Can Stress Cause Autoimmunity?

Autoimmune diseases are usually multifactorial that include things like genetics, environmental factors, diet, hormones, and stress. We know that genetics can be a huge factor, but not the deciding factor that causes someone to develop an autoimmune disease. For example, Crohns disease is multifactorial and someone who has a parent that has Crohn's disease is 20-30% more likely to develop it (Feuerstein, 2017). Many of these diseases are out of our control, but these multifactorial ones can be managed with good diet, behaviors, and treatment. In the main research article I was looking at, it emphasized that both physiological and physical stress have been implicated in the development of autoimmune diseases. They saw this effect in animal and human studies. They also found that up to 80% of patients reported emotional stress before disease onset (Stojanovich, 2008). The stress before and the onset of the diseases then increases the stress of the person which creates this vicious cycle where the person is in a prolonged period of stress that disrupts the immune system. This is also due to stress triggered hormones being released that leads to immune dysregulation and increasing cytokine production. The specific cytokine talked about was IL-6 which is a proinflammatory cytokine. Anytime we have chronic inflammation, it's typically a bad thing that leads to something like arthritis depending on the area being affected. 

To sum it up, stress is a factor to autoimmune disease and is one of the factors that we can limit. Habits and lifestyle choice are some of the best ways to have a better life despite having an autoimmune disease.

Feuerstein, J. D., & Cheifetz, A. S. (2017). Crohn Disease: Epidemiology, Diagnosis, and Management. Mayo Clinic proceedings, 92(7), 1088–1103. https://doi.org/10.1016/j.mayocp.2017.04.010

Stojanovich, L., & Marisavljevich, D. (2008). Stress as a trigger of autoimmune disease. Autoimmunity reviews, 7(3), 209–213. https://doi.org/10.1016/j.autrev.2007.11.007

Ehlers Danlos Qualities & Tragedies of Life

Working in healthcare, even emergency care, providers are accustomed to their department "frequent fliers" - those individuals frequently presenting to seek medical care. One subset of these repeat clientile rest in those diagnosed with Ehlers Danlos Syndrome (EDS), a connective tissue (bone, tendon, ligament, and blood vessel) disorder that causes joint hypermobility, skin hyperextensibility, and tissue fragility (The Ehlers Danlos Society, 2023) to varying degrees. Research suggests a strong genetic component to the disease, meaning there are no current cures but rather a focus on alleviating symptoms as they arise. 

These patients do not have a choice but to seek care within the very system that oppresses and diminishes their experiences. The first EDS patient I encountered was seeking treatment for their sixth (6th) hip replacement within a 12-month period. As a 41-year-old... Increased joint mobility contributes to abnormal ranges of motion that cause pain and dislocations, attributing to a decreased quality of life and unbelievably limiting expectations of living; Ehlers Danlos patients can experience a dislocating joint up to once per day (Parry, 2017). Although there are varying degrees of symptomatic expression, early recognition and treatment can present novel treatment options for those affected. 

For the diseases that we are able to recognize and treat early, physical therapy becomes the primary focus, but research progresses as time continues. Joint disability and dislocation lead to an inhibition in activities of daily life, generally curating a protective and preemtpive course of treatment. Families can initiate anticonvulsive, symptom-alleviating, or best-attempt premature treatment to combat EDS. With knowledge of potential future EDS struggles, a family is able to prepare for their independent course of treatment to grant a sense of autonomy to the patient. 

The Ehlers Danlos Society. (2023, July 24). What is EDS?. The Ehlers Danlos Society. https://www.ehlers-danlos.com/what-is-eds/

Parry, J. (2017, January 11). Managing dislocations and subluxations in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. Managing dislocations and subluxations in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders – The Ehlers-Danlos Support UK. https://www.ehlers-danlos.org/information/managing-dislocations-and-subluxations-in-hypermobile-ehlers-danlos-syndrome-and-hypermobility-spectrum-disorders/

EDS and Autonomy of Choice

Working in healthcare, even emergency care, providers are accustomed to their department "frequent fliers" - those individuals frequently presenting to seek medical care. One subset of these repeat clientile rest in those diagnosed with Ehlers Danlos Syndrome (EDS), a connective tissue (bone, tendon, ligament, and blood vessel) disorder that causes joint hypermobility, skin hyperextensibility, and tissue fragility (The Ehlers Danlos Society, 2023) to varying degrees. Research suggests a strong genetic component to the disease, meaning there are no current cures but rather a focus on alleviating symptoms as they arise. 

These patients do not have a choice but to seek care within the very system that oppresses and diminishes their experiences. The first EDS patient I encountered was seeking treatment for their sixth (6th) hip replacement within a 12-month period. As a 41-year-old... Increased joint mobility contributes to abnormal ranges of motion that cause pain and dislocations, attributing to a decreased quality of life and unbelievably limiting expectations of living; Ehlers Danlos patients can experience a dislocating joint up to once per day (Parry, 2017). Although there are varying degrees of symptomatic expression, early recognition and treatment can present novel treatment options for those affected. 

For the diseases that we are able to recognize and treat early, physical therapy becomes the primary focus, but research progresses as time continues. Joint disability and dislocation lead to an inhibition in activities of daily life, generally curating a protective and preemtpive course of treatment. With knowledge of potential future EDS struggles, a family is able to prepare for their independent course of treatment to grant a sense of autonomy to the patient. 

The Ehlers Danlos Society. (2023, July 24). What is EDS?. The Ehlers Danlos Society. https://www.ehlers-danlos.com/what-is-eds/

Parry, J. (2017, January 11). Managing dislocations and subluxations in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. Managing dislocations and subluxations in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders – The Ehlers-Danlos Support UK. https://www.ehlers-danlos.org/information/managing-dislocations-and-subluxations-in-hypermobile-ehlers-danlos-syndrome-and-hypermobility-spectrum-disorders/

How Does Caffeine Affect Us Physiologically?

 Considering a large population around the world drinks coffee or some kind of caffeinated drink, I decided to do some research looking into the effects and what's going on physiologically when we consume these products. 

What I found was that caffeine generally has three effects on the central nervous system. One of them is its ability to stimulate antagonism at the adenosine receptor level. Methylxanthine, a naturally occurring molecule in coffee, teas, and energy drinks triggers a stimulatory effect on these receptors which are important releasing neurotransmitters for sleep regulation, arousal, cognition, memory, and learning (Fiani, 2021).  The second mechanism affects how methylxanthine promotes the movement of calcium through the sarcoplasmic reticulum and plasma membrane. Then, the calcium is released by the synaptic into the peripheral and central nervous systems. It once again affects the neurotransmitters that are dependent on the calcium entering the nerve endings. Research said that with a low concentration/ low dosage of caffeine, the calcium uptake is greater than normal. It also said that a large dosage inhibits this calcium uptake which is probably due to too much calcium flooding the system. The final mechanism mention was methylxanthines ability to inhibit phosphodiesterases which prevents cAMP from being broken down. cAMPs function is to release hormones like dopamine, epinephrine, and norepinephrine when there is an accumulation of it. This affects your mood, memory, alertness, and cognitive function. It's some really interesting stuff and the conclusion that this study came to was that caffeine had the biggest effects on mood, specifically anxiety, enhancing processing speed, short term and long term memory in adults (Lieberman, 2002). Children were not well research in this study and called for more attention and research to be done in the pediatric population. 

Fiani, B., Zhu, L., Musch, B. L., Briceno, S., Andel, R., Sadeq, N., & Ansari, A. Z. (2021). The Neurophysiology of Caffeine as a Central Nervous System Stimulant and the Resultant Effects on Cognitive Function. Cureus, 13(5), e15032. https://doi.org/10.7759/cureus.15032

Lieberman, H. R., Tharion, W. J., Shukitt-Hale, B., Speckman, K. L., & Tulley, R. (2002). Effects of caffeine, sleep loss, and stress on cognitive performance and mood during U.S. Navy SEAL training. Sea-Air-Land. Psychopharmacology, 164(3), 250–261. https://doi.org/10.1007/s00213-002-1217-9

Surrogacy Dilemma

    Pregnancy is, in my opinion, one of the greatest biological capabilities that we are capable of. Developing a human being within your own body and then going on to be its parent and raise the child into a fully grown capable human being is something many people in our world dream of. However, for some this is not a possibility due to infertility issues that may arise under a wide array of circumstance. A rise in infertility has lead to an increase in assisted reproductive techniques, or surrogacy, as a common practice. Surrogacy is when a surrogate mother bears a child for a couple or individual who are may be infertile. There are two types of surrogacy that can be implemented, the first being gestational fertility, which as become more common, which uses in vitro fertilization and then places the embryo within the surrogate mother (Saxon et al. 2012). The other type is traditional surrogacy, where the surrogate mother is impregnated with the fathers sperm artificially, this means that the surrogate mother is genetically and gestational the mother of the child (Saxon et al. 2012). Typically, when surrogacy is performed, there is a contract signed between the mother and the couple or individual who will be the child's parents.

    There, of course, are a handful of ethical issues that arise when discussing the idea of surrogacy. The first being the idea that when a surrogacy is performed, it creates a divided between genetic, gestational, and social parenthood, as the surrogate mother will be the gestational (and potentially genetic) mother of the child, while the parents will take over for the social aspect of parenthood (Meinke, 1988). Another issue that comes up is the detrimental effects that surrogacy can have on the surrogate mother. There is an extreme amount of stress that comes with being a mother and going through pregnancy under normal circumstance, but in surrogacy there is added stress due to the emotional and psychological effects that can arise from giving up the baby (Meinke, 1988). In fact, there have been cases where the surrogate mother refused to give up the child and had to go to court to sort out the custody of the child.The final ethical issue that I will talk about is perhaps the most concerning to me, the idea of commercial vs. altruistic surrogacy. This is an area where things get very complicated, as both sides of the argument have significant ethical issues. With commercialized surrogacy, the mother is financially rewarded, which can lead to the the development of a market for this type of exchange. This can lead to exploitation by coercion and potential reproductive labor being forced on individuals, especially in lower income areas (Blazier and Janssens, 2020). On the other side, altruistic surrogacy also has ethical issues. This is when there is no financial reward to the surrogate mother, with can lead to exploitation in other ways (Blazier and Janssens, 2020). There have been countries that have taken up each approach, with the Netherlands taking a altruistic approach and India taking a commercial approach to surrogacy, but, overall it is clear that both sides have their issues, and there is regulations that need to be put in place to keep the best interest of the mothers and the couples in mind.

Blazier, J., & Janssens, R. (2020). Regulating the international surrogacy market:the ethics of commercial surrogacy in the Netherlands and India. Medicine, Health Care and Philosophy, 23(4), 621–630. https://doi.org/10.1007/s11019-020-09976-x 

Saxena, P., Mishra, A., & Malik, S. (2012). Surrogacy: Ethical and legal issues. Indian Journal of Community Medicine, 37(4), 211. https://doi.org/10.4103/0970-0218.103466 

Surrogate motherhood: Ethical and legal issues ... - georgetown university. (n.d.). https://repository.library.georgetown.edu/bitstream/handle/10822/556906/sn6.pdf?sequence=1 

Physiology of Peripheral Nerve Injuries

     When one thinks of nerve damage in the body, our minds may first go to internal causes such as diabetes or autoimmune diseases such as rheumatoid arthritis. In fact, I would probably agree with this train of thought, especially as someone who is more aware of the internal processes of the body than the common person. That is until I was called to the hospital one day last summer to pick up my sister who had cut her finger while opening a package. Initially the doctors did not think that there was any serious damage in the finger, and sent her on her way with a bit of surgical glue to close the wound. A few days later, however, she began to loose feeling in her finger, which of course began to raise some flags. She finally went to see an orthopedic surgeon, who identified that she had in fact completely severed the nerve in her hand and would need to go into surgery as soon as possible to attempt to repair the nerve.

     This type of peripheral nerve injury (PNI) by laceration makes up about 30% of all PNIs (Burnett and Zager, 2004). When an injury to the nerve takes place, there is a degenerative process that takes place, and the damaged nerve endings will retract due to the elastic endoneurium (Burnett and Zager, 2004). Inflammation then occurs, leading to swelling and the formation of scar tissue(Burnett and Zager, 2004). If this is not treated shortly after the injury, there can be detrimental affects to the nerve, including nerve death, this is what happened in the case of my sister. Due to the fact that the ER doctors did not initially detect any issue with the nerve and she was sent home, this allowed for the degradation to occur to the nerve causing it to die. As I mentioned, she was able to get a surgery performed to try and resolve the issue, but they had to use a cadaver nerve to replace the damaged nerve in her finger. There were a few months of treatment and occupational therapy required, but now she is able to fully use her finger again with fully neurological function.

Burnett, M. G., & Zager, E. L. (2004). Pathophysiology of peripheral nerve injury: A brief review. Neurosurgical Focus, 16(5), 1–7. https://doi.org/10.3171/foc.2004.16.5.2 

The Costly Consequences of Vaccine Misinformation

Misinformation-fueled hysteria has produced conspiracies surrounding vaccinations for years, tragically and predominantly arising from a scientist frustrated with his data yielding undesired results. Andrew Wakefield believed a positive correlation existed between the Measles, Mumps, & Rubella (MMR) Vaccine and autism diagnoses in children - setting out on a mission to prove it. The eventually-published studies vastly skewed any data collected, while demonstrating poor experimental etiquette - ranging from extremely small sample size (12 subjects) to declining recognition of other contributions and correlations in his discussions (Children's Hospital of Philadelphia, 2013). 

Autism did not receive an official, distinguishable definition until the mid-2000s, preceded by ideals of Asperberger Syndrome (National Autistic Society). With the combination MMR vaccine becoming available in 1971, closely followed by the main Wakefield paper being published in 1998, a monumentally drastic reduction of parent's opting to vaccinate their children resulted. Initial approval of the MMR vaccine gave way to vaccination requirements, educational propagation, and eager compliance that was undone by Wakefield and his supporters. 

While vaccines possess risks (as is applicable to any medication), their dangers are extensively and carefully examined before being accepted and promoted for human use. Vaccines were generally accepted as the future of eradicating contagious diseases until skepticism degraded this hope, festering fear instead. This fear has not only affected the MMR subset of vaccines, but grown to encompass the concept of vaccines in general; as conspiracy continues to be fed, declining vaccination rates lead to decreased immunity and a higher susceptibility of becoming infected - regardless of immunization status (Conis, 2019). This inaccurate vaccine trepidation must be resolved for the future of treatable diseases within humanity. 

The Children’s Hospital of Philadelphia. (2014, November 5). Vaccines and Autism. Children’s Hospital of     Philadelphia. https://www.chop.edu/centers-programs/vaccine-education-center/vaccines-and-other-            conditions/vaccines-autism

Conis, E. (2019). Measles and the Modern History of Vaccination. Public Health Reports, 134(2), 118–125. https://doi.org/10.1177/0033354919826558

National Autistic Society. (n.d.-b). The history of autism. National Autistic Society. https://www.autism.org.uk/advice-and-guidance/what-is-autism/the-history-of-autism