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11,1997 • T he P ortland O bserver
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Meningitus targets youth Why Do We Use Drugs?
Bacterial meningitis is not solely
a childhood disease, but a dispro
portionate number o f its victims are
infants and children. The symptoms
and the speed of their onset can
strike terror in the heart of a parent.
It may happen something like
this: A child may have been suffer
ing from a cold or a sore throat or,
perhaps, nothing at all. Suddenly,
the youngster is irritable, running a
high fever, complaining o f head
ache, and vomiting.
Infants develop an eerie, high-
pitched cry. Muscles in the neck and
elsewhere may stiffen. The child
may become delirious, slip into a
coma, or have convulsions.
An alarmed parent’s first impulse
under these circumstances is to seek
emergency medical care. It is pre
cisely the right response. Without
treatment, the disease may be lethal,
and the danger increases with youth;
a very young child could die within
hours of the time the first signs of
illness appear.
Whenever meningitis is suspected
— in a child or adult — the patient
should be rushed to the nearest hos
pital. Before the advent of antibiot
ics, the vast majority of bacterial
meningitis cases, in those ofall ages,
proved fatal.
Now, with prompt diagnosis and
treatment, more than 90 percent sur
vive; among those who receive timely
medical care, the relatively few fa
talities now occur mostly among the
extremely young and the extremely
old.
Multiple Causes
Meningitis is an inflammation of
the meninges, the membranes sur
rounding the brain and spinal cord.
Sometimes, perhaps even most of
the time, the infectious agent is a
virus. Those cases, however, are
cause for far less concern than the
ones resulting from bacterial infec
tion.
According to experts, there are
probably more cases of viral menin
gitis than bacterial, but many mild
cases go undiagnosed and unre
ported. Bacterial meningitis, how
ever, is a serious infection for which
individuals usually seek medical at
tention.
That serious infection may be
caused by any of a number of bacte
ria. Many people would assume, from
its name, that the bacterium called
Neisseria meningitidis (also known
as meningococcus) is the major cause
o f the disease. In fact, it ranks sec
ond to another organism.
The leading cause of bacterial
meningitis is actually a strain, type b,
o f the confusingly
nam ed
Haemophilus influenzae (Hib), so
called because, when it was first iden
tified, it was erroneously believed to
be the cause of influenza or “flu”
(which is actually caused by a virus).
These two bacteria, together with
the pneumococcus Streptococcus
pneumoniae, account for four out of
five cases o f bacterial meningitis.
"Now, with prompt
diagnosis and
treatment, more than
90 percent survive;
among those who
receive timely
medical care, the
relatively few
fatalities now occur
mostly among the
extremely young and
the extremely old. "
Diagnosis And Treatment
Hospital diagnosis of bacterial
meningitis begins with a lumbar
puncture (“spinal tap”) to obtain a
sample o f the cerebrospinal fluid
that bathes the brain and flows down
through the spinal canal.
Normally clear, the fluid is ana
lyzed for the presence of bacteria
and other evidence o f infection.
Samples of blood, urine, and respi
ratory secretions may also be taken.
But since the disease can progress
so quickly, treatment — with intra
venous antibiotics — is started even
before any test results are available.
Among those drugs currently
widely used to treat bacterial menin
gitis are a class of antibiotics called
cep h alo sp o rin s,
especially
cefo tax im e
(C lafo ran )
and
ceftriaxone (Rocephin), and various
members of the penicillin family.
At least a week o f treatment, and
sometimes more, is needed. When
H. influenzae type b or meningococ
cal meningitis has been diagnosed,
household members and other close
contacts may be placed on a short
course of prophylaxis (prevention)
with the antibiotic rifampin (Rifadin,
Rimactane).
The dread of bacterial meningi
tis, whatever the cause, is based not
only on its reputation as a killer but
on the possibility o f neurological
complications— lingering deficits
that can be especially devastating in
infants and children, who are still
growing and developing.
Those complications may include
persistent hearing loss, mental re
tardation, and recurrent convulsions,
and they occur in 20 to 30 percent of
those who survive a bout of bacterial
meningitis.
An additional type of therapy has
been proposed for children with bac
terial meningitis, based on the pos
sibility of staving off one of these
neurological aftereffects.
One group of researchers has sug
gested that adding dexamethasone,
a corticosteroid hormone, to the an
tibiotic treatment may help prevent
subsequent deafness. This treatment,
however, is controversial Corticos
teroids are powerful medications that
can have serious, adverse side ef
fects.
The Special Hib Threat
Over the past few years, there
have been about 2,400 to 2,900 cases
of meningococcal infection reported
annually to the national Centers for
Disease Control in Atlanta. Some
46 percent to 47 percent are in chil
dren and teens (who compose 27
percent of the population).
These figures show that Hib cases
outnumber meningococcal menin
gitis cases by about 3 to 1. Among
small children, the comparative at
tack rate has been far higher.
According to CDC, before the
introduction of the first vaccine, 1 in
200 children in the United States
developed an invasive Hib infection
by the age of 5; 60 percent of those
children had meningitis, and 3 to 6
percent died.
What causes acne?
Pimples. Nearly everyone has
suffered through them— some more
than others. They are an almost uni
versal affliction o f adolescence.
Even one or two “zits” can cause
much posturing and worrying in
front of a mirror. A handful may
cause panic. And a face full can
result in permanent scarring — both
of the skin and the psyche.
Although acne can’t be cured, it
can be treated successfully in the
vast majority of people. Some cases,
especially the mild types, can be
cleared up completely. Vigorous
treatment o f the more severe types of
acne can help prevent facial scar
ring.
Technically called acne vulgaris,
this skin disease affects millions of
Americans annually. It can vary from
quite mild to extremely severe.
About 80 percent of all teenagers
develop acne, but the disease may
also start as late as age 25 or 30,
particularly in women.
No one knows for sure exactly
what causes acne, or why it usually
begins in adolescence. But a number
of factors, most importantly heredity,
play a role.
If a parent had acne, there’s a good
chance the child will.
Acne develops when the seba
ceous glands and the lining of the
skin duct surrounding hair follicles
(pilosebaceous units) begin to work
overtime, as they do in adolescence.
The glands produce more sebum,
making the skin more oily.
Normally the lining of the duct
sheds cells that are carried to the
surface of the skin by the sebum.
When the duct is blocked, cells and
sebum accumulate, forming a plug
(comedo).
If the plug stays below the surface
of the skin, it is called a “closed”
comedo or whitehead. If the plug
enlarges and pops out o f the duct, it
is called an “open” comedo or black
head because the tip is dark. This is
not dirt and will not wash away.
The discoloration is due to a
buildup of melanin, the dark pig
ment in the skin. Pilosebaceous units
are found all over the body, but there
are more on the face, upper chest,
and back, which explains why acne
usually occurs in these places.
Arthritus pain: causes & relief
In many diseases of the arthritis
family, a malfunctioning and hy
peractive immune system is to blame.
In the development of many of these
diseases, the distinction between the
body’s own tissues and those o f a
foreign invader (such as a virus or a
bacteria) is weakened or destroyed,
resulting in misguided immune sys
tem attacks. Sometimes, as in rheu
matoid arthritis, researchers now
believe that a virus or bacterium can
trick the body into launching an
inappropriate response through “mo
lecular mimicry.” Certain bacterial
proteins, for example, may mimic
the shape or amino acid sequence of
other proteins involved in a normal
immune response. The result is an
aberrant attack that leads to progres
sive joint destruction, and for some
individuals, decades of disability.
More recently, researchers have theo
rized that rheumatoid arthritis may
arise from a defect in the central
nervous system’s response to inflam-
%
mation and stress. This theory has
not been proven in people.
Osteoarthritis, which is also
sometimes called degenerative joint
disease, is primarily associated with
the wear and tear on weight-bearing
joints (the hips or the spine) as we
age. However, in recent years, scien
tists have identified at least one ge
netic link to osteoarthritis and other
genetic flaws such as a defect in the
way joints fit together, are suspect.
Also, increasing evidence has shown
that obesity places too much stress
on the joints, contributing to the
development of this disease.
Relieving arthritis pain often in
volves a combination of exercise,
medications, rest, and ways to pro
tect the joints.
Much depends on which type of
arthritis is causing the pain, how
many joints are involved, how se
vere the disease is, and the age of the
patient.
What experts stress most, how-
t
ever, is that relieving arthritis has
the best shot if the disease is caught
early.
When these diseases are diag
nosed early, modest exercises can
delay long-term degenerative
changes and move patients closer to
normal mobility and function. Exer
cises are also important to improv
ing patients’ mental attitudes.
Because early intervention is so
important, the Arthritis Foundation,
a major voluntary organization de
voted to arthritis in Atlanta, Ga.,
lists the following warning signs if
they persist for more than two weeks;
• Swelling in one or more joints
• Early morning stiffness
• Recurring pain or tenderness in
any joint
• Inability to move a joint normally.
• Obvious redness and warmth in a
joint
• Unexplained weight loss, fever,
or weakness, combined with joint
pain.
While the disease o f addiction is
complicated, a core issue is that the
use of most addictive substances is
pleasurable for some period o f time.
Not only that, but as anyone who
has ever experienced relapse can
tell you, the initial use o f a drug or
alcohol led to the second use, and
then the third use, and so on and so
on. We refer to this property as
reinforcement. Indeed, this is of
ten the key element in the persis
tence o f any addictive behavior.
Although the range o f addictive
substances includes a variety of
different chemicals with different
biological activities, it seems that
reinforcement, leading to contin
ued use, is the result o f a common
physiology which exists for all
drugs o f abuse.
To understand how this works,
you must know a little o f how the
brain works. The brain is bunches of
individual nerves that communicate
with each other and which are ar
ranged into distinct areas to serve
specific functions. When one nerve
communicates with a second, it re
leases a chemical called a neuro-trans
mitter into the space between them;
this space is called a synapse. The
second nerve reacts after its receptor
binds to this chemical. Depending on
which chemical is released, the activ
ity of the second nerve can either
increase or decrease. All drugs act
either by affecting how much of a
neuro-transmitter is in the synapse, or
interacting directly with a receptor.
Whole areas of the brain can be ex
cited or depressed in this fashion.
There is an area of the brain in
which increased activity will be per
ceived as pleasurable. We know that
lab animals with electrodes planted
in this area o f their brains, giving
small electric shocks, will continue
to seek this stimulation. They will
ignore all other bodily needs such as
eating. The pleasure they are appar
ently feeling reinforces whatever
behavior is needed to continue the
shocks. This area is called the nucleus
accumbans and may be thought of
as the pleasure center. Nerves origi
nating from other areas of the brain
project to this area. By releasing a
neuro-transmitter called dopamine,
these nerves will increase the activ
ity in the nucleus accumbans giv
ing pleasure. Almost all drugs of
abuse have been implicated in in
creasing activity in this area. Co
caine and other stimulants directly
increase the amount of dopamine
in the synapse and quickly increase
the activity of this area. Heroin,
pills, alcohol and even marijuana
have been shown to increase activ
ity as well.
Research needs to be done to
find out how the various drugs do
this with the hope that treatments
may be developed to block the rein
forcing properties of drugs. This
has already begun with the use of a
drug called Revia, which affects
the way heroin and alcohol work
and is useful in preventing con
tinuing use of these drugs.
Yoga as Positive Addiction
by
L onny J. B rown , P h D
The ancient Eastern self-care discipline of yoga sure
has come a long way in a short time in America. Not so
long ago the word “yoga” automatically evoked images
of eccentric gurus or hippies performing bizarre con
tortions in pursuit of spiritual bliss. But today, world-
class athletes, media celebrities, harried housewives
and business people are all discovering the many health
benefits o f this gentle art in our competitive and
stressful society.
One very promising development is the use of yoga
in therapeutic and recovery settings. Though a rela
tively new application, rehabilitative yoga is proving to
be a highly effective therapy for substance abuse and its
related problems. For the recovering addict, yoga offers
some distinct advantages: It is low-cost, safe, easy to
learn, and requires no special equipment or environ
ment. Whenever yoga has been utilized regularly in
recovery programs, the results achieved have been
impressive.
For nearly two years, in a class I conducted at Beech
Hill — an alcohol rehabilitation hospital in Dublin,
New Hampshire — I had the unique opportunity of
introducing scores o f recovering alcoholics of all ages
and backgrounds to the possibility of a new lease on
life through “hatha” yoga, the approach based on
stretching, deep breathing exercises, and relaxation
techniques. Despite the many obstacles that one
would expect in such an unlikely setting, the results
were most encouraging.
The institutionalized alcoholic is a perfect candi
date for a modified (“E-Z Does It”) beginner’s yoga
class. Years of stress and physical deterioration have
left his or her body impaired and weak. Muscle tone,
concentration and will power are all typically quite
diminished. Yoga provides a mild therapeutic move
ment routine. When performed properly, the benefits
can be felt immediately. Upon experiencing the relax
ation and energy of just one class, patient motivation
for self-care often increases. Even minimal effort —
a few slow deep breaths, some expansive stretching
— creates noticeable corrections, and makes the
value of the exercise self-evident. Were this not the
case, I’m certain that yoga would quickly prove
inaccessible and irrelevant to these over-stressed
folks, who often have short attention spans and a
conditioned expectation of instant gratification. Magi
cally, yoga delivers.
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