Thursday, March 31, 2011

in the throes of pre-graduate school anxiety

There are some types of uncertainty with which I do well (lab project outcomes).  Other types of uncertainty (did I choose the right graduate program) highlight the fomentation of anxiety at which I excel.

I have read that this is a common after-effect of deciding on a program, or a post doctoral or even faculty position.  The additional consideration that I am entering this with a much more specialized background than most students (read: 4 years in a lab where I introduced, managed and wrote manuscripts for my own projects) puts the anxiety into perspective.

I have chosen an excellent program, with a handful of outstanding mentors and a supportive student populous; and in it, I will thrive.

My particular mental block comes from peering (possibly, too) far into my future.  Research, for me, will always be most exciting in the world of repairing neurodegenerative pathologies that lead to motor dysfunction.  Ideally, Parkinson's and Huntington's diseases.  But there are also technical skills hovering in my dreams that I can only learn (in my chosen program) in spinal cord injury research.

This is perfectly adequate in terms of developing interventions for motor impairments.  However, it presents a confound to the seamless progression of my academic career.  Namely, if I transition from the basal ganglia (PD and HD, where I have spent the last four years) to the spinal cord, I risk limiting my future post doc positions to spinal cord labs.

Had I the resources, I would present the stats on graduate students who obtained post doc/ faculty positions in a different sub-field of neuroscience than their graduate studies...  For the time being, I will attempt to resolve my inner conflict with the hope that it will all settle itself when I get there.

Wednesday, March 23, 2011

Monday, March 21, 2011

scientists with disabilities: part deux

The first part of this discussion can be found here.

It's time for some pro-activity.

There is an opportunity through the Society for Neuroscience called the Neuroscience Scholars Program.  It is a small three-year stipend for aspiring neuroscientists to fund enrichment opportunities such as conference attendance, workshops, travel for methodology training, etc.  It is aimed at those students of underrepresented race or ethnicity, from a disadvantaged background or with a disability.

Although I hate to refer to Crohn's as a disability, it can be very much an impairment to normal activity.  Therefore, I have decided to apply for the scholarship in the hope that the support from the program will ease my pursuit of opportunities beyond the laboratory.  One of these is to begin giving a voice to scientists with health impairments.  When I first decided to work toward my PhD, I scoured the internet and other resources for evidence that a chronic health condition such as Crohn's did not condemn one to mediocre science.  Instead, such a condition forces a researcher to be more innovative about approaching and negotiating obstacles, both in and outside of the lab.   I found several historical (e.g., Edison's diabetes, Einstein's dyslexia, Galileo's chronic rheumatic seizures) but almost no modern accounts of success. 

In my case, although I have had intermittent years which took a horrible toll on my soul, I found solace in my ability to continue with scientific inquiry.  When I could not conduct experiments, I read and wrote.  When I could not think clearly, I did extraordinary amounts of smaller tasks which involved more muscle memory than mind.  When I had to go slowly, I gave up reading or movie-watching time to relieve myself of the stress of time constraints on my lab projects.  There are always avenues that could be modified to accommodate the changes in my body.  There are always new strategies.

It warms my heart whenever celebrities out themselves in the media as maintaining a modified rockstar or celebrity athlete lifestyle with Crohns.  It gives hope to those of us who only see the seemingly flawless outcome, otherwise.  I decided that someone needed to be that celebrity for the world of science.  It is certainly not me, but I am taking steps to reach out to the physically and mentally disabled communities of scientific researchers (if you know of any, please send them my way).  With the support of the Neuroscience Scholars Program, I would hope to enhance this outreach in the way that CDSN and have provided a support and resource hub for Crohnies and scientists.

Wish me luck.

Friday, March 18, 2011

cry of the neglected tummeh

Alright, I can take a hint.

I've been far too stressed, eating too many salts and sugars, indulged in a little more wine than I should.  Or, I have a stomach virus.  The fatigue, nausea and pain are indicative of either.

For the second day in a row, my gut is calling out for attention.  "Drug me!  Heat me!  Love me!"  I'm not a thrilled.  But I totally deserve it.  Perhaps its also calling, "Slow down!"...

I'll give it another day or two before I implement Prednisone or Promethazine.

Thursday, March 17, 2011

a role for pattern-recognition receptors in gut flora dysbiosis in Crohn's

It's not been a spectacular last few days, and I've not been feeling particularly well.  The stress of my rotting teeth/jaw, decaying scalp, deteriorating wallet, work transitioning and the realization that in three months I will be leaving all the people I love is, indeed, catching up with me.

So I decided to make all efforts to allow today to be as awesome as possible... excluding exercising.  I'm at work at 6am, which is early for me these days, in order to finish a project before 1pm... so that I can make it to my fourth dental appointment in the last three weeks... so that I can receive some more bad news... so that I can be sucked down into the gutter and then be plucked out again by a dinner with two of my favorite human beings tonight.

I've been reading a lot of literature on the imbalance of helpful and harmful gut flora lately, a condition called dysbiosis.  There have been several microbiota implicated in Crohn's disease (klebsiella, E. coli, paratuberculosis, Campylobacter jejuni, enterohepatic Helicobacter species).  However, a recent review in Nature suggests that no single bacterium has been definitively associated with Crohn's.  Instead, Si Ming Man and colleagues argue that defective sensing, killing off and generally balancing of gut microbiota is largely due to defective pattern-recognition receptors.

Pattern-recognition receptors are just what they sound like. They allow the host [read: intestine] to identify molecular fluctuations in gut microbiota that might indicate harm, and activate an immune response.  These pattern-recognition receptors (mostly toll-like receptors) in membranes of the epithelial cells that line the gut activate nuclear factor kB (NFkB), which leads to productions of interleukins and the infamous TNFalpha.
Man SM, Kaakoush NO, & Mitchell HM (2011). The role of bacteria and pattern-recognition receptors in Crohn's disease. Nature reviews. Gastroenterology & hepatology, 8 (3), 152-68 PMID: 21304476

Wednesday, March 16, 2011

some more great research into the role of gut flora in digestive disease

A recent article in Scientific American left me surprisingly impressed with its coverage of some very well done research presented by post doctoral fellow Michelle Smith at the International Human Microbiome Congress in Vancouver, Canada.  Kwashiorkor is the condition that causes the abdominal swelling due to malnutrition that is so common in poverty- and famine-stricken regions.  Smith concluded that differences in gut flora can determine individual susceptibility to malnutrition and other illnesses.

This kind of research bodes well for the acceptance of balancing gut flora as an approach to treating many gastrointestinal disorders.

Friday, March 11, 2011

resources for the neurosciences graduate student

I can't stress enough the importance of networking in the scientific community.  Be it for collaboration on a study, tips on a technique, developing your career or just commiserating, your peers in the world of research are often your greatest resource.

Some of the links in my Procrastination Station are some networking resources which I have found to be outstanding.  Benchfly and Society for Neuroscience's Menthorship Program.

What is terrific about Benchfly is that it transcends individual scientific fields and highlights what we share between specializations.  This is a hub for video protocol sharing and career jump-starting, survival and development.

The relatively new Mentorship Program through SfN is specific to SfN members.  It is a way for fledgling scientists to connect with the masters of the trade through whom to find guidance and tips.

If you have a favorite networking and development site, please share it with me!

Wednesday, March 9, 2011

on not so terrific starts to the day

Dear 3am,
          Back off.  It's not going to happen for us.
          Not without Prednisone, anyway.
                               - R

I keep waking up in cold sweats with anxieties about my jaw falling off and my lab falling apart when I leave in July.  Perhaps it's my overzealous ego rearing its ugly head, but I like my teeth and no one can deny that the pace in my lab will slow when I leave.  In my defense, my boss is stressed about it, too.  Half of my stress comes from wanting to assure him that everything will be fine when I'm worried that it wont.

It's really not so terrific to dread going in to work each morning because your guilt pangs are so intense and your confrontational skills are so lacking that you spend the wee hours of the morning anticipating incidents and practicing being stern with hard-headed and cocksure trainees who are convinced that they don't actually need to be trained.

Were I feeling better, I'd just go for a run and start the morning, but I'm not.  Everyone around me is flaunting their cold, and my defective immune system is trying to convince me that I haven't caught it.  Well played, I-Sys, but not well enough.

Three cheers for no nausea though, eh?

Saturday, March 5, 2011

wherein Crohn's disease meets dental work

I do have good news forthcoming.  It is being delayed by my promise to withhold such commentary here until my guest post is published on the esteemed BenchFly blog.

In the meantime, I have been to the dentist.  Admittedly, it has been two years since my last visit.  Part of the reason for this is because I've been so overwhelmed with directly Crohn's-related medical appointments/maintenance.  I emphasize directly, here, because my new dentist was kind enough to give me the gritty details (te he) of how the current condition of my teeth and jaw is indebted to my Crohn's treatments.

Just to brag, I have six new cavities, one previously filled cavity that has deepened and threatens to warrant a root canal, and jaw misalignment which threatens to evolve into a serious TMJ problem.  My wallet is thrilled.

For a brief history, I had no dental problems until the age of 20.  No cavities, no alignment problem, no braces.  Then, after my second Prednisone stint, I suddenly had three cavities.  Two years later, one of those cavities became root canal-worthy -- over the Atlantic on a flight to Israel, no less.  Now, at 25 and following my third and longest acute Prednisone treatment and my first year of Remicade, I am blessed with an onslaught of six new cavities, a potential second root canal and likely TMJ.

When I was younger, my dentist gave me the same spiel every six months: "Your gums are bleeding so clearly you're not flossing.  You need to floss more."  As an avid every-other-day flosser up until college, I was prompted to give up the habit when my dental health declined despite my scrupulous efforts and I decided the flossing mantra was bullshit.

My new dentist told me that it was very apparent that I was taking care of my teeth (the flossing habit returned when my husband entered the picture), and that my medications were sure doing a number on my bones.  Say, what?

My renowned gastro was very convinced each time I asked (before each of my three Prednisone treatments to date), that my treatments were so short-lived that my bones were not a concern [repeat: not a concern].  So I wasn't adamant about calcium supplements [read: there were no calcium supplements involved during the first ten years of my treatments].  Nor fluoride treatments.  Oops.  Your gastro hardly ever cautions you to take care of your teeth on Prednisone or Remicade, but the above developments in decay are not specific to me.  Google it.

My new dentist's explanations included citing the bone density loss associated with prolonged Prednisone, or multiple short acute treatments.  Remicade's role seems to be more subtle, in terms of causing dry mouth which, by decreasing salivary flow, decreases the washing-over of gums and teeth with salivary disinfectants such as lysozymes and peroxidases which help fight cavity-forming bacteria.  This example is in addition to Remicade's suppression of the immune response, in itself making the mouth more susceptible to bacterial invasion.

As a scientist, I am embarrassed at not having assumed these conditions of my own accord and treated them despite a lack of concern on my physician's part.  As a human being, I feel bummed and duped.

I am currently brushing twice a day, flossing once a day, using anti-cavity fluoride rinse twice a day, having each cavity filled over several appointments, chewing xylitol gum daily, fitting a mouth guard in attempt to ward off TMJ, and taking calcium supplements religiously.

Wouldn't it have been nice if a gastroenterologist could have helped me prepare to fight these potential side-effects at any of the three times that I've been put on Prednisone, or when I started Remicade treatments?  In fairness, they're not dentists.  But also in fairness, "bone density loss" implies inclusion of teeth as components of one's physiology.  In yet even more fairness, I have not been to the dentist in two years, and perhaps a good dentists like my new one would have mentioned something earlier on that would have helped me to prevent this mess.  Live and learn, eh?  Now we know what my fellowship money will be spent on.