By Richard P. Holm, MD
 
For years I cared for a lovely woman with scleroderma. It all started with Raynaud’s phenomenon a condition causing her fingers, after an exposure to cold, to become pale-white then blue or red and painful. Raynaud’s phenomenon occurs in about four percent of the population, is usually not associated with any other condition, but sometimes goes with rheumatoid arthritis, lupus or, in this case, scleroderma. My patient also experienced progressively tight and shiny skin on her hands, then chest, then everywhere. She had tiny red spider vein spots (telangiectasia), heartburn, weight loss, weakness and puffy joints. Over the years her fingers became scarred and quite immobile with always worsening sores on the tips. Through it all, this wonderful lady had a very positive attitude and always seemed to have a smile on her face, although, near the end, the skin of her face became so tight that smiling became a challenge.
 
Yearly, about three in 100,000 middle-aged U.S. adults develop scleroderma (or when full-blown called systemic sclerosis). Normally, after a cut or a sore develops and in order to heal the wound, our bodies trigger both the immune system (to fight off invasion of bacteria, fungi and viruses) and special repair cells (to close off the wound with collagen and scar tissue). Once the damage has been repaired, extra collagen production usually stops, but not with scleroderma. For some unknown reason, scarring continues uncontrolled. At this time, treatment for this very puzzling auto-immune condition is restricted to treatment of symptoms; no cure for scleroderma exists.
 
We think that inheritance, hormones, certain infections and long-term exposure to pesticides, silica dust or polyvinyl chloride all might have something to do with the cause, but we really don’t know. We also don’t know why four times as many women get it as men; why it it can involve just a spot or a sword shape skin area and never progress; why it may or may not occur with Raynaud’s phenomenon, involvement of the esophagus and smaller parts of the skin but doesn’t progress; and why, in some unfortunate cases, it progresses everywhere, like in my patient.
 
Similar to many other autoimmune conditions, scleroderma is one where the immune system, for some undefined reason, runs amok, mistaking normal tissue as a foreign invader. Scientists and physicians are on the hunt to learn first why scleroderma happens and then how to stop the process.
 
If we understood more about scleroderma, we would all find it easier to smile.
 
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By Richard P. Holm, MD
 
Be careful when you mess with Mother Nature. Once we began defining the human genome, we started to realize how many bacteria, fungi, and viruses live in and on our bodies. We believe that each person standing in front of us are made up of equal numbers of human cells to the number of non-human cells. These are not mere hitchhikers, they are essential to our living. Even within each human cell we have components called mitochondria that originally were bacteria. Eons ago they became incorporated and an essential part of the functioning human cell. We couldn’t survive without the outsiders. Simply put, we are like a country made up of natives AND immigrants working together for the good of the whole.
 
The attached non-human organisms, together, make up what has been called the human microbiome or microbiota. Researchers are trying to know better what is a normal or abnormal microbiome, what causes it to be imbalanced, and what can be done to enhance a healthy microscopic environment of organisms that are getting a lift on our bodies.
 
A powerful example of imbalance comes when the use of antibiotics alters the microbiome and results in the emergence of a harmful and even deadly overgrowth infection by a bacterium called Clostridium difficile (C. diff). The result is a very sick large intestine. Think how weeds take over a lawn when the grass is destroyed.
 
Aside from the invasive, severe, gut illness of C. diff, there are other human conditions and illnesses that may be related to an imbalanced microbiome such as: irritable bowel syndrome, psoriasis of the skin, uncomfortable infections of the vagina, obesity and rheumatoid arthritis, as well as neuropsychiatric disorders such as autism, schizophrenia, obsessive-compulsive disorder, attention deficit disorder and chronic fatigue syndrome. Research is ongoing and we have a lot more to know before we have microbiome related treatments.
 
We all know that, when used appropriately, antibiotics help people and save lives, but experts estimate that 20 to 50 percent of the use of these microbiome disturbing antibiotics are inappropriate or unnecessary when used in hospital settings, and that percentage is worse when used in outpatient settings.
 
Understanding and protecting our normal flora, our microbiome, the community of organisms that live in, on, and around us gives us a whole new way of dealing with many illnesses. We need to be very careful to use antibiotics only when absolutely necessary. Be careful when you mess with Mother Nature.
 
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By Joanie S. Holm, RN CNP
 
The famous American artist, Andrew Wyeth, graced the world with many works of art. One of his most famous, Christina’s World, is at home in the Museum of Modern Art in New York City. This painting portrays a woman in a field of tall grass at the bottom of a hill below a dilapidated farm.  On close inspection, it is noted that the women has rail thin arms and hands that seem to claw the ground.
 
The woman is Christina Olson, a friend and neighbor of Wyeth’s in Maine. Christina was an extremely independent woman who suffered from a progressive neuromuscular disorder thought to be Charcot-Marie-Tooth disease (or CMT). Her ability to walk as a toddler slowly diminished as she aged. She refused to use a wheelchair or walker, preferring to use her arms for crawling.
 
Charcot-Marie-Tooth disease is one of the most common inherited neurological disorders, affecting approximately 1 in 2,500 people in the United States. The disease is named for the three physicians who first identified it in 1886: Jean-Martin Charcot and Pierre Marie in Paris, France, and Howard Henry Tooth in Cambridge, England. CMT comprises a group of disorders that affect peripheral nerves, those that lie outside of the brain and spinal cord. CMT is caused by a gene mutation that affects the covering of the nerves. There is no cure and treatment is aimed at symptomatic care.
 
Upon learning of the story behind the famous and beautiful Andrew Wyeth painting, I enjoy it at a different level. Andrew Wyeth got to know the soul inside the women who had physical struggles in this life. I’m grateful to him for giving this to the world.
 
I’m also grateful for Drs. Charcot, Marie, Tooth and all of the other scientist who helped and continue to put the puzzle pieces together for those who suffer with neurodegenerative diseases. Their work may not be lauded as masterpieces and displayed in the museums of the world, but their contribution to society should not be overlooked.
 
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By Richard P. Holm MD
 
It was a Boy Scout canoe trip into the Minnesota Canadian boundary waters in the summer of 1965 when a gangly group of DeSmet Scouts discovered the sun again after two days of chilling and soaking rain. Taking our noon break from canoeing all day, we found a solar exposed, very large, warm, and welcoming rock on an island and stretched out on its warm surface We took off our shirts and dried our soaked socks while reveling in the renewing rays of the sun.
 
At that moment I could feel the wonderful power and force of ol’ sol beaming into me. I remember thinking how the sun’s radiation was the visible energy source for life on this earth, and I wanted more of it. It must be a natural instinct to want exposure to the rays of the sun. Think how people seem to gravitate to the beach for sunbathing, and how sad some get in the days of the winter solstice when there’s not enough of it.
 
Recently, we have become more aware of the importance of enough vitamin D which our bodies manufacture when rays of sun come in contact with our skin. We can also get this important vitamin from the oil of deep-sea fish (such as cod) who live in very dark waters gathering their vitamin D by eating falling phytoplankton who mostly live on the sun-soaked surface water. The fish store their plankton-source vitamin D in their livers, and it is that cod-liver oil source of vitamin D that supplemented children for many years. Now we can take fish oil capsules, flax seed oil (another vitamin D source) and vitamin D3 supplements which all work to do almost the same thing as laying out on a warm rock in the boundary waters. Still, we know that just about 50 percent of people don’t get enough vitamin D.
 
The flip side of all this sun and vitamin D talk is that one can get too much of both. One should not take more than 5,000 international units (IU) of vitamin D per day, and one should avoid too much sun. We know that excessive sun (or tanning booth) exposure causes premature skin aging with wrinkles, sagging, brown spots, rough skin, not to mention skin cancers.  You hear and read everywhere the following words of advice: use sunscreen, wear protective clothing and avoid tanning booths.
 
But after two days of a soaking cold rain, it should be okay to lay out on a warm rock.
 
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