Graying hair is a big concern for both men and women. After age 30 hair begins to gray 10-20% every decade. The process by which hair grays revolves around the presence or absence of a cell type in the hair shaft.  The pigment is derived from melanin in cells called melanocytes.  These cells are the same cells that produce skin pigment and make us brown or give us olive complexions. When the pigment in the hair shaft dies the hair becomes gray or loses pigment.

Stress does not produce gray hair in contrast popular belief. Stress causes hair loss, but not graying. Genetics plays the most significant effect on whether you are going to be gray. Premature gray hair has a genetic basis and that would be defined as gray hair before the age of 30, more likely from the early teen years. Race plays a major role: Caucasians get gray in their mid-thirties, Asians in their late thirties, and African Americans in their mid-forties.

The most interesting aspects about going gray are the fact that gray hair is associated with many conditions such as autoimmune disease, lack of vitamin B12, thyroid disease, and something called vitiligo, a condition wherein pigment is lost in various parts of the body.

Smokers are 2 ½ times more likely to go gray before age thirty.  Continued smoking can also make gray hair look yellowish.

What is C. difficile and where does it come from?

In medicine C. difficile is called an emerging pathogen. The proper name for this infection is Clostridium difficile and it is a bacterium which produces spores.  Spores are like seeds that are heat resistant and sometimes antibiotic resistant.  Found primarily in health care facilities, the infections have been increasing in recent years.  Hospitals and nursing facilities are the institutions where this infection can be found. Sometimes it is very resistant to treatment and has caused death in some patients.

The disease is usually associated with antibiotic use. All antibiotics carry a risk of C difficile infection. After the C. difficile colonizes the bowel, spores vegetate and multiply. Then the bacterium secretes a toxin or poison that can cause a form of colitis and severe diarrhea.

More than 20% of patients hospitalized and on some form of antibiotic can have C. difficile infection.  In the community where a person has been on antibiotics and not hospitalized, the incidence of the diarrheal producing organism is only 1-2%.

c. difficile is one of the main reasons that we ask our doctors to wash their hands between visits of patients in the hospital or in the nursing home. The spores or little seeds can be on chairs, beds, tables and patients for weeks or months.  Patient rooms must be cleaned after a C. difficile produced diarrheal illness and doctors have to follow the rules of hand hygiene.

As with every bacterial infection, this one is particularly difficult to eradicate in some patients and there are certain genetic strains of the bacterium that are more toxic and deadlier than others. These are the infections that produce extensive bowel disease and even death of the patients who are infected.

We generally use specific tests of any patient who has greater than 3 unformed stools over a 24-hour period for greater than two days. The stool can be sent to the lab for diagnostic testing to be sure that C. difficile is the real culprit. In over 30% of patients the disease continues to reoccur.

If one stops the offending antibiotic, the disease goes away on its own in 20% of cases.  Diarrhea which does not go away on its own might require strong and more specific antibiotics to kill the organism. If you are a careful reader, this might sound a bit contradictory, but this infection like all others can respond to antibiotics which are specific and are not the same as those which caused the initial infection.

This is one disease which can be very resistant to treatment and is another reason why your doctor should not use antibiotics indiscriminately for “the common cold” or an infection caused by a virus and not a bacterium.  Indiscriminate use of antibiotics can produce an even bigger problem for you the patient.  Aside from C. difficile, the main reason we have bacterial resistance for many of our common antibiotics is the indiscriminate use of them. Ask your physician if you really need an antibiotic.  Some doctors have the idea that the patient will feel better with an antibiotic which is not needed and practice less than excellent evidence-based medicine.

Commentary

I recently heard about a person who was found by a neighbor to be unresponsive; not breathing and with no pulse.  The neighbor did not wish to do CPR, even though the 911 dispatcher was willing to give direction on the telephone. The patient was essentially dead, but that determination should be made by EMS and not the neighbor, who was apparently so frightened that he did not wish to begin CPR in the chance that he might do something wrong. There is always a chance that a patient might possibly come to life with artificial resuscitation until EMTs and police arrive. Regular people can save lives if they listen to dispatchers or better yet, know how to do CPR themselves.

Most sudden deaths can be brought back if CPR is instituted and if an AED (automatic electrical defibrillator) is present and can be hooked up to the patient immediately. Most public places like schools, airports, churches and stadiums have these devices on the wall.  It would be a good idea to familiarize yourself with the location of these devices, which are easy to use, when you are in a public place.  Better yet, take a course in CPR and the use of the AED.  There is nothing more satisfying than saving someone’s life in an emergency, while you wait for the professionals.  As we say, “time is brain” and CPR is the way to make sure that you the deceased the best chance of coming back to life.