Chapter Eleven

"Without you, I'm working with the rain falling down/ I'm half a party in a one dog town/ I need you to chase these blues away..."

Neurons: A cell that is transmitting information using neurotransmitters.

Neurotransmitters: A chemical released at the end of a nerve, telling the immune system how to behave via the information it delivers.

Norepinephrine: A neurotransmitter that is responsible for mobilizing the brain and body to take action.

Acetylcholine: The central neurotransmitter communicated through the parasympathetic pathway.

Lab Notes:

When the vagus nerve is electrically stimulated, those neurotransmitters tell the spleen how to behave.

Neurons communicate using either electrical or chemical signals through sensory stimuli.

When the vagus nerve is stimulated, it sends an electrical signal down to the spleen.

When it arrives at the spleen, the electrical signal then converts to a chemical signal.

A neurotransmitter called norepinephrine interacts with t-cells in the spleen, which then releases acetylcholine, the other neurotransmitter.

At that point, the acetylcholine travels to the macrophages – which are white blood cells – and tells the macrophages to turn off the overproduction of inflammation.

Those two neurotransmitters are our MVPs here – we need them at bat to turn off the overproduction of inflammatory cytokines.

Before the batter goes up, though, you gotta give ‘em a bat (or in this case, a zap).

What’s more, Dr. Sangeeta Chavan and her team discovered a small cluster of neurons within the brain stem that is responsible for the production of inflammation in the immune system, traveling by way of the vagus nerve.

While it’s been known that the vagus nerve is the ‘inflammatory reflex’ and that stimulating the nerve inhibits inflammation and cytokine production, it was not yet understood the origin of where the signals that travel down the vagus nerve come from. Dr. Chavan and her team discovered that anti-inflammatory (cholinergic) neurons from the brain stem’s dorsal motor nucleus communicate with the spleen by way of the vagus nerve.

This is wildly significant and a major advancement and milestone in the field of bioelectronic medicine. The more that we understand the functional neuroanatomy of the origins of how our immune system functions as a result of not only nerves, but our brain itself, the better we can create devices and therapeutics that target certain outcomes to prevent, treat, and cure the diseases of today.

Class dismissed.


The Land of Experience

In June and July of 2014, my doctors and I were trying to wean me off prednisone – I was on it nonstop for too many years at that point, and they were concerned that I would develop osteoporosis from it, as prednisone breaks down and weakens bones.

During my prednisone taper, I spent most of those two months in bed — the pain, swelling, nausea, fatigue, insomnia, depression, and anxiety of the wean made it almost impossible to function.

Prednisone affects every part of the body and coming off it isn’t just a matter of worrying about the inflammation flaring more, it’s also a matter of how it impacts the emotional state and circadian rhythm. The reason these side effects occur is that my body was dependent on prednisone to provide it with cortisol, so my adrenal glands basically stopped producing normal levels on their own, because there was no need to. Now they had to start producing again, and they were having a hard time — my hormone levels were all over the place. Scientifically, it made perfect sense — I kept reminding myself of that because as a generally happy person, it was hard to feel hopelessly depressed and anxious without a solid, tangible reason that I could pinpoint (other than my disease symptoms flaring more, which should have been enough).

As I laid in bed every day, I felt ridiculously uncomfortable in my skin in every way — and I was tired of it. I was in the middle of paradise, on summer vacation, trapped in my bedroom.

One Sunday morning, Sean laid down next to me. I was on my back, pillows propping up my knees, laying in the dark with just enough light coming through the shades to prove it was, indeed, daytime. Sean pulled himself up next to me on his side and put his hand on the top of my head, stroking my forehead with his thumb. I turned my head toward him and burst into tears. “I hate seeing you in this pain, little lady,” he said, stroking my forehead. “Let’s get out of here, I know you can’t do much right now, but let’s just go for a drive.”

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