Tuesday, February 26, 2013

Breastfeeding I: Colostrum, Antibodies, diarrhea prevention

Human milk provides protection against disease for a baby. There are many ways that it does this, much beyond what I can delineate in my non-studying time allotted. So I will start at the very beginning and then continue later.

A vaginal birth allows the baby's gut to be colonized by healthy bacteria which will deter disease by preventing the growth of unhealthy bacteria. #2 provide essential nutrients such as vitamin K. The proper colonization of the gut is why adults take probiotics, which will be another post.

The first milk secreted by the mother after birth is called colostrum because it is soooo different from 'mature' milk. It actually selectively facilitates the establishment of healthy gut bacteria Lactobacillus bifidus along with aiding the passage of meconium, or baby fecal matter that is still sterile from being in the mother, or not yet full of healthy bacteria.

Colostrum has less kcal than mature milk that will be secreted a few days later but has a higher amount of protein, fat soluble vitamins, and minerals. Further, it has a VERY high level of antibodies against bacteria and viruses that may be present in the birth canal.

These secreted antibodies are called IgA (immunoglobulin A) and are fascinating because the act like little pac-men for the viruses and bacteria. They are secreted by the adult gut and are specific for the topography of bacteria, viruses, etc. The immunoglobuns thus grab onto the bacteria or viruses and hold onto them preventing them from infecting you. In the adult,  IgA is secreted in the nose, the salivary glands, and throughout the gut along with into the breast milk.

In the second trimester of pregnancy, the human breast fills with inflammatory cells and it is thought that it is for this purpose: to identify and greatly increase the amount of secretory IgA made against any bacteria or viruses present in the environment and therefore protect the baby. Not only that but the degree of protection against organisms causing disease is proportional to the amount of HUMAN milk the infant receives, meaning exclusive breast feeding = greater protection vs diseases that cause diarrhea, nausea, etc. It is well established in the medical community that ingested antibodies from human milk provide gastrointestinal immunity against the following digestive tract/enteric pathogens that cause diarrhea: E. Coli, Salmonella typhirium, Shigella, V. Cholerae, Giardia, rotavirus, C. Diff, C jejuni. Therefore the antibodies in human breast milk in combination with the nutrients that help healthy bacteria survive protect the baby against diarrhea, GI ilnesses, etc.

Further the mother secretes immune cells (lymphocytes, T-Cells) that give specific immunity for bacteria present in the environment to the baby whose immune system cannot yet make those bacteria.

Saturday, February 9, 2013

A Brief Update

It is discouraging and scary to be coming back from this injury. Strange that I say this as I have come back from two ACL reconstructions. But there the injury was fixed. This time I know I have no miniscus and a meniscal tear. It is not "fixed" and it is up to me to change my training accordingly. Also running cannot be my priority. My schooling is my priority and that takes up a lot of time and effort. There is no clear path forward.

I went for a 14 mile run on tired legs on Thursday and really died at the end; my legs felt like lead. That used to be easy and at an easy pace (~7:30). Now it is difficult to brutal. My physical therapist said on Friday that people have come back from worse and that I will be back out there. And I will try. I know I am not alone when I run, I know I have my mom and my cat (who I put to sleep when her kidneys failed the day after my mom had been hospitalized with her final seizure. She sometimes visits me in dreams. She had been abused by previous owners, so I spent a lot of time sitting with her until I was the first person with whom she connected.) But is is hard to have loved something so much and have it taken away suddenly, whether it be a mother, a cat, or running. But hopefully I can get it all back.

I know I have strength in me. But between school and being in the worst shape since my ACL reconstructions, it is scary. I'm going to keep plugging away at my schoolwork and keep going to physical therapy and hopefully soon I will be back out there racing with my friends and comrades. I won't be at the front of the pack. That isn't how the body works. I will have to take some time to earn my way back up there. Wish me luck; I need it!

Monday, February 4, 2013

It's okay to be a chubby runner!

It was around 3 o'clock on what was a Tuesday or Wednesday afternoon when I got the call. I was fourteen and was doing nothing much after getting home from school. It was my dad's voice on the phone:

"I've got it Courtney"
"What dad, what have you got?"
"I've got the sport that will take you to the Olympics"
[pause... I'd never thought about going to the Olympics .. didn't have any idea why I was getting this call out of the blue]
"And what sport is that dad?"
[another pause... thoughts of being like the guys in Cool Runnings going through my head]

"Why bobsledding?"
"Because you can run fast and weigh a lot"

[pause as I get kind of excited, sounds like fun, but then I realize....]

"Dad, did you just call me fat?"

Yes that is the call that no fourteen year old girl wants to receive.... the fat call. I was chubby and kinda short. One guy who tried to date me in middle school ACTUALLY tried to flirt with me by calling me Courtney FAT-man before giving me his nike wrist band and trying to hold my hand! But I could still out-sprint most everyone in a soccer game. One time I remember hearing the parents from the other team commenting on how long my legs were... and I am 5'4" now, probably was shorter then, and weighed probably ~140lbs. So I knew didn't have long legs, I could just run faster then their daughters. And I remember telling my dad about that and wondering how fast I had to be running to create the illusion of long legs...

I think that training as a chubby athlete all my life has prevented a lot of injury. It takes a lot more muscle to run in a 140lb body than a 110lb body. Then as I dropped weight while living in Montana, I could sustain those speeds.

Now after having been injured I'm back up to ~127, which is 10-15lbs higher than my ideal racing weight. It will come back off if I keep training. But earlier today I did 5 mile repeats at a sub-6 minute pace (between 5:56 and 5:39) while weighing about 15 lbs more than most girls that can run like that.... As great as it would be to be a bobsledder, I can just stick with running for now and see how far this woman who was a happy-go-lucky Chubby girl can get in the running world :)

Sunday, February 3, 2013

My story vs the tragedy of Mr. Richard Fee

I was diagnosed as a child with ADHD. Apparently I "wrote the longest, most creative stories" my teacher had ever read a second grader write and I "stared out the window the entire day." In high school I tried stimulants and didn't like them, they made me focus on things I didn't want to acknowledge, like how boring class was, as opposed to the funny things I could imagine happening to make class interesting. And I didn't really care about my grades, I wanted to be a professional soccer player, and I performed very well on the SATs, so who cares about a few Cs, right? (I still got all As in math and physics...)

I remember my mom asking me to take them, but I was not adequately invested in my classes to compromise my happiness for classroom achievement. I remember laughing too hard to sit still and having my physics teacher kick me out of class to go run laps around the school. I almost failed freshman biology because I was always either late or forgot my homework and we had to hand our homework in before the bell rang. My freshman English teacher contacted me ten years after I graduated, telling me she remembered how funny I was in her class... But her class is one of the only classes in which I DON'T remember being disruptive or misbehaving, I only remember repeatedly forgetting to do the homework because I did not write it down or lost the paper on which I wrote it down, etc. I remember my first real boyfriend, sophomore year of college, saying "I have learned not to take it personally if you start giggling while we are kissing" because regularly I'd just think of something funny and start laughing in the middle of trying to kiss a boy,  in the middle of class, really in the middle of anything but a funeral.

In college I ended up having to take time off school because I couldn't focus on my classes and didn't get anything done when I sat down to study. (During this time period I also contemplated becoming a professional flamenco dancer. My dreams of future employment are as scattered as one would imagine from a girl with ADHD). Before returning to school I came to the agreement with myself that my intellectual future was worth trying medication. So I went on Strattera, a non stimulant, and took it regularly for over a year. However, it slowly began to make me nauseous, a known side effect, and I had to go off. I finally tried the stimulant medications again for the first time since high school. I am glad I stayed off medication through most of high school and college and would definitely recommend the same to kids. I know that I am bright and high functioning. I know that I do not NEED medication. But to be a really high functioning student where organization matters, I need help. I have an organizer that comes once a month because that is all I can afford, etc. The thing that I love most about myself: my sheer enthusiasm, energy, and spunkiness, has its downfalls, and that really sucks. It upsets me to take any medication, but without it I do not think I could have gotten into or stayed in medical school.

Taking adderall scares the living bejesus out of me and I have talked about that on end with the psychiatrist about any and every other possibility  He knows the psychiatrist who first diagnosed me many many years ago. I don't like using anyone else as the whole deal of taking stimulants scares me and makes me feel as though I am a sketchyperson. Last year and this summer I kept going off of adderall in order to race, 3-5 days before races. I had a tutor say to me "you have to choose, running or medical school" referring to my decision to keep going off of my meds. This really resonated with me because she was right. If I were a patient and my doctor said "oh, renal function tests, I didn't learn those that well because I didn't study as well that week... Well, I had a race coming up and didn't want to take my medication, so sorry, but the meds you were taking caused acute tubular necrosis which we would have caught, but now you are in renal failure need a transplant... but dialysis should help until we find a donor. Sorry, just didn't see it." That would be horrible. So I worry a lot about how to strike the right balance between my scholastic training and my running not just in terms of time but also in terms of when I can and cannot go off of the adderall to race.

My legs are cramped up and I think it's a combination of adderall and all the sitting. Nothing is worse for my running than taking adderall. It is probably a big part of what is leading to my injury. This is because my body is always stressed out. I have to do workouts in the morning or else I can't do the workout because I took adderall to study... Sometimes I can if it is only 5mg much earlier in the day and it has worn off, but otherwise my legs cramp, my heart races, I get light headed and my tongue gets all tingly, and I just can't do it. It is scary! And I stop and give up for that day.

The story of Mr. Richard Fee (http://www.nytimes.com/2013/02/03/us/concerns-about-adhd-practices-and-amphetamine-addiction.html?pagewanted=1&_r=0&hp) made me cry this morning. I don't know if he had a predisposition to paranoid schizophrenia. He sounds a lot like my good friend, Matt, who had a schizophrenic attack while I was in college. I remember sneaking into Matt's apartment to clean when he wasn't there because if he was then he may have attacked me. Eventually he made it back to his parents house. Less than a month after he left his apartment, I called his parents house. I received a threatening message asking me to never call again and that is the last I know if him. But as he descended into madness, I was the only person there for him and the way Matt changed is seared into my memory. Stimulants can induce psychosis. This observation is what lead to the creation of many anti-psychotic medications whose action is the opposite of that of stimulants.

I am afraid of medication. I do not like taking it. This is the big difference between myself and the man described in the article. I tried every other option and continue to try every other option because in my gut I KNOW STIMULANTS ARE BAD. Currently, I am on 5-15mg/day every day I do not race/am not preparing for a race, because I am studying every day. I am also trying a new prescription fish oil supplement with the hope of forever going off of adderall: http://vayarin.com/  We will see, but the whole thing is scary and I hope that the world doesn't judge people like me. But I guess I am putting this out there, so I will be criticized. But my dream is to be a doctor and help others who have struggled to fit into society as I have struggled and the only way I can do that is by being honest about my struggle.