Sunday, December 19, 2010

Guess I’ll eat some worms

By Richard P. Holm, M.D.

This month, a scientific journal reported the remarkable case of a 35-year-old man who took an unusual treatment for ulcerative colitis. His colon was so inflamed and sore that he had been advised by doctors to have it surgically removed. After researching experimental therapy for ulcerative colitis, he decided to travel to Thailand where a doctor gave him 1,500 roundworm eggs to swallow.

The idea that worms might have something to do with ulcerative colitis and Crohn’s disease came from the observation that colitis is common in developed countries like America, where worm or parasitic infections are rare. In contrast, colitis is rare in countries where virtually the entire population has worms living inside of them.

This is similar to scientist David Strachan’s “hygiene hypothesis,” that was presented in the British Medical Journal in 1989. He showed data that hay fever and eczema were more common in families with one child than in larger families, and he speculated that the difference was because of an earlier and broader exposure to infections in the larger families. He suggested that more exposure to the dirty world results in less allergies.

Strachan’s idea has expanded and the “hygiene hypothesis” proposes that in developed countries, as a result of a “too-clean” environment, there is an increase in the diseases of the immune system such as inflammatory bowel disease, multiple sclerosis, asthma, and even childhood-onset diabetes mellitus type 1. Remember, however, the “hygiene hypothesis” is still just theory.

Let’s get back to our patient with colitis that traveled to Thailand. To everyone’s delight, after eating worm eggs, the gentleman quickly became symptom free. About three years later, after a relapse, he took more eggs and got better again. Over the six years that scientists studied the patient, they found his immune system was changed by worm therapy and noted that his colon had increased mucous production.

We are not talking night crawlers here, and some worm infections can be very harmful in humans, so people should not eat worms without scientific direction. Studies are now underway using pig whipworms, which are a less-aggressive worm, in treating not only inflammatory bowel disease, but also multiple sclerosis.

“Nobody loves me, everybody hates me, guess I’ll eat some worms.” Maybe some day we’ll be eating worms for colitis, too.

Monday, December 13, 2010

On suffering

By Richard P. Holm, M.D.

Part of the mantra or sacred prayer of every physician is to reduce suffering, but what is it to suffer? The dictionary explains suffering as more than just experiencing something unpleasant or painful. The origin of the word comes from the Latin word “sufferre” or “to bear,” as if carrying a burden.

It is interesting to note that neuro-imaging maps have found that a certain part of the brain fires up when we feel either physical pain or emotional distress. Two radically different kinds of suffering seem to share a single neurological space in our heads. I also read in researching this topic that some individuals feel suffering leads to the construction of meaning in life and that it helps us to know more about our world.

To better understand the concept of suffering, this week I asked a number of patients and friends what it was that had caused them the most suffering. Surprisingly not one described an experience of physical pain. Rather the answers all turned around emotional loss. I heard about emptiness and anxiety following the death of parents and siblings, about the psychological stress of having kids, and a lot about the depression following divorce. People seem to forget about physical pain, but they remember emotional hurting.

Recently a national survey of hospice directors asked how we treat those dying from various illnesses and I was asked to fill out a form with challenging questions. Two questions were especially difficult for me: “Is pain and suffering a means for spiritual growth?” and “Should physicians seek to relieve patients’ spiritual suffering just as much as patients’ physical pain?”

I have no problem with the idea that people grow from suffering, but I struggle with the subtle implication that to relieve people of life’s emotional and spiritual pain could possibly rob their lives of meaning.

Bottom line, emotional pain is probably more significant than most of us realize, and my hat is off to the psychiatrists and psychologists whose jobs concentrate on just that part of the quest to enhance human health.

May we all find meaning in this crazy and sometimes hurtful life, and may we all find some help when it gets too painful.

Dr. Rick Holm wrote this editorial for “On Call®,” a weekly program about health on South Dakota Public Broadcasting-Television that is produced by the South Dakota Cooperative Extension Service. “On Call” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain.