition, Dr. Alexander Leaf, Jackson Professor of Clinical Medicine, Emeritus, at Harvard University, espoused this belief. His position was assailed by Dr. Iqwal Mangat of the University of Toronto and, perhaps most tellingly, by information from the recent Adventist Health Study. This study showed that in fat biopsies taken from vegetarians, the content of DHA was very adequate. This means whatever theories of fat metabolism may be raised, the reality is that vegetarians are able to obtain sufficient DHA. This means we do not see a need at this time to recommend fish be added to the vegetarian’s diet.
In the same vein, we also feel a well-balanced and ample vegetarian diet is quite adequate for the pregnant mother and her child.
Lest we fail to be fair to those vegetarians who do consume fish, it is appropriate to recognize there are benefits to fish-eating. These include a decreased risk of heart attack mortality, probably related to the antiarrhythmic effect of fish oils, and apart from the contaminants fish does not have health concerns. Fish taken from unpolluted waters, such as deep oceans, do not have the same level of problems we see with fish that are farmed or from coastal waters.
In several nations and island populations, fish is a very important part of the diet. Our basis for vegetarianism is the quest for optimal health. Because of geographic differences in availability of foodstuffs, we are loath to recommend a rigid diet, and would caution a careful and well-planned transition from one’s usual diet to a vegetarian diet. The biblical record of Jesus eating and serving fish in His glorified state surely allays any questions as to the morality of eating fish. Ellen White’s preference for fish over flesh meat also suggests that any problem with fish relates to its contamination. For those with ample choice and quantities of foods available to them, particularly nuts and seeds, we see no reason for them to include fish in their diet. Conversely, we know of no health hazard for the eating of unpolluted fish.
How much of a problem is cardiovascular disease to those not living in Western countries? Your question is very relevant, because cardiovascular disease has often been described as a disease found in developed or Western societies.
Unfortunately, bad habits seem to be learned much more quickly than good ones, and consequently, we are now seeing an increasing number of cardiovascular deaths in developing countries. This increase is taking place while the mortality rate for cardiovascular disease has actually declined slightly in the United States.
Lifestyle factors are clearly and overwhelmingly important. Many studies show that the 2 to 3 percent of individuals who eat a vegetarian diet that includes nuts, whole grains, fruits, and vegetables, and who exercise regularly, have very few cardiovascular deaths. But there is increasing evidence that the cholesterol story we have both taught and learned is not as straightforward as was thought.
Predictors other than cholesterol, such as vitamin D levels and inflammation indicators such as C-reactive protein, may have as much significance for prognosis as cholesterol levels. Of concern is the increasing rate of cardiovascular disease in women. Cardiovascular disease, on a global basis, is actually much more of a serious problem than is HIV infection. China has one of the highest stroke rates, and much of this can be related to smoking. We often think the United States must have the highest cardiovascular disease rates (i.e., strokes and heart attacks). This is not true, however. Many other countries have higher mortality rates from cardiovascular disease. India, China, Argentina, and Scotland have high rates.
Diet is clearly a factor, but by no means the only factor. By 2020, tobacco will be the single greatest health hazard worldwide.
While there has been a decline in smoking in the Western world, it is skyrocketing in the world at large. Exercise is a wonder-worker even in obese persons. Obese individuals who exercise experience half the cardiovascular disease of those who are inactive. It makes little sense to be a dietary fanatic as a couch potato. This does not mean exercise compensates for obesity, because both an unhealthful diet and lack of exercise are independent risk factors for cardiovascular disease.
Fruits and vegetables markedly increase one’s chance of avoiding cardiovascular disease, as does the consumption of an ounce of nuts at least a few times a week.
While some people promote fish consumption, it has the same profile as red meat in causing colon cancer.
No matter where one lives, the classic five elements of a healthful lifestyle—regular exercise, a plant-based diet, whole grains, nuts, and water as the principal fluid result in reduced cardiovascular risk.
The largest lifestyle problem facing the world’s population is the reduction of tobacco consumption. Elimination should be our goal, but for those not motivated as Adventists are by spiritual concerns the expectation of the total elimination of global tobacco usage is not realistic.
The second most rewarding lifestyle intervention, on a global basis, would be to exercise more. We need 150 minutes of moderately hard exercise a week. This means exercise should induce a light sweat to be of sufficient intensity.
I have been diagnosed as having Bell’s palsy. It doesn’t seem to have totally resolved. Can you give any suggestions? Bell’s palsy is a form of acute peripheral facial weakness, of which the cause is not known. It is typically recognized by an inability to close the eye, and a drooping of the mouth on the affected side.
About a third of the patients with this clinical picture do not have Bell’s palsy, but may have a varicella zoster virus infection (which causes chicken pox and then shingles later in life), trauma, Lyme disease, diabetes, hypertension, or even a tumor.
The majority―two thirds―have Bell’s palsy. A few cases have been noted to have herpes simplex virus in the fluid around the facial nerve, which has led to the use of antiviral treatments.
Typically, in the majority of cases the palsy clears up; but without treatment, 20 to 30 percent will have residual weakness.
Some studies have shown swelling of the facial nerve, suggesting inflammation, so prednisone has been used as treatment. When given in the first 72 hours, it reduces the number of people suffering permanent damage to approximately 5 percent.
A couple of studies added acyclovir or valacyclovir, antiviral therapies, to the prednisone, and one found some benefit that the other did not. In fact, acyclovir alone seemed to have poorer recovery than no treatment in one group.
Our recommendation would be early treatment with prednisone (within the first 72 hours), but after that it is probably too late, and you will not get much benefit.
On an encouraging note, you will be far more aware of minor residual weakness than anyone else. In fact, people don’t always notice much about others, so stop worrying about your appearance and enjoy life!
I have diverticulosis but no symptoms. My aunt had this, but with a lot of pain. Should I be worried? We believe your aunt probably had diverticulitis. This is where there is inflammation in these diverticuli you have been found to have. Diverticuli usually form in the colon, and are characterized by outpouchings of the colon, which look like little buds on the colon. When these are present and no symptoms exist, they are usually not a cause for alarm. Should they become blocked or even infected, they may cause problems. Such problems can range from discomfort to serious situations of perforation or abscess formation much like appendicitis, and sometimes obstruction of the bowel.
Treatment may involve antibiotic therapy to kill the causative bacteria, or surgery to drain pus and possibly remove diseased segments of bowel.
The diagnosis of diverticulosis is made with some 95 percent accuracy with a computed tomography (CT) scan; this may be able to show a difference between diverticulitis and other problems. The disease diverticulitis is staged into four levels of severity, ranging from a small pericolic abscess to a large abscess, then to perforation; stage four is where fecal material has spilled into the peritoneum, the thin membrane that lines the abdominal and pelvic cavities. Being symptom-free, you do not have this problem―but perhaps a look at causative factors might help you limit the progression of your diverticulosis.
Men and women seem equally at risk for diverticular disease, and its prevalence increases with age. It is more common in Western and industrialized nations, where it may be present in 10 percent of those younger than 40 years of age, and in 50 to 70 percent of those age 80 or older.
Epidemiologic studies suggest diets low in fiber and high in refined carbohydrates may play a role in the cause of diverticulosis. Decreased physical activity, constipation, obesity, smoking, and the use of nonsteroidal anti-inflammatory drugs have all been implicated as possible causative factors. So if any of these factors apply to you, and we suspect some will, you should try to change your lifestyle in those areas.
Even for readers who don’t have diverticulosis, the same recommendations apply: more fruits, vegetables, whole grains, exercise, and less refined foods!
Our baby, fortunately, is now healthy, but she had severe jaundice at birth. Though the doctors looked for blood-group problems, they could not find the cause. She is thriving now and looks great, but do you think there could be complications later in life?
Jaundice in newborns is fairly common, affecting up to 60 percent of infants during the first week of life. The usual cause is that a baby has a high level of hemoglobin, the name for the red color in the blood. This hemoglobin has to be processed by the baby’s liver and excreted in the bile, but in most babies the liver metabolism is not switched on immediately. The hemoglobin is converted to bilirubin (the yellow pigment) and joined with an acid to make it soluble in the bile. It is important that this joining with the acid not take place before birth, because it would then not be able to cross the placenta. Before joining with the acid, the bilirubin is called unconjugated, because it is not processed, or conjugated, once joined with glucuronic acid. Babies with jaundice need to be carefully monitored, because high levels of bilirubin can damage an infant’s brain. Such outcomes, fortunately, are very rare these days, because doctors are aware of the dangers.
Some conditions further heighten the normal breakdown of red blood cells to bilirubin, and because an infant’s liver is immature they may cause a greater risk of jaundice. Among these is a blood-group incompatibility between mother and infant. One that is better known is where the mother is Rhesus negative and her baby or babies are Rh-positive.
The sequence of events is as follows: The baby’s blood cells cross the placenta into the mother’s circulation, and her immune system then makes antibodies that break down the “alien” red blood cells. These antibodies, unfortunately, can cross the placenta and attack the baby’s red blood cells inside the baby itself. It is usually a mother’s second or third baby that is more severely affected, because the repeated pregnancies act like “booster” stimulants to the mother’s immune system. Fortunately, today, an injection of antibody to the Rh antigen given to Rh-negative women prevents the more serious of these problems. The preparation is called Rhogam.
Other babies may be born with inherited disorders that cause their blood cells to break down more rapidly than normal, such as spherocytosis, or enzyme deficiency. Still other babies may have disorders of the liver, whereby the normal conjugation process is slowed down. A common one is called Gilbert’s syndrome.
The birthing process is difficult, and some babies are born with bruising under the scalp called a cephalo-hematoma, which is a collection of blood beneath the fibrous membrane covering the bones of the skull. As this blood is reabsorbed, it may deliver more hemoglobin than the liver can cope with.
The largest group of healthy babies that are jaundiced are those in whom breast milk is either inadequate in amount or contains large amounts of progesterone compounds, which further slow the liver’s maturity. These are transient effects and, if the jaundice level is not very high, of little consequence.
Phototherapy is a process whereby babies are exposed to intense light with, of course, little patches over their eyes. The light breaks the bilirubin, which can be excreted by the kidneys. The use of phototherapy has so greatly reduced the need for exchange transfusion that the once-common procedure is now rare.
Seeing your daughter has been discharged from the hospital, it can be assumed that she will have no further problems with effects of jaundice; although, should she have an underlying disorder, she could exhibit a tendency to anemia—but that would not be life-threatening. Follow up with your physician, and don’t worry; it sounds as though you have a healthy little girl.