Gratitude - 12/18/18

I am so grateful for a few things today.

I am really grateful for my sister in law today. She sent me a message letting me know how much she cares about me and that I have a heart of gold. That message really meant a lot to me and has helped me to smile over the week. It has also brought a thought to mind... what am I doing with that heart of gold? Am I helping others? How am I using that heart and generosity to help others? I am grateful to the joy and wonderment she brought into my life this week.

I love John Oliver. I learn so much from him and appreciate the research and work his team accomplishes to educate his viewers and it makes a difference in my life. One of my final school papers before I graduated was on sexual education - I got the idea for the paper and started my research using one of his episodes. (See link here) I have been able to rest some days this week and go over some of his older episodes and enjoy and relearn. I am glad to have the opportunity to re-watch them through Youtube and think over the information contained in them.

I got two Christmas cards today. One of them is from my brother and his family and the pictures and the joy contained in them are so obvious and wonderful. I put it on my fridge and I look at it every time I walk by. One of my nieces looks a lot like me and I look in awe of genetics and how genes can be turned on in different pieces of different families. Bug doesn't look much like me at all if I think about it. The other card is from a good friend who sent me the newest noise Christmas album that he put together with music from lots of groups. I can't wait to listen to it tomorrow when I'm trying to get a good walk in. I'm not going to do Christmas cards this year so I am very grateful for every card that I get. They give me a lot of joy.

I discovered a new author today- B.B. Haywood. I have started the author's first book ("Town in a Blueberry Jam") and I am enjoying it in my free time very much.


I had a gluten exposure recently and I have been fighting the pain and exhaustion that comes with it. It hasn't been that bad this time and I am so glad that I am spending less time just fighting my body to get it to move and do what needs to be done. I am thankful for my treadmill because I can walk slowly and intermittently in a warm place... Maine sure is cold right now. Being able to try and keep my health up in a warm safe place is not something I take for granted.

I am grateful for my very best friend. She keeps me sane, less lonely, thoughtful, and as self sufficient as I can be right now. She is supportive and I can't thank her enough.

I am grateful for my ex. He really does a lot of things for me and I appreciate it very much. I am very grateful.

What are you grateful for today?

Things to Smile About

I'm trying to recover from a gluten exposure this week. I hate the way that my body feels as it tries to heal up because everything feels fragile and weak or doesn't work well. I lose most of my desire for food and have no desire to do anything but remain stationary. For the most part, the option of doing nothing really isn't a viable choice so I try to accomplish the minimum needed so that I am able to give my body the rest it needs to heal up. So today I did some needful errands and chores as well as paperwork and have tried to intersperse restful behavior throughout. Settling down to rest sometimes allows me to really look at some of my 'favorite' things and enjoy them for what they are... instead of just a quick glance as I head off or out to do something. Here are a few of them.

I got this really cool dragon from a Value Village in Seattle. I had been shopping with Shaneen and Katey and I can't remember who suggested that 'who doesn't need a cool dragon in the house'... but I decided I did. Bug loves it and considers it his and as it gets moved and carried around enough it is starting to break around the wings and ears. But I can't help but smile every time I look at it. Its a pretty cool piece of work and I wonder who made it and how they managed to let it go.

I love this vase. I'm not sure why specifically, but I love the way it looks and I always smile when I look at it. Daisies are my favorite flowers and they look great in it and each emphasizes the beauty of the other. I have no idea who made this vase, but it's pretty awesome.

I love houseplants. I got this one when someone left it in the free room at the transfer station and I happily scooped it up and brought it home. I got it last fall and it had a pink flower or two but almost no leaves. I tried to water it and coax it into growth and got absolutely nothing... just a few leaves that limped along on the stems throughout the winter. This summer I made sure the plant spent a lot of time outside and it developed lots of leaves and several flowers, but as fall came it still didn't have the 'hearty' look I had hoped for. So I have fussed and worried about it concerned that it might struggle to survive this winter as well. However, while the flowers are gone, all of the remaining leaves have stayed on. not only that, but soft slim tendrils are stretching up my wall to wrap around the curtain rod. Just seeing that brings a large smile to my face.It is still a bit 'awkward' in how is it growing and in appearance, but I see that as a metaphor for life and enjoy it anyway.

When Remus had his tail removed, the stump looked naked, tight, and weird. It looked a bit indecent and watching him 'wag' it was hilarious and appalling all at once. I remember telling Katey that I hoped he managed to get some of the hair to grow back onto it so that it was 'less' difficult to look at. Today, Remus sat by me hoping for as much attention as he could get and I got a really good close look at his stump... and it is beautiful. The hair has grown over it and the stitches are starting to fall out as everything heals. (Purple stitches on dark black skin looked a bit odd as well.) I am so glad that his tail matches the rest of him now and when he wags it the tail looks like a part of him instead of something stuck on with glue.

I found myself thinking of the film 'Picnic' today. I love the story and the images so I pulled it out today to watch. Its only about five minutes long and it is for children, but I love it and find it restful and fun to watch all the same. I just want to hug the little mouse when he finds and hugs his doll. It's a sweet peaceful film to enjoy.






These are the main things that brought some joy into my life today. I intend to spend what little of the day is left with a book by one of my favorite authors.(She must be a favorite- I've named a few cats after characters from her novels. Cyril is the most recent animal to share the name of the cat who annoys Racer in the police station although my Cyril is much more calm and docile than his namesake in the novels :) What did you enjoy today?

Bloodborne Pathogens Answer Key

Here are the answers I promised for the test I posted yesterday. I have also included some page numbers in the manual for those who are so inclined and have a manual. :)

1. A - (p. 4)

2. A - (p. 5 (6)

3. C - (p. 5)

4. B - (p. 4, 5)

5. C - (p. 4)

6. A - (p. 7)

7. D - (p. 8-9)

8. A - (p. 16-17)

9. B - (p. 9-10)

10. D - (p. 4)

11. D - (p. 9)

12. C - (p. 11)

13. A - (p. 5)

14. D

15. B - (p. 9-10)

16. D

17. B

18. C

19. D

20. B - (p. 5)

21. B - (p. 5)

22. D - (p. 9-10)

23. C - (p. 3, 11)

24. D

25. B - (p. 5)

pictures from: http://gotpulse.com/Bloodborne-Pathogen-Training.html

Bloodborne Pathogens Course Practice Test

As a Basic Life Support Instructor, I sometimes take the time to create practice tests for students to see how well the information has been maintained. The American Heart Association doesn't always have a test for a class and I sometimes have students ask for a pretest to get ideas on what the class covers. I wrote this test a few years ago and thought I would put it here for people to use. I will post the answers for it tomorrow. :)



1. What are Bloodborne Pathogens?
A. Germs in the blood that make people sick
B. Germs in the air that make people sick
C. Germs in all bodily fluids that make people sick
D. Germs in the environment that make people sick

2. Bloodborne pathogens training teaches....
A. How to act if an exposure to a bloodborne pathogen occurs
B. The employee to quickly leave the scene of a blood spill
C. How to clean up a blood spill without personal protective equipment
D. Safe handling of blood without wearing gloves

3. What does the 'P' in PACT stand for?
A. Power
B. Pathogen
C. Protect
D. Pulmonary

4. The main ways bloodborne pathogens can enter the body and make you sick include...
A. Picking up a towel with a small drop of blood while wearing gloves
B. Getting stuck with a sharp object that has blood on it
C. Wearing gloves with blood on them
D. Wearing gloves and picking up a container that has blood inside it

5. Which one of these symptoms is not a symptom of HIV/ AIDS?
A. Swollen glands and unexplained fever
B. Poor appetite with rapid weight loss
C. Manic or strong energy
D. Increased chance of catching other illnesses

6. Universal precautions refers to what?
A. Treating all bodily fluids as if it is infectious.
B. Wearing UV sunglasses outside.
C. Never leaving your house.
D. Protecting yourself against Universal aliens.

7. The purpose of (rubber) gloving up is to what?
A. Provide a sterile environment.
B. Make you look professional.
C. Keep your fingerprints out of the scene.
D. Protect
4
8. What is the best way to dispose of needles and other sharps?
A. After using the sharp, carefully dispose of it into a sharps disposal container
B. After using sharp, throw object directly into nearest trash container
C. Cap the needle and discard into a trash container
D. After using the sharp, carefully dispose of it into a biohazard waste bag

9. Washing Hands and skin after exposure
A. is not always necessary
B. is done with soap and large amounts of water
C. is not necessary if gloves are worn
D. is not necessary if waterless hand sanitizers are available and used

10. Which one of these symptoms is not a symptom of Hepatitis?
A. Nausea, vomiting and abdominal pain
B. Damage to the liver
C. Unexplained tiredness
D. Inflammation and contusions all over the body

11. Personal protective equipment may include all but:
A. goggles and/ or face shields
B. gown, apron, booties or shoe covers
C. cap or hood
D. sunglasses and work gloves

12. Biohazard waste warning labels are usually what color?
A. Black
B. Red
C. Orange
D. Yellow

13. What does the 'C' in PACT stand for?
A. Clean
B. Cardiac
C. Control
D. Content

14. An exposure control plan contains specific details and instructions on how to clean up a mess with blood- containing materials. All of the following usually part of that plan except:
A. Use the appropriate personal protective equipment
B. Dispose of cleaning materials and any personal protective equipment in the appropriate waste containers.
C. use absorbent materials to wipe up large amounts of blood
D. watching your co-workers struggle to clean and taping it all for posterity

15. You have cleaned up a blood spill and have removed your gloves. To protect yourself you should also:
A. Use waterless hand sanitizer
B. Wash hands immediately with soap and large amounts of water
C. Go to the break room for a glass of water and to fill out the necessary paperwork
D. Put the gloves in the closest trash can

16. What are the main diseases of concern when discussing the blood borne pathogen standard?
A. HAV, HDV, HEV.
B. PVC, BVD, HIB.
C. PCP, H2O, CDC
D. HIV, HBV, HCV

17. How many days can Hepatitis C live in dry blood?
A. 1 day
B. 4 days
C. 7 days
D. 14 days

18. What site of the human body is the most common site for TB disease?
A. Brain
B. Kidneys
C. Lungs
D. Liver

19. Hepatitis B and C can be spread by:
A. Having unprotected sex with an infected person.
B. Blood-to-blood contact with an infected person.
C. Eating food or drinking water infected with feces.
D. Both a and b.

20. Which of these is not a common entry point for bloodborne pathogens to enter the body?
A. Eyes and nose
B. Ears
C. Cuts or injuries in skin surface
D. Mouth

21. What does the 'A' in PACT stand for?
A. Assess
B. Act
C. Asphyxiate
D. Action

22. What is the single most effective form of protection for you and others during a bloodborne pathogen exposure?
A. Vaccination
B. Not eating in contaminated areas
C. Clean clothing
D. Hand washing

23. If you are exposed to potentially infectious materials on the job, you may request a vaccine for which bloodborne disease?
A. HIV
B. Syphilis
C. Hepatitis B
D. Brucellosis

24. Bloodborne pathogens may enter your system through:
A. open sores / skin abrasions
B. dermatitis
C. mucous membranes
D. all of the above

25. What does the 'T' in PACT stand for?
A. Talk
B. Tell
C. Touch
D. Time

Feedback and comments are welcome! Enjoy :)

pictures from: http://floridahomeboundfhb.com/Initial_orientation/Bloodborne/bloodb.php, http://www.slideshare.net/glenbrooksouth/blood-borne-pathogen-training

Bloodborne Pathogens: Introduction and Class Outline

One of the classes that I teach in my spare time is a Bloodborne Pathogens class. It is a class that is recommended for dentists, healthcare providers and other professionals who may deal with blood and other bodily fluids on a frequent basis. I created a basic outline to cover the information in class and I thought I would take some time over the next week to share some of the information that I give to students on a regular basis. I am hopeful that a few people can enjoy and possible use this information in your own lives. Over the next few days I will post my home written pretest along with answers.... Enjoy :)

What are Bloodborne Pathogens?

• Microorganisms present in the blood of persons who are infected with them (germs that make people sick)
What are examples of diseases that are caused by bloodborne pathogens?
• Hepatitis B infection -HBV-
Symptoms of Hepatitis – yellowing of skin or whites of the eyes, tired, abdominal pain, gastrointestinal problems including nausea and diarrhea, loss of appetite, damage to liver (can lead to death)
• Hepatitis C infection – HCV- can live in dried blood at least six hours and up to four days. (Hepatitis A is NOT transmitted by blood - it is transmitted by eating)
• Human Immunodeficiency Virus - HIV-, which causes AIDS – extreme tiredness, poor appetite with (rapid) weight loss, fever, swollen glands, etc. (affected person will get other illnesses easier (immunosupression) and can lead to death)

The Goal of this class is to discuss and reduce exposures as well as how to stay safe in environments and situations where exposures are more likely to happen!

How are bloodborne pathogens transmitted?
• By blood-to-blood contact only!
• Not by casual contact such as hugging, shaking hands, sneezing
Which body fluids may contain BBP?
• Human blood, semen
• Not urine, feces, vomit - unless visibly contaminated with blood
What are 'Universal Precautions'?
• You must treat all human blood as though it may contain any bloodborne pathogen... treat all bodily fliuds as if they are none to be infectious.
• You cannot tell if someone is infected by looking at them because many of these diseases do not show symptoms
What are the routes of infection of BBP in the general population or Most Common Forms/Paths of Exposure?
• Sexual contact
• Sharing needles among injecting drug users
• Mother to unborn child
What are the routes of infection of BBP in the workplace?
• Puncture or cut from a contaminated sharp object (needle, broken glass). This is the highest risk!
• Contact with broken skin (cut, hangnail, dermatitis including slight damage from shaving)
• Contact with mucous membranes of eyes, nose, mouth
Make a PACT, Know How to Act!
P - Protect : Protect yourself from blood or blood-containing materials
A - Act : Act quickly and safety
C - Clean : Clean the area that has blood or blood – containing materials
T - Tell : Tell your supervisor about the incident
How can I protect myself at work?
• Wear gloves if you need to touch human blood, used condoms or any item that can be or is suspected to be contaminated.
• Do not pick up needles or syringes with your hands. Use tongs or broom and dustpan.
• Do not use your hands to compress trash (to make more room in the bag). (A good rule is to not put your hands anywhere that you can not see everything they might touch)
• Use disinfectant to wipe up blood.
• Always wash your hands after you remove your gloves.
• Always wash your hands before you eat lunch and before you leave at the end of the day.

What should I do if I am stuck or cut with a contaminated sharp object (such as a needle stick or cut from broken glass, or if I get blood on an open cut, or in my mouth or eyes)?
• Wash the exposed area well
• Follow your companies procedures for notifying your Infection Control manager as set up in your company's Blood Borne Pathogens control guidelines
• Exposure control plan should include
• all job classifications that have chance of exposure to blood
• list of all tasks and procedures through which exposure may occur and are performed by employees
• methods of compliance to protect employees
• procedure for how to review problems

Are there vaccines available to prevent any of these diseases?
• There is a vaccine to prevent Hepatitis B that is given in three shots over a six month period
• You may get them through your physician or local health center or immunization clinic.
• Cost varies- some employers and health insurances will pay for these shots... never hurts to ask. :)

Feedback and comments are welcome! :)

pictures from: http://www.ehow.com/list_6822351_list-bloodborne-pathogens.html, http://www.emsworld.com/article/10320719/borne-free,

Journey Forth #6 : The Accidental Relationship between Gluten and Casein

When I was first diagnosed with celiac disease and started to research the disorder but also the foods that were available, I ran across many people who started pushing me towards a gluten free-casein free diet not only for myself but for Bug as well- we both have the disease and I think he can thank my genes for that ;) I was skeptical and I am still a bit questioning about some theories behind the diet. This particular diet is recommended for many people with celiac disease and other food allergies and it has become one of the diets of choice for individuals with autism and other developmental disorders and is sometimes recommended for people with mental health disorders such as schizophrenia. So I'll cover the basics of both. (Can I stress that I am wading into territory that is not firmly entrenched in science or statistics yet.)

The basics of this diet are that the individual not only avoids gluten but also all foods that contain the dairy protein. Some need to do this due to a true allergy and some people report that they have reactions that are similar to gluten intolerance when consuming the dairy protein. This protein can be found in butter, cheese, cream and milk, as well as yogurt and countless other products including chocolate, lunch meat or other prepared meat products and other non-dairy products. Symptoms of a true milk allergy are very similar to gluten intolerance as well as wheat allergy and celiac disease so trying to separate out the allergies and sensitivities can be pretty rough and time consuming. The most common symptoms may include; multiple skin reactions, anaphylaxis, multiple digestive complaints (including diarrhea, vomiting, and pain), multiple reactions in the lungs (coughing, sneezing, shortness of breath or wheezing), migraines, irritability, hyperactivity and other personality changes, insomnia, fatigue, depression and anxiety... to start the list. ;) If the challenge of eliminating gluten from the diet seems to be formidable, adding the need for casein removal can make the challenge seem like a herculean task.

There are a few reasons put forward for the similarities in symptoms and the immune reactions in the body between ingestion of gluten and casein. All three have been and are currently under study by researchers.

Casein is one of the most common food allergies and some studies suggest that as much as thirty percent of the general population have elevated amounts of the antibodies in their blood.

Casein has a similar molecular structure to gluten and they both create similar metabolic byproducts from their breakdown and digestion.

The enzyme that is needed to digest dairy is found in the brush borders and the tips of the villi in the small intestine... which is the first area that is damaged in gluten consumption for those individuals who are susceptible. With the necessary enzymes being in low numbers or decimated, the digestive process fails until healing and enzyme re-population has commenced... in some cases, a year after a gluten exposure.

For many parents of children with mental health disorders or developmental delays such as autism, this diet is not seen as a “diet” per se, but as a necessity and way of life. The changes in both behavior as well as mentation have been pretty well documented in self reporting and other unofficial forums. From personal experience, I feel a lot more in 'control' of my mind when I haven't had gluten- celiac aside. These experiences as well as watching and learning from friends and parents who have navigated these particular waters, I have found a great deal of confirmation in my mind that there is a great deal of positive evidence for recommendation of this particular diet for people with specific diagnoses or conditions. So even as I stress that the scientific evidence isn't there yet, I feel like I would be remiss if I hadn’t taken the time to discuss it. Whether the problems are due to the body's confusion of the proteins, lack or appropriate digestive enzymes or even another allergy... the problems are very real and need to be dealt with by individual sufferers on a daily basis.

What are your thoughts? Do you personally have experiences with this diet and individuals who use it? Please share if you are willing to...! :)

Journey Forth #4 : Some Common Myths about Gluten and Celiac Disease

When I was first starting the process that led to my diagnosis of celiac disease, I heard many things that I found out later either were not true... or the fact that they happened to be true in my case was unusual. So I thought I would write a short post on the most common myths (at least the ones that I have heard) and mention the true facts behind them.

1. Celiac disease is a simple gastrointestinal disease – For people who have celiac, they soon learn that the disease is anything but simple and doesn't only effect the digestive system. As discussed in past posts, this disorder affects every part of the body and some doctors believe that this disease is primarily a neurological one with some symptoms being digestive... and not the other way around. Even if that viewpoint isn't entirely true, the evidence of how this auto immune disorder effects and damages all organs and body systems seems pretty conclusive.

2. Celiac disease is a children's disease – While children are more likely to be diagnosed and diagnosed early, adults have the disorder as well in pretty high numbers. Estimates on undiagnosed adult celiacs range from 1 in 20 to potentially 1 in 6 for simply gluten intolerance. The symptoms tend to be more noticeable and obvious in children and adults tend to have less obvious or more ignorable symptoms... as well as the unfortunate fact that they are also more likely to be wrongly diagnosed. It is estimated that only 5% of celiacs have been diagnosed which makes up about one percent of the American population. Also, this disorder cannot be 'outgrown' and once truly diagnosed... you will have the disease for your entire life. In essence, there is no cure.

3. Celiac disease is the same as a wheat allergy – this really isn't true. While some people with celiac disease also have a wheat allergy (I might be one of those), most do not. Celiac disease is an auto immune disorder and as such the body responds differently than it does to an allergy. While both are dangerous and not problems to take lightly, they are not the same. Those with a wheat allergy can still eat barley and rye, while those with the celiac disease cannot.

4. Eating Gluten makes you fat – This isn't a true statement at all. Many people have started eating gluten free as a diet choice- some celebrities have made it more popular and 'trendy'. When it comes to gaining weight the answer is usually very straight forward... it you take in more calories than you burn, you will gain weight. While there are exceptions, the vast majority of people who start a gluten free diet will actually gain weight for a few reasons. One is that the person's lifestyle hasn't changed at all. Their eating habits, social customs and physical activity levels are what really cause an individual to develop weight gain. Another reason is that gluten free foods are thought by some to have fewer calories in them then their regular counterparts- with few exceptions, that is an erroneous assumption. Gluten free foods tend to have more fat and sugar to balance the lack of gluten protein. In order to make texture, color, and taste more 'normal', these are the ingredients that tend to be tweaked... and are also the main things that cause weight gain. Also, the average person's diet is heavy on grains with fewer legumes, fresh fruits, vegetables, and other foods that are naturally gluten free. Processed food is another factor in weight gain and so simply changing an unhealthy way of eating for an unhealthy diet without gluten doesn't really change much. Last, exercise is important for anyone and most people will gain weight if they tend to be sedentary creatures (anyone seen a thin sloth? :D Just kidding) All in all, most people do not lose weight on the gluten free diet and most individuals will put on some pounds when beginning the diet.

5. People who suffer from Celiac disease are skinny - Hmm, mostly not true. Yes there are a small percentage of people who are too slender due to the symptoms of eating gluten and the damage that it causes to the patient. However, around 40% of people who are diagnosed with celiac are overweight at initial diagnosis. Less than five percent of patients are underweight. So, not only is a person's weight not necessarily a good indicator for diagnosis, it may actually help convince people that they do not have celiac disease simply because of their extra weight... not a credible diagnostic tool.

So... do you have any thoughts on these myths? Know of one that I missed? What are your thoughts?

Journey Forth #2 : The Dietary Needs of Celiac Disease Along with Skin Challenges

In principle, a gluten free diet is quite a simple thing. An individual who avoids four specific foods that carry the gluten protein / amino acids are safe and can refrain from more damage, but also begin healing as well. Those foods are wheat, barley, rye and triticale. That seems pretty easy on the surface especially if you look at the list of flours and foods you can eat- sorghum, soy, seeds, tapioca, teff, wild rice, yucca, amaranth, arrowroot, buckwheat, cassava, corn, flax, Indian rice grass, legumes, millet, nuts, potatoes, quinoa, rice, soy, beans, vegetables, fruit, most dairy and meat, eggs, etc... However, that is where the simplicity ends.

For anyone who doesn't cook... or cannot afford fresh and unprocessed food, the challenge has just begun because an individual who tries to navigate the waters of grocery shopping can become seriously depressed. Fresh food is great and healthy, but pretty expensive. Processed gluten free foods are becoming easy to get, but there is not a lot of choice (most of it is desserts, bread or mixes) and they are also expensive- sometimes several times more money than the 'regular' product. (An example would be bread... the average price of wheat bread is around $2 or less... a gluten free loaf is usually at least $5.) And gluten is in everything else... it's in soups, spices, drinks, dairy products, snack foods, and almost anything you can buy to eat. It's also in almost all personal care products, medicines, and cleaners too. To add a little more difficulty, gluten-free food is usually not fortified with extra vitamins and minerals so it is more crucial that balanced and appropriate foods are consumed. So, for the most mildly affected, they need only navigate the complicated food maze of shopping and cooking and only worry about personal care products that can accidentally be ingested such as lip balm, medicines, mouthwash... some basics that some people do not use anyway. But for the more challenged, the more sensitive... for those whose immune systems are completely 'wacked out', they are in serious trouble. (I will admit that I made up that scientific term :)

For most celiacs, the skin is a great barrier not only for protection from many disease, dehydration and from gluten. Holding a pile of flour in their hand is nothing if they wash carefully and wandering into a bakery with the air full of the smells of fresh bread and wheat is only a tease to a person who cannot taste. To those, the majority of celiacs, I am a bit jealous. I have found that sometimes I do not even have the luxury of recognizing the 'smell' of the baking and the gluten that has been atomized in the air before I am struggling to breathe and heaving... bent over and sometimes vomiting with a strength and a lack of control I didn't know I possessed. There are many places I will not go due to this extreme reaction that my body and my mind can not seem to control. If I go into a place and start to not feel well or suspect that there is very little chance of being able to avoid exposure or illness, I leave. I may be angry, sad, frustrated... but I leave anyway. It's just too terrible to contemplate the pain and distress of an exposure... the pain and vomiting that lasts for weeks, the shaking, twitching, itching, headaches... no church activity, no community activity is worth it to me. I've tried too many times and suffered for sometimes months afterward to really risk that much again. One challenge that I have is that my skin is not a good barrier; while it does protect me from many diseases and most dehydration, it is an unloaded shield against gluten.

Skin conditions that can go hand in hand with celiac disease range from the 'simple' to the more complex. Only two conditions – that of hives and of Dermatitis Herpetiformis- can be clearly labeled a cause/effect of the disease. These others are still under study by researchers and medical professionals to determine which came first... the celiac or the skin disorder. It is unknown why some of these disorders occur together so frequently; wether they share common genetic roots or that gluten may be a common trigger. where aren't too many so I'll give some basic information on them with the formerly mentioned first. :)

1. Hives – This word describes a rash or outbreak of red bumps on the surface of the skin that are warm, itchy and usually appear quite suddenly upon either contact or ingestion of a product/object that someone is allergic to – some common allergies that cause this form of swelling and rash are peanuts, cats, bug bites, etc... This is not a very common side affect in celiac disorder and is highly debated in the medical community with some for and some against. I have sometimes gotten hives from external contact with gluten and I do very much avoid it as I have felt sick or had some symptoms afterwords – this has happened EVEN when I didn't know the gluten was there and actually thought the food or product was safe. Other people have reported hives after gluten exposures on the cheeks and arms/wrists.

2. Dermatitis Herpetiformis – this is a painful and itchy skin manifestation of the disease. For many people affected, they will feel minimal digestive complaints so this is usually diagnosed with a biopsy of the sores and bumps on the skin which are caused by the immune system in the intestine itself producing an antibody that enters the bloodstream and can collect in the small blood vessels in the skin, causing the sores and rashes. This quirk in the celiac disorder affects more men than women and the skin problems usually resolve with the gluten free diet and usually are not exacerbated by touching gluten- very much an inside the body sort of thing. And I must stress that this skin manifestation is in no way related to the herpes virus – this is a problem with gluten and celiac disease, pure and simple. These blisters are painful and can be very challenging to hide which adds to the stress of the situation for the affected individual. It is also very often confused for other problems including bug bites and allergies, eczema, dermatitis herpetiformis, hives and contact dermatitis and psoriasis.

3. Psoriasis – This disease causes the skin to become thick, scaly looking and red. It is caused when the immune system sends out faulty signals that tend to speed up the growth cycle of the epidermis layer of skin cells and is thought to be one of the most common autoimmune disorders in the United States. So skin cells that would take weeks to reach and replace the outer layers of skin would now arrive at the surface of the skin within days and it is this action that causes the common symptoms. Many patients often have high levels of gluten antibodies in their blood even if they haven't been previously diagnosed. In some individuals, psoriasis will not only affect the the skin but the joints and will develop arthritis as part of the disorder.

4. Acne – The bacteria filled, painful bumps and 'whiteheads' that can form on the face and the rest of the body are fairly well known to many people- especially teenagers. They can be caused by general hormone fluctuations, but in celiac disease, they are thought to form from hormonal imbalances caused by the malabsorption of nutrients... robbing the body's systems of the correct tools it needs for homeostasis.

5. Dry Skin (chronic) – This is very common in those individuals affected by celiac disease and in its mild to moderate forms are pretty easy to control by lotions and even supplements. It is thought to be caused from the lack of nutrients that are able to get to the skin due to the inability to absorb nutrients and it has been found that thought who follow the gluten free diet may still be deficient in some of the skins specific nourishing needs (such as vitamin E) due to removing most or all grains from their diet... even the 'safe' ones. For individuals whose bodies are really unable to recover from the gastrointestinal damage that has been caused, this can be a life long problem.

6. Alopecia Areata- This auto immune condition attacks the hair follicles causing the hair to fall out and in some cases, fail to regrow even with treatment. While the majority of sufferers develop bald spots on the scalp, other areas of the body can be affected as well including areas of beard growth. Some individuals also report symptoms of skin tingling or pain in the areas of hair loss. There is some evidence that living a gluten free lifestyle can change the health of the hair follicles and allow for healing and some hair regrowth... but it is certainly not a given! Also, an individual with celiac disease who continues to eat gluten can get alopecia from nutritional deficiencies from the malabsorption of nutrients- these deficiencies include iron, vitamin C and the B's, biotin, selenium, calcium and protein.

7. Eczema – This is a skin condition that is more likely to affect people who already have some problems with allergies. The skin develops inflammation and raised bumps or areas of severe irritability. Depending on the affected individuals skin color, the affected areas make look reddish to brownish color or may look lighter or darker than the skin around it. All the stricken areas tend to also appear dry with thickened or even scaly skin. No matter what the rash or discoloration looks like, it is always itchy! This disorder is found more often in children and there is growing evidence linking the development of eczema in those with celiac disease.

8. Keratin Pilaris – This skin condition usually manifests itself through tiny goosebumps- like marks on the skin that feel a little bit like rubbing a shark skin the wrong way or even mild sandpaper. They are most common on the back of the upper arms or on the back itself, but can also be found on other parts of the body on the skin. When they appear on the face, they can sometimes be mistaken for acne. They are more likely to be more prevalent in winter or in an environment that is cooler with a lower air moisture content. The good news is that while this spots are not pretty and may be distressing to the person who suffers from them, they rarely hurt, itch, or do anything that caused discomfort to the patient. This disorder is also common amongst individuals who also have eczema.

I am extremely lucky. While I have challenges with dry skin often and hives occasionally, my health has not been affected by any of these skin disorders. As research continues on into the causes and needs of all of these disorders, I am hopeful that many of them will become more rare and less challenging for those who have to live with them. Are you or anyone you know affected by any of these skin disorders? If so, do you have any experience with any of the potential links above? Have you been tested for antibodies or attempted the gluten free diet for symptom relief? If you have followed a gluten free diet for a while, will you share your thoughts on it and how it has helped (or not helped) you and your health? Any tips for those navigating the beginnings of gluten elimination in the diet. Please share!