Effect of Silicone-Doped Hydroxyapatite on Bone Regeneration and ...: Ingenta Connect

Effect of Silicone-Doped Hydroxyapatite on Bone Regeneration and ...: Ingenta Connect

CHILD ABUSE

Since the title of this blog is “Oxygen the Spark of Life” a reader might well ask why I am addressing the subject of child abuse. In all my posts I have tried to show that normal brain activity depends on normal energy metabolism, highly dependent on appropriate nutrition. I have had an unusual experience with child abuse and the nature of the extreme cruelty is hard to explain as coming from a parent with normal brain function. I am going to recount the history of three unusual cases. They were so awful that it resulted in a symposium at Cleveland Clinic Foundation where every member of the many public organizations in the city dealing with children’s welfare were invited. Many years later, I met a woman that told me that it had led to the establishment of the “hotline” that operates in Cleveland today. They all happened so many years ago that identification would be impossible. Perhaps the most tragic case was Charlie who was brought for medical consultation “to explain all those scars on his body”. The point is that the correct nature of the cause of the injuries is never given. It is “this strange disease” or “he fell off a wall” etc. So a physician has to be a detective as well as a sympathetic listener. It turned out that the real cause of Charlie’s scars was repeated cigarette burns perpetrated by his mother. This has been reported in other cases. It comes from the brain of a parent under extreme stress and in a high state of anger and irritability. Previous posts have indicated that poor nutrition can create excessive irritability that makes it difficult to suppress primitive animal-like action. Then there was Vicki, aged four, who was admitted to the hospital with an obvious case of Kwashiorkor, the typical appearance of protein starvation seen today in children of third world countries. Vicki quickly began to flourish, even with “hospital food” and it turned out that it was a case of attempted homicidal starvation. Although this could not be proved, the mother was ordered to appear with the child at regular intervals, so that her behavior could be monitored. Each time that she made an appearance the child was clothed in a new outfit, each one being of a different color,obviously an effort to indicate how good a mother she was. One day the child appeared with three bruises on her forehead. This was explained by a fall when "an older sibling had pulled a rug out from where Vicki was standing". I must add here that all this was before the Child Abuse law was established in Ohio. At that time it was necessary only to report a suspicion to the police, extremely difficult for a physician to do since it conflicts with his training and experience. Later, Vicki was brought into the emergency room in coma and was passed immediately to neurosurgery where the brain tissue was found to be abnormal in appearance and substance. When she died, nothing could be proved but I suspect that she was smothered. The last case I want to describe was a 6-month old infant referred by a pediatrician who had found an enlarged liver in the child. He was scheduled for liver biopsy but with TLC from the nurses he began to sit up by himself for the first time and to my great surprise, I found that the liver could no longer be felt to be enlarged. I cancelled the biopsy and told the mother what the findings were and that she would need to follow up with the pediatrician. As I was reporting to her, there was a sudden and dramatic dilatation of her pupils, a reflection of acute reaction of the autonomic (automatic) nervous system. I became suspicious that she was on the verge of a nervous breakdown and wrote to the pediatrician asking him to watch out for possible child abuse. The mother was referred to a psychiatrist who reported that she was perfectly normal. A month or two later, this child was in an emergency room with a skull fracture, still accepted as “an accident”. The next event proved the underlying truth when the child was found drowned in a bath tub. I later received a letter from the pediatrician telling me of the final event and adding, “ I wonder how we could have prevented this”? I was unable to explain how something as important to an infant as TLC could rapidly lead to a return of an enlarged liver to normal. It did, however, lead me toward the importance of “mind over matter” in consideration of health and disease. Had the simple charm of loving care turned on the placebo effect? Doctors are trained to accept the complaints of a patient and at this relatively early era in mid 20th century, child abuse was not as well known as it is today. I have suggested in previous articles and papers that murder can occur in blind rage (seeing red), even on the spur of the moment. A crime can be accepted in Ohio as “temporary insanity” if it can be proved that the criminal “knows what he is doing but is powerless to stop himself from doing it”. This, totally different from cold blooded planned crime, was illustrated very well by Dostoyevsky in his novel, “Crime and Punishment”. The trouble is that it is virtually impossible to prove. In the case of child abuse, the abusive actions often occur impulsively and seem to be well beyond the powers of reason. The extraordinary love of motherhood is an icon of human behavior. I hypothesize that the brain of an abusing parent is biochemically abnormal and the child, in some way, irritates her/him to release a physical action known to be wrong, but beyond the power of reason and control. Although child abusers, like wife abusers, are more commonly from the lower socioeconomic members of society, it is certainly not confined to them. Alcohol and/or poor diet may well enter the picture in many cases, thus introducing biochemical changes that cause excessive irritability, overwhelming the power of reason. For this to be explored and researched, it would be necessary to accept the possibility. Our society and our medical thinking is very far from that.

MICRO-ORGANISMS ARE OPPORTUNIST

As a brief prelude, those who know a little about English history will remember that Henry VIII “dissolved” the monasteries so that he could grab their cash. My teaching hospital, St Bartholomew’s, was founded by a monk named Rahere in 1123 as a monastery in “the smooth field”, now known as Smithfield in the City of London. Thus “dear old Henry” dissolved it! Later when he became sick from syphilis he wanted somewhere that would treat him so he refounded it and became known paradoxically as the founder. Thus there is a statue of him over the entrance gate to this day. As a young intern in this, my teaching hospital, I had an experience that I have remembered through 64 years of medical practice. One night I was confronted with a middle aged man with pneumonia. This was before the days of antibiotics: the first sulfonamide had just been synthesized. The patient was known to have chronic tuberculosis and the pneumonia was an additional factor. There was little that we could do for him. In the morning I was standing in the ward entrance. The hospital was made up of wards for males and females separately and each consisted of about 30 beds. The only privacy was a curtain that was used to surround each bed as required. Each ward was presided over by a head nurse who was called Sister. Her flowing cap and the name Sister were inherited from the time when monks were the doctors and lay sisters were the nurses in monasteries. Every physician in an English hospital and especially young interns listened to Sister at his peril. She ruled the ward with an iron rod. She is truly a historical figure. The next morning, while I was standing in the ward entrance, my “chief” had entered and was standing behind me. He said “O, I see you have a dying patient” and of course, I asked him how he knew. “Well,” he said, pointing to my patient with pneumonia, “you see how that patient’s fingers are picking at the edge of the bed-sheet, occasionally pointing at the ceiling and picking at thin air: that is consistent with what we recognize as a toxic brain”. Well, of course, he died and the autopsy showed that his entire body was infiltrated with micro-abscesses filled with staphylococci. The lab work before he died showed nothing that would even hint at disease. The white cell count was normal: he had no elevated temperature and other blood tests were all normal. Laboratory tests are used really to see how a sick person is responding to any form of “stress”, including any form of infection. They really demonstrate how the body defenses are responding to an attack. It was clear that he had not put up any kind of defense at all. In fact, due to poverty, poor diet and the ensuing tuberculosis, his defense mechanisms were simply not functioning. The important factor that I learned the hard way was that the part of his brain that acts as a computer below conscious level was “sick” and that it had failed to organize any kind of defense. The next time I saw this phenomenon was when I was an assistant in a family practice in Leicester, a Midlands city. One evening two young women came into the surgery (office) at the end of evening hours and said “we want you to come and see our Dad”. I asked whether it could wait until morning and they said “no—we want you to come now. He’s got a cough”. When I entered the bedroom I saw a middle aged man who was kneeling on a bed with a single blue light bulb over the bed as the only lighting. He was looking at me with sightless eyes, pointing at me and “picking at thin air”. He proved to have meningitis caused by a pneumococcus, an unusual organism for meningitis but a common one for pneumonia. The family had failed to call me for his “cough” that was due to pneumonia that had preceded the meningitis. Because of his extreme disability through poverty, lousy diet and poor living conditions, the organism that had caused pneumonia had spread to the spinal tissues to cause meningitis. He had the same situation as the one already described. It has been a vivid memory that has guided me to see how the brain is responsible for our body defenses in any sort of attack, whether it be an infection, an injury or virtually any form of “stress”. So, it is fascinating now to see that research has indeed shown how the brain “gets into the act”. It has recently been found that the lower part of the brain, the computer, receives information that an organism is attacking. It then dictates what has come to be known as the “inflammatory reflex”. It organizes this vital defensive mechanism because of messages from the attacked tissue to the brain through an important nerve called the vagus. This nerve runs from the lower part of the brain to many organs in the body, carrying signals from and to them. Thus it turns on the inflammatory reflex, controls the right degree of inflammation and then turns it off. We need inflammation as a defense but it has to be carefully controlled. If something goes wrong with it, an important part of our defense is compromised. The mechanism depends on chemistry (and probably electricity) derived from food that supply our cells with the ingredients to synthesize cellular energy that enable this vital reflex to function. Both these unfortunate patients were killed by organisms that quickly overwhelmed their depleted natural defenses. Thus, you might say that the attacking organisms were opportunists. They “cashed in” on an easy opportunity to win what is essentially a war between us and our environment. We are bombarded with stressors that we cannot see, against which we have to mount a defense. As Darwin theorized, it is the survival of the fittest. The term “opportunist” is officially reserved for organisms that attack us only when our ability to defend ourselves has been damaged severely enough through disease to threaten death. For example, candida albicans is a yeast, known as “opportunist” since it is generally considered never to launch an attack unless serious illness has prevailed. We all know, of course, that Louis Pasteur introduced us to the fact that organisms that could only be seen with a microscope could kill us. This was really the first paradigm in medicine that led us ever since to seek ways and means to “kill the enemy”, whether it be bacteria, virus or cancer cell. I find it fascinating that Pasteur is said to have remarked on his death bed “I was wrong! It is the body defenses that matter”. Thus, perhaps Louis Pasteur indicated the next medical paradigm. I think that we should consider all pathogenic micro-organisms to be potentially “opportunist”. In recent years I have seen many children with autism who commonly develop yeast infections and although they are certainly biochemically compromised, they are not by any means “near death”. We are seeing diseases caused by infections with organisms like chlamydia that appear to be classified as “opportunist” but I believe that our profligate diet, the air we breathe, water and food pollution are all combining to weaken our defenses so that organisms that do not usually attack are being given a better opportunity to win the war. I believe that we should regard any pathogenic micro-organism as an opportunist, because it is much less likely to win a war when our bodily defenses are well organized. Think of the body as like an old fashioned fortress. There was a central control in the shape of a commander and the defenders obeyed his orders. If the commander was asleep or otherwise out of commission, any attack on the fortress would be potentially doomed. I have been engaged in answering patient’s questions on a new website called ”Health Tap”. This is where a great deal of free answers are provided by a large group of doctors who give some of their time to this beneficial connection between doctor and patients. What surprised me was that the answer I have had to give to so many of these questions has been “diet”. It was so common that I must look like a “broken record” to some. The fact is, however, that the nature of our fuel supply is one of the very few things that we can do preventively to maintain health. As long as we drive a two ton machine to a supermarket and buy our food in cardboard boxes, we are like cars that have been provided with the wrong fuel. The resulting failure to synthesize sufficient cellular energy winds up by supplying our only natural enemies with plenty of opportunity. It was not doctors that stopped the common appearance of tuberculosis. It was better housing, hygiene and less starvation. It is not too surprising that this dread disease has recently made its reappearance and is Mother Nature’s comment on our modern diet. The only difference is that we have swung from too little food to too much of the wrong food, the Yin and Yang that rule the natural order of things.

Please read my views on peer review here.


http://www.webmedcentral.com/article_view/1863

Kamal Mahawar