William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
A little fiber history
Fiber became a household word back in 1970s when Dr. Denis Burkitt, a man nicknamed the Fiber Man, and his colleagues made "the fiber hypothesis" that states that fiber can prevent certain diseases. Through their work in Africa, they discovered that diseases that were common in the Western cultures were not common there. These included heart attacks and high blood pressure (cardiovascular diseases), obesity and diabetes (metabolic disorders), intestinal problems (constipation, diverticulosis, diverticulitis, gallstones, appendicitis, hemorrhoids, polyps, and colon cancer), varicose veins and blood clots (deep vein thrombosis). The primary dietary difference was the high intake of fiber and low intake of refined carbohydrates in the African population. Burkitt also noted the emergence of these diseases in the United States and England after 1890 following the introduction of a new milling technique that removed fiber from whole grain flour to produce white flour.
While the exact mechanism by which fiber might prevent these diseases remained unknown, Burkitt made a discovery about the beneficial impact that fiber had on bowel movements and how that related to certain diseases. Burkitt noted that he was able to predict the number of a patient's hospital visits from the size and frequency of their bowel movements. Those with high intakes of fiber had more frequent and bulky stools and had less illness. Burkitt proposed that fiber's health benefits stemmed from its ability to increase stool bulk and speed up how quickly stool moves through the colon. Since these findings, controversy remains. A great deal of research has both supported and disputed what Burkitt had discovered.
Felty's syndrome facts
What is Felty's syndrome?
Felty's syndrome is a complication of long-standing rheumatoid arthritis. Felty's syndrome is defined by the presence of three conditions: rheumatoid arthritis, an enlarged spleen (splenomegaly), and an abnormally low white blood cell count. Felty's syndrome is uncommon. It affects less than 1% of patients with rheumatoid arthritis.
What are the symptoms of Felty's syndrome?
Some patients with Felty's syndrome have more infections, such as pneumonia or skin infections, than the average person. This increased susceptibility to infections is attributed to the low white blood counts that are characteristic of Felty's syndrome. Ulcers in the skin over the legs can complicate Felty's syndrome.
What causes Felty's syndrome?
The cause of Felty's syndrome is not known. Some patients with rheumatoid arthritis develop Felty's syndrome but most do not. White blood cells are produced in the bone marrow. There seems to be an active bone marrow function in patients with Felty's syndrome, producing white cells, despite the low numbers of circulating white blood cells. White cells may be stored excessively in the spleen of a patient with Felty's syndrome. This is especially true in patients with Felty's syndrome that have antibodies against the particular type of white blood cells usually affected (cells called granulocytes or neutrophils).
How is Felty's syndrome diagnosed?
There is no single test for Felty's syndrome. It is diagnosed based on the presence of the three conditions mentioned above. Most patients do have rheumatoid arthritis antibodies (rheumatoid factor) in the blood.
How is Felty's syndrome treated?
Treatment of Felty's syndrome is not always required. The underlying rheumatoid arthritis is managed in the standard fashion. Treatments used for patients with recurring infections, active arthritis, or ulcer in the legs include rheumatoid disease modifying drugs, such as methotrexate and azathioprine. Patients with severe infectious diseases may benefit by weekly injections with a stimulating factor (granulocyte stimulating factor/GSF) that acts to increase the amount of white blood cells. Surgical removal of the spleen has been performed for the same reasons but has not been evaluated by long-term research studies.
Medically Reviewed by a Doctor on 4/7/2015