Why Physicians Need to Pay Attention to Malingering And Exaggeration

Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs (APA,1994).

The word “malingering” comes from the French word “malinger” meaning “poor or weakly” as these are the characteristics feigned or exaggerated by the malingerer. Malingering has been documented as far back as in the Bible when David feigned insanity to escape a king he was afraid of. There have many books written about malingering and thousands of research articles written about it.

Malingering and/or exaggeration for external gain are both common in society. For example, last week, 18 people were arrested in New York State for workers compensation fraud. At a minimum, when one adds up how much money the state of New York paid out on fraudulent claims in these cases it comes to at least $243,000. To have pulled this off, it required physicians and other health care professionals to have signed off disability claims forms. While malingering can manifest by verbally feigning or grossly exaggerating symptoms, some people go through much greater lengths to malinger. For example, last week a California psychologist was accused of faking her own rape by splitting her own lip with a pin, scraping her knuckles with sandpaper, having her friend punch her in the face, and wetting her pants to give the appearance she had been knocked unconscious. The motive? To convince her husband to move from the neighborhood.

On 12/11/12, a Virginian woman was charged with fraudulently claiming that she had cancer to raise money from sympathetic supporters for personal reasons. She’s not the first to have done so. Earlier this year, a man was arrested for fraudulently obtaining almost a million dollars in sympathy donations by claiming he had cancer.  

Physicians and other health care professionals should be very concerned about exaggeration and malingering because they are enabling the process if they are not taking reasonable steps to detect it and address it. Many health care providers do not address this topic in their exams or clinical notes for several reasons, included but not limited to, a) not wanting to deal with the “hassle” of identifying the problem, such as confronting someone (which can be uncomfortable) and/or dealing with complaints, b) extreme patient advocacy, c) not wanting to believe that some patients distort their presentations for external reasons due to an overly trusting worldview, and d) concerns that identification of this problem will harm the patient in some way (e.g., loss of benefits).

While false positive identification of malingering and exaggeration is a legitimate concern (of which there are many ways to address this in the scientific literature), not identifying it can harm other patients and society in two main ways. First, malingering and exaggerated presentations rise insurance costs for all citizens because the insurance company has to spent thousands of dollars on services/treatments that need not be provided or at least not to the extent that they were provided. Most importantly, however, patients with more genuine needs have delayed access to health care services because appointments are taken by people who are trying to game the system and/or who do actually need that particular service.

While a public forum is clearly not the appropriate place to discuss malingering and exaggeration detection strategies, healthcare providers need to go to greater lengths to consider and assess response bias in their evaluations or at least refer to someone who will. There are many texts, research articles, conference workshops, and invited speakers that can be used as sources to provide healthcare providers with more information on the topic. A recent article written by myself and some colleagues discusses how to provide feedback about malingering and exaggeration to the patient. An upcoming edited book entitled Mild Traumatic Brain Injury: Symptom Validity Assessment and Malingering (Publisher: Springer) by myself and Dr. Shane Bush will address this topic and many others (including techniques that general healthcare providers can use).

Ultimately, you cannot effectively treat patients who do not want to get better and who do not actually have the problem you believe you are treating (or have it but to a much lower extent than they are claiming). This does not mean every patient is treated like a malingerer, but rather, that objective data (which can be obtained via a neuropsychological evaluation) combined with clinical experience and research knowledge should be used to guide clinical decision making as opposed to purely relying on subjective reporting, subjective impressions, and a desire to help. All of this can be done in a respectful, caring, and patient centered way.

Also see: Why Sports Leagues Need to Pay Attention to Malingering.

Reference: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th ed. Washington, DC: American Psychiatric Association; 1994.

MedFriendly in 2012: The Redesign is Coming

When I first created MedFriendly in 2001, I had no knowledge whatsoever as to how to make a website. I picked up some books to learn how to write in HTML (hypertext markup language) and also read some online tutorials. HTML is the computer language behind the scenes that tells your browser (e.g, Internet Explorer, Firefox, Chrome) how a webpage should look. Back is 2001, it was acceptable to create websites this way.


Things were much simpler back then. But, as always happens, technology improved and more advanced website design features began getting implemented into websites. These design features became impossible to render without more advanced computer knowledge. Lacking such knowledge (my only computer class was in the 3rd grade on massive cathode ray tube monitors) I kept finding creative ways around this problem and managed to keep the site looking fresher as the years went by.

Over the past few years, I integrated a centralized database system which serves all of the advertisements you see on MedFriendly (except the blog). This way, if an advertiser changed their ad code throughout the site, I did not need to go to every page and fix it. All I had to do was change the ad code in the database. To use a database, I needed to change all of MedFriendly page extensions (except the home page) from .html to .php5. It was a great deal of work and when it was finally done, although I solved one problem, I had inadvertently created another. Pages loaded slower and Google did not rank .php5 pages as highly as .html pages. This means less visitors to the site.

Converting all of the pages back to .html files the way I had them was unthinkable. Not without a new approach. Fortunately, technology has advanced to the degree that there are many good options out there today and I am now working with what is known as a content management system. This will allow me to create the highest quality web pages with a very professional look and will allow me to easily control all aspects of the site from a single master location. Pages will load much faster, the site will be more secure, and I will be able to add so many new features to the site that the sky is the limit. I have begun working on this project today and will update readers here on the progress. Since this project is so massive, there may be days where a blog entry can’t get done, but it is all for the greater good. MedFriendly simply has to modernize to stay relevant and I am dedicated to doing that. I appreciate your readership and support and would greatly appreciate hearing ways you believe the site can be better such as new features you would like to see. Stay tuned.

Suicide by Piranha

According to U.S statistics, the most common cause of suicide is use of firearms (55%). Second is hanging or suffocation (20.2%). Third is poisoning (e.g., drug overdose, cardon monoxide poisoning) (17%). Fourth is falls (e.g., jumping off a building) (2.1%). Fifth is cutting/piercing (e.g., wrist slicing) (1.5%). Sixth is drowning (1.1%). Seventh is fire ( 0.5%). 

RECOMMENDED BOOK: When Darkness Comes: Saying "No" to Suicide

What’s not on the list? Jumping into a lake of piranhas. That’s what a teenage fisherman in Bolivia chose to do when he jumped off a canoe in an intoxicated state. The piranha converged on him and he bled to death by suffering dozens of bites from the razor sharp teeth on his throat and face. All that was needed was one bite sized chunk to be removed from his jugular vein and it would spell the end. The teenager was drunk at the time so one can question whether he was thinking clearly about what he was doing but the local police chief is on record saying that this person knew the area very well and knew that there were scores of piranha in the lake that time for year. 

Piranha are ferocious fish. They are rumored to be able to strip the flesh off of a large animal in minutes when attacking in packs.One of the most interesting things I learned about piranha’s was from Jeremy Wade on one of my favorite shows, River Monsters. On one of the shows, he jumped in a lake of piranhas but remained very still. No bites. As soon as he threw a pole in the water (once safely in a boat) and began thrashing the line, near-instant bites. Piranhas, it seems, are attracted to the thrashing of an animals because it signals helplessness. Just remember that if anyone ever throws you in a lake of piranhas.

Don't Let the Bedbugs Bite!

Don’t let the bedbugs bite. What used to be a funny phrase uttered to children before tucking them into bed has now become a serious concern for people sleeping in hotels, college dorms, hospitals, shelters, and in their own homes. This pandemic has made many consider staying home from a vacation or enrolling in online classes for college. But what are bedbugs anyway, what do the bites look like, and what can you do to get rid of them? Below is a pictoral guide that gives you some of these answers.

First, here is a picture of a bedbug (also known as Cimex lectularius) under the microscope. The purple looking structure is a needle-sharp body part known as a proboscis, which is inserteded into the host’s skin (human or animal) and allows it to feed on blood for about three to five minute. The bedbug injects saliva into the wound that contains anesthetic (pain reliever) to prevent the host from awakening and anticoagulant to keep the blood from clotting.

Here is what a bedbug looks like when magnified without distorting the color although this picture is also magnified:

Bedbugs are actually very small (less than or equal to a half a centimeter) but you can see them without a microscope if you are a keen observer. As you can see from the picture they are flat-shaped and do not have wings. They can be brown or whitish but after drinking blood turn a rusty red color as a result, like this:

Bedbugs are attracted to carbon dioxide and body heat so they like to be where people are. They are called bedbugs because they like to hide in mattresses and bedding. They hide in small crevices and can be in luggage, boxes, trash, furniture, and clothes. Humans are dinner sources for them and their favorite time to feed is just before the sun rises. When finished with their meal, they swell up like a tick. Unlike ticks, they then fall off the host, crawl into their hiding place, and digest their meal. They sometimes leave blood stains along the seams of mattresses but can also leave dark droppings behind as well.

The first sign that a bedbug has bitten you are red itchy bites that look like this usually on the arms or shoulders, sometimes in straight rows:

The bites don’t usually need to be treated but they can get infected, especially when scratched. In this case, or when the skin reaction is more severe, seeing your doctor can result in treatment. This can be treated with antiseptic lotions and/or creams. Creams with corticosteroids may be used to decrease inflammation. Creams with antihistamines may be used to decrease the itching. These creams can also be used if there seems to be an allergic reaction or if the skin reactions get bigger like this:

Although most common in developing countries, they have been present in North America more due to increased international travel. They can live for 10 months and can go weeks without food. The good news is that bedbugs do not appear to carry or spread human disease.

How to get rid of them? Get rid of mattresses and box springs infested with bedbugs. You can also cover the bed with a plastic mattress bag to trap the bugs. Infested clothes and bedding should be washed in hot water and dried on high heat. Any furniture of cracks (e.g., in wood floors or doors) should be cleaned and vacuumed as should suitcases. Calling an exterminator is another option. If you use your own insecticide (e.g., in cracks of floors or bedframes) this should not be applied to areas that result in direct skin contact.

SHOCKING Psoriasis Pictures from 1899

There is nothing quite like going through old medical textbooks to see how the authors used to present medical conditions in pictures. These days, authors go to great lengths to protect confidentiality by not showing the patient’s face or by placing black bars over the patient’s eyes. In the late 1800s and early 1900s, patients were shown with various ailments, with the face and eyes for all to see. The pictures of the conditions also differed back then in being quite startling, whereas today’s medical texts are sometimes less dramatic in terms of the pictoral presentations.

MedFriendly will be featuring some entries from time to time highlighting what some classic medical texts showed about various medical conditions in the late 1800s to early 1900s. The first entry is about the skin condition, psoriasis. Psoriasis is a common condition that many people have which causes redness and irritation. It usually causes thick red skin with flaky silver-white patches. It is a lifelong condition that can go away for a long time but later return. It often occurs on the elbow but can occur anywhere. It can be a rather unsightly condition. What many people do not know is that it can actually be disfiguring.

Below are some pictures of psoriasis from an 1899 text called Atlas of diseases of the skin by Dr. Franz Mracek. Here is a leg:

Foot

Leg

Arm

Back

Belly

Hand

What's Causing My Headache?!

Headache is one of the most common symptoms we all experience. Sometimes, the cause is serious and other times it is not. Below is a list of indicators that may suggest the particular causes of a headache. Please keep in mind that these are possibilities and that you should consult your doctor for more information. You should also consult your doctor if your symptoms do not match the patterns described on the following list:

FEVER: Headache with a temperature over 100 degrees.

EPIDURAL HEMORRHAGE: An epidural hemorrhage is bleeding outside of the outermost layer that covers the brain. Symptoms include a headache with a head injury in the past few days, in addition to feeling unusually drowsy, and/or vomiting, or feeling nauseous (sick to one's stomach). No temperature over 100 degrees Fahrenheit (F). If this applies to you, it is an emergency, and you should get medical help immediately.

HEAD INJURY: Headache with a head injury within the past few days, without feeling unusually drowsy and/or vomiting, or feeling nauseous. No temperature over 100 degrees Fahrenheit (F). A continuous headache is common following a head injury.

RAISED PRESSURE IN THE EYE: Severe pain in and around one eye, blurry vision in that eye, and nausea or vomiting. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. If this applies to you, it is an emergency and you should get medical help immediately.

SUBARACHNOID HEMORRHAGE: A subarachnoid hemorrhage is bleeding between the first two layers that cover the brain. Symptoms are headache, nausea and vomiting, as well as two or more of the following symptoms: dislike of bright light, drowsiness or confusion, and pain when you touch your chin to your chest. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No severe pain in and around one eye. If this applies to you, it is an emergency and you should get medical help immediately.

INFLAMMATION OF ARTERIES IN THE HEAD: Nausea and vomiting as well as a sudden throbbing pain in the side or sides of the head. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No severe pain in and around one eye. No dislike of bright light, drowsiness or confusion, or pain when you touch your chin to your chest. If this applies to you, it is an emergency and you should get medical help immediately.

MIGRAINE HEADACHES (see section above on different types of headaches for description): Nausea as well as disturbed vision that occurs with vomiting, followed by pain on one side of the head. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No severe pain in and around one eye. No dislike of bright light, drowsiness or confusion, or pain when you touch your chin to your chest. No sudden throbbing pain in the side or sides of the head.

DRINKING TOO MUCH ALCOHOL: Experience of a similar headache while waking up the past several days or more out of the past week. The headache occurs only when drinking a lot of alcohol the night before. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No nausea or vomiting.

TENSION, BRAIN TUMOR, OR HIGH BLOOD PRESSURE: Experience of a similar headache while waking up the past several days or more out of the past week. The headaches do not occur only when drinking a lot of alcohol the night before. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. If the pain is in the back of the head, tension or high blood pressure is a more likely cause than a brain tumor. If nausea and vomiting is present and the headache reoccurs and is experienced while waking up, this indicates a brain tumor. If the group of symptoms mentioned in this paragraph applies to you, it is an emergency and you should get medical help immediately.

SINUSITIS: Sinusitis is inflammation of air-filled openings (known as facial sinuses) in the bones surrounding the nose. Symptoms are a current or recent stuffy nose and a dull pain and pain to the touch around the eyes and cheekbones that worsens when bending forward. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No nausea or vomiting. No similar headaches while waking up the past several days or more out of the past week.

COMMON COLD: Headache and a current or recent stuffy nose. No dull pain or pain to the touch around the eyes and cheekbones that worsens when bending forward. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No nausea or vomiting. No similar headaches while waking up the past several days or more out of the past week.

NERVOUSNESS, TENION HEADACHES: Headache and feeling tense or under stress and/or having poor sleep. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No nausea or vomiting. No similar headaches while waking up the past several days or more out of the past week. No current or recent stuffy nose.

STRAIN ON NECK MUSCLES: Headache that occur after reading or doing work that requires you to be close to something, such as sewing. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No nausea or vomiting. No similar headaches while waking up the past several days or more out of the past week. No feeling tense or under stress and/or having poor sleep.

COMMON CAUSES SUCH AS: Hunger, drinking more alcohol than usual, being in a stuff, noisy, smoky area, exposure to strong sunlight. Headache, with the common causes just mentioned, occurring in the 12 hours before the headaches began. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No nausea or vomiting. No similar headaches while waking up the past several days or more out of the past week. No feeling tense or under stress and/or having poor sleep. Headache does not occur after reading or doing work that requires you to be close to something, such as sewing.

MEDICATION SIDE EFFECT: Headache in addition to taking medication and/or taking birth-control pills. No temperature over 100 degrees Fahrenheit (F). No head injury within the past few days. No nausea or vomiting. No similar headaches while waking up the past several days or more out of the past week. No feeling tense or under stress and/or having poor sleep. Headache does not occur after reading or doing work that requires you to be close to something, such as sewing. The common causes mentioned in the last section have not occurred within 12 hours before the headache began. You should talk to your doctor if you think a medication side effect is causing your headache.

Dentist Threatens to Sue Patient for Negative Review

There are many websites where you can find reviews of doctors by patients. While some helpful information can be gained by perusing such sites, one has to be careful before drawing too many conclusions from the reviews. The reason is because it is human nature to take the time and energy to complain when upset as opposed to writing something positive when you are happy. Therefore, patients are more likely to post negative experiences on such websites, leaving a skewed set of results. Many doctors, particularly those in private practice, do not like these types of websites because one or more negative reviews can turn away business.

As a result, some doctors have resorted to having patients sign contracts to prevent them from publishing any commentary or writing anything disparaging about their experience with the doctor. One New York City dentist (Dr. Stacy Makhnevich) did just that recently and then threatened to sue a patient (Robert Lee) who wrote a negative review on a website about her. The patient stated that the dentist billed him $4766 after sending the necessary paperwork to the wrong insurance company and refusing to hand the forms over so he could submit them himself, instead referring him to a third party who charges 5% of the total bill for the service. For each day the negative review remained online line, $100 was allegedly charged to the patient from the dentist.

Guest Blog Entry: Medical Advancements Come Out of Current Wars

Today's guest blog entry was written by Nick Jameson.

Since the earliest days of human civilization, war has been a regular and repeated phenomenon that destroys lives and tears societies apart. In its earliest days, a war required the mobilization of every member of a given state, and its ultimate victory or defeat promised to forever alter the fabric of that civilization. Then, for several centuries during the Middle Ages, the Renaissance, and the Industrial Revolution, war reverted to a more small-scale affair among professional armies. Countries won, and lost, and gained territories, but life for the average person continued unchanged.

The past century has seen a return to total war – one that involves every member of society. World War I and World War II were momentous and bloody events that defined a generation for anyone living in an affected country. Together, the two wars killed millions upon millions of people and completely altered the course of modernity.

But the World Wars also ushered in tremendous advancements, many of which would not have occurred – or, at least, would not have occurred as quickly – without having war as a stimulus. On a technological level, advancements were made in nearly all aspects of military engagement: planes and naval ships were improved, the atomic bomb was developed, and communication lines were strengthened. Furthermore, on a medical level, the war ushered in the widespread use of penicillin, various immunizations, and gas masks in response to chemical attacks.

The medical advancements seen in World War II come as little surprise, considering that millions of injured and sick soldiers were being treated by some of the smartest doctors and scientists out there. Consequently, such advancements realized in the face of a major war can be seen as a silver lining amidst all the death and bloodshed. While companies such as Huntingdon Life Sciences are always pursuing the latest medical breakthroughs, it is during a time of war when the full resources of society and of the federal government get behind this endeavor.

So what, then, are the medical advancements coming out of our current wars in Iraq and Afghanistan? While neither engagement can be described as a total war, both conflicts have been among the costliest in history, and they have both made use of countless technological advancements. With Iraq coming to an end and Afghanistan winding down, it is a good time to start considering the medical improvements that these wars may leave as their legacies.

The two main medical advancements of our current wars come in the areas of mental health and prosthetic limbs. For years, veterans suffering from Post-traumatic Stress Disorder (PTSD) upon arriving home from combat were brushed aside, their problems not fully understood. These days, veterans with PTSD are usually diagnosed and provided treatment. But the recent wars in Iraq and Afghanistan brought that treatment to a new level: thanks to medical advancements in the realm of diagnosis and drug treatments, the U.S. military is better equipped to identify those veterans with PTSD and work to help them readjust to society.

Advancements in prosthetic limbs have been equally beneficial to a different type of injured soldier returning home. Although casualty rates in Iraq and Afghanistan have been far surpassed by other American wars, the injury rate is high and veterans are arriving home with limbs that have been amputated or blown off by a bomb. In past wars, these veterans would have had little recourse but to learn how to live without that limb. This is no longer the case. As a result of advancements in biomedical engineering, veterans can be retrofitted with prosthetics that act – and even look – just like a natural limb.

These advancements will continue to benefit civilian society long after the wars are over and the soldiers have arrived home. While the life lost during a military engagement is almost always senseless and unnecessary, we can take heart in the fact that generations of people will benefit from the medical advancements that come out of it.

And the Top 5 MedFriendly Blog Entries in November Were...

Below are the top 5 most popular blog entries for the month of November. This is a monthly feature of the MedFriendly Blog and gives readers a chance to catch up on the most popular blog entries they may have missed. Overall, another terrific month for the MedFriendly Blog. Please post a comment if you have blog entry suggestions. Here is the Top 5 list:

1. The SHOCKING Ingredients In A McRib Sandwich: This popular entry had 253 views. A must read if you are even thinking of ordering the McRib.

2. 10 Easy ways to Improve Your Mood and Outlook on Life: Check out this entry to put a smile on your face and add a little pep to your step. 102 page views this month.

3.  Does Your Kids Cereal Contain BHT or BHA – An Ingredient on Jet Fuels? Mine Did: My cereal cabinet looks a lot different since I wrote this. 99 page views this month.

4. Woman Injects Cement& Tire Sealant Into Woman’s Backside: The pictures tell the story. 92 page views this month.

5. Why Neuropsychological Testing is Helpful in Dementia Evaluations: As a neuropsychologist, this makes me happy that 91 page views were recorded and it cracked the Top 5.

Radiation from Full Body Airport Scanners: Why I Opt for the Pat Down

X-rays are forms of radiation that are strong enough to damage and mutate DNA in such a way that it causes cancer. Many people believe that they are only exposed to radiation when they go to the dentist and get an X-ray. However, we live in a radioactive world, with radiation all around us such as in the very air we breathe. Our bodies are exposed to radiation every day. One source is cosmic rays from outer space and another is food. That’s right…food. All organic food (e.g., carrots, bananas) contains a small amount of radiation from radioactive potassium and radium. Even water contains small amounts of radiation.

Most human exposure to radiation is from medical procedures such as X-rays, CT scans, and mammograms. Radiation can be measured in a unit known as millirems. The According to the U.S. Nuclear Regulatory Committee, the average American is exposed to 620 millirems of radiation, with 310 miilirems coming from the environment. If you receive a whole body CT scan, you receive 1000 millirems of radiation, which is much more than the yearly exposure. Get a CT scan of the chest and you received 700 millirems, again more than the yearly dose. Dental x-rays? Well, they only give you 1.5 millirems. However, there is level of radiation that is technically “safe” since the health effects of radiation are cumulative. That is, the more radiation you are exposed to, the worse of an effect it has on your health.

So, there is some degree of radiation exposure you will get no matter what. But why expose yourself to any extra radiation? One source of needless radiation you can avoid are full body scanners at airports. These are known as backscatter scanners. It had traditionally been thought that these scanner expose you to very low levels of radiation (e.g., .005 to .01 millirems). The Transportation Safety Administration insists this level is safe (e.g., 1000 such scans is equal to 1 chest x-ray) , but the non-profit investigative journalism organization, ProPublica, insists that the U.S. government glossed over cancer concerns as it rolled out these scanners and that the radiation exposure level is much higher. Researchers at Columbia University have said that the machines emit 20 times more radiation that originally estimated. The Inter-Agency Committee on Radiation Safety indicated that pregnant women and children are particularly at risk by these scanners.

On 11/14/11, the European commission announced new policy that they would ban these types of scanners due to concerns about health and safety. Instead of using X-ray scanners, they are replacing them with millimeter-waver scanners, which use low energy radio waves. Due to the low energy, these scanners do not have the power to cause genetic mutations and thus should not cause cancer. On 11/21/11, the head of the TSA reneged on his prior plan to re-study the safety of the scanners, stating they were safe. Not being a radiation expert, I really don’t know who is right. But I do know that I can at least opt out of these scans and that is what I did the last time I went to the airport. The result is a pat down but I found the whole experience easy to deal with. At least I know  did not expose myself and my family to needless radiation. And just in case you were wondering, metal detectors at the airports do not expose you to x-rays or damaging forms of radiation.

Elderly Woman with Dementia Allegedly Waterboarded by Staff after Dispute Over Ice Cream

Besides abuse of children, abuse of the elderly is one of the most despicable crimes in society. A shocking example of this was revealed in a story about two nursing home employees who allegedly putting an elderly patient (age 89) with severe dementia through a mock drowning with a shower spray. Why? Because they got into an argument with her over…ice cream.  Pathetic.

Fortunately, a co-worker witnessed the abuse and reported it. But it makes you wonder what would have happened if the witness did not report it or if there was no witness. If the patient had severe dementia, she likely would not have the cognitive abilities to report the crime and if she did report it, it is likely that no one would have believed her due to her medical state.

Having more staff present in nursing homes increases the chances that a witness will be present. Having a witness present, though, is not enough if the witness is scared to report what he/she has seen. This is why hospitals, nursing homes, and other medical facilities should have anonymous abuse reporting mechanisms that are well publicized.

It is ideal to have responsible family members present to visit the elderly in medical facilities because staff would be less likely to abuse a patient who they know have family members who are keeping an eye on the patient and have a close relationship with hospital workers (particularly those in senior positions) and who are advocating for them. Unfortunately, patients with no family members who are isolated are the ones most vulnerable to abuse because they have no one to look out for them.  Checking over a loved on for unexplained bruises, cuts, or other marks on the body should be done regularly. Reasonable explanations (e.g., slip and fall) for marks on the body (e.g., black and blue) should have some confirmatory documentation in the medical record. Suspected abuse should be reported immediately so that it does not continue to occur.

Woman Injects Cement & Tire Sealant Into Ladie's Backside

When I was in training, I remember once evaluating a former physician who had lost his license partly due to finishing his surgical procedures with wood screws from Home Depot instead of standard surgical screws. In addition, he used rubber cement instead of the standard surgical adhesives. He proudly defended his actions and stated that the wood screws worked better and saved him money. He did not seem to have any regrets over what he had done, despite the fact that patients were harmed. This was the case that came to mind today when I read about a woman who had gone to a person who she thought was a plastic surgeon to get a curvier body. Given that plastic surgery is expensive, she tried to save money and saw someone referred by a friend. After paying $700, she reportedly received toxic injections of cement, mineral oil, and flat tire sealant! This caused her to develop serious medical problems. You can read more about this story here.

While trying to save money is generally a good idea, it is not a good idea when it comes at the expense of picking someone not qualified to provide the desired medical service – in this case, plastic surgery. When trying to find a new doctor, I have put together a brief set of tips on how to do this in a way to minimize dealing with a charlatan. One of the tips I did not mention in that article was to walk away if the person does not physically appear professional to you. This is admittedly subjective and starts to enter into somewhat controversial territory, but if I am going to a plastic surgeon and she walks in with giant feathers dangling from her ears, I am likely walking away. I say this based on a picture of the person (Oneal Ron Morris) above who allegedly posed as a plastic surgeon and injected the concoction of toxic substances. Of course, I don’t know if she was wearing these earrings or some other odd form of apparel when the patient met her, but if so, it is a red flag.

I have used the word “she” above but “he” is the more accurate word to use because Morris was a man who identifies as a woman. Given that Morris was allegedly presenting as someone who can improve another person’s body curvature, I would personally be concerned if I saw that the doctors own body curvature looked like this.

When seeking a plastic surgeon, it is best to have one who is board certified because this provides an additional safety net. A board certified doctor (from a reputable organization) is one who has been vetted by his/her peers to have the appropriate training and education to perform a specialized service and has passed a rigorous examination(s) in the particular specialty area. For physicians, the main board certifying authority is the American Board of Medical Specialists, which oversees the American Board of Plastic Surgery.

Another tip is to find out if the plastic surgeon has privileges at the hospital. This is important because hospitals do background checks on their doctors. If the doctor says he/she has hospital privileges at a particular hospital, call the hospital and confirm this if you have doubts.

Why Healthcare Providers Should Not Hug Their Patients

Imagine this scenario. You are a male health care provider and you complete an evaluation of a woman close to your age. You establish good rapport as you always do, she laughs at some of the same jokes you make with all patients, and she expresses delight that you are listening to her problems (unlike those other providers she says she has seen), feels you are helping her, and is looking forward to the next appointment with you. At the end of the visit, she walks up to you and opens her arms to give you a hug. What do you do?

Many may feel that they do not want to offend the patient and so they go on and give the hug even though they may not feel comfortable. In my opinion, this is the wrong choice. For starters, hugs, unlike handshakes, are sometimes intimate gestures. You hug your spouse during intimate moments but you do not shake your spouse’s hand. A hug is much more informal compared to the handshake, which results in a slippery slope.

As health care providers who need to be objective, it is important to maintain some boundaries that maintain the doctor-patient relationship (add any healthcare provider you want to in place of doctor). Hugging patients blurs those boundaries. For example, it will be more difficult to tell patients news they may not want to hear (but need to hear for their sake) if they begin to see you more like a friend or family member than a professional.

Another problem is that in this day and age, concerns about lawsuits and patient complaints are more prevalent than ever. The concern in this case is that the meaning of a hug can be misconstrued by a patient as meaning something more intimate than was intended. In addition or alternatively, some accidental touching to sensitive body area can occur during a hug that is misinterpreted by either person. This can raise concerns of sexual harassment as the person can claim that the touch was unwelcome. This is more likely to occur if the health care provider initiates the hug. It is more likely to occur when the hugger is a male health care provider and the recipient is a woman or a child. Female to female and female to child sexual harassment claims are much less common. This means that female health care providers do not need to worry as much about a sexual harassment claim based on hugging patients but the crossing of professional boundary lines issue remains. 

When a patient tries to initiate a hug, my response is to simply say in a nice and respectful way that I am not allowed to hug patients because it crosses a boundary line. Then I offer my hand for a handshake. This can admittedly result in some slight embarrassment on both sides, but it is better to be safe than sorry. This solution is better than one that a supervisor once told me he used, which was to say “I think you need to get your hugs from somebody else,” which sounded too rejecting to me. If the patient insists on hugging you and lunges on you, it is best to document this clearly in your clinical note and explain that this cannot occur again.

The advice I provided above also applies when interacting with patient family members. That being said, there may always be a rare exception depending on the case and circumstances.

10 Ways to Protect Your Children from Child Sex Offenders

Tonight, I sit here in Syracuse, NY, shocked to hear sexual abuse allegations against long-term Syracuse University assistant men’s basketball coach, Bernie Fine. You see, I am a HUGE Syracuse Orange Fan. I do NOT want to believe this is true. Head coach, Jim Boeheim says the allegations are false but we will need to await the results of the police investigation.

For anyone watching the news in the past few weeks, these allegations come in the wake of the Notre Dame child sex abuse scandal that rocked the country. People have once again been reminded about the dangers of sexual abuse. The ways sexual predators operate were best exposed, in my opinion, during the recurring MSNBC special known as “To Catch a Predator” by Chris Hansen.  In it, Hansen documented how sexual predators lured child victims online and came to their home to engage in sexual relations, thinking that the children’s parents were gone.

Regardless of whether the allegations against Bernie Fine are true, people must be wondering what they can do to keep their children safe some sexual predators. A few suggestions are listed below.

1. TALK TO YOUR CHILDREN: If a child is inappropriately touched, he/she needs to feel comfortable discussing it with you. It is an uncomfortable topic for sure, but if you have an established relationship with your child such that the child can feel free to come to you and discuss any topic, good or bad, the child is more likely to come forwards if something inappropriate occurs. From a young age, children need to be told that if anyone touches their private parts or touches them in a way that makes them feel uncomfortable that they need to tell you about it as soon as possible. Make sure your children know never to go somewhere with a stranger and that if a stranger grabs them, that they should try to scream, get away, and run to an area of safety. Let your child know in advance that if a predator threatens to harm the parent if he/she tells of any abuse, that the parent will actually be ok and to tell someone anyway.

2. SEARCH ON-LINE SEXUAL OFFENDER REGISTRIES: Check your state’s online sexual offended registry, such as this one in New York. These registries allow you to see if there are sexual offenders living in your area, what their names are, where they live, and what they were charged with. Once you know where they are, you can make sure your child knows not to go there.

3. BE VIGALENT: Be mindful of where your children are. Do not let them stand at a bus-stop alone. Do not let them spend alone time with adults you do not know. Do not let them veer away from you in public places, such as the mall.

4. COMBATING GETTING LOST: If your children get lost in a public place, they can become easy pretty for a sexual predator. Make sure they know what to do if lost, such as seeking out a cashier or police officer and providing that person with a name, address, and phone number.

5. SPEND TIME WITH YOUR CHILDREN: Sexual predators try to prey on the most vulnerable children, which includes people who do not see their parents much. Thus, if you spend frequent time with your child, that is time that no one else will be doing so.

6. COMPUTER AND PHONE USE: Be aware of what websites your children are viewing (e.g., check the history log), install filters that prevent visits to adult websites, limit, ban, or closely monitor participation in social media sites (Facebook, Google+, MySpace, Twitter) based on the child’s age, and tell them to not develop relationships with strangers on-line, give out their phone number/address, or meet strangers from on-line (or the newspaper) in person. Make sure your child knows that strangers on-line may pretend to be people they are not. Monitor text messages and pictures your child sends for inappropriate content.

7. DO NOT GET OVERLY COMFORTABLE WITH STRANGERS: Sexual predators are typically charming. You may believe that you know the person and feel comfortable because he/she is nice, but neighbors, babysitters, priests, teachers, coaches, and even family members can be sexual predators in your midst. Do not let your guard down and be very careful who you chose to leave your child alone with. Do not allow taps on the buttocks, touching of the legs, tickling, or other inappropriate touching to go on if your feel it is inappropriate.

8. USE FEMALE BABYSITTERS: Sexual predators are almost always men. Thus, your child is likely to be safer with a female babysitter.

9. TEACH SELF DEFENSE: Teach your child some self-defense strategies to use if a sexual predator makes threatening physical advances to a child.

10. SECURE YOUR HOME: Keep doors and windows locked. This is crucial. Many sex offenders state after being caught that if a door entering the house was locked that he/she would likely have moved on. If you can, have a dog or dogs that bark when strangers come. 

10 Easy Ways To Improve Your Mood and Outlook on Life

The next time you go to a book store or search for books online, you will notice that you will not find any books on how to think negatively. The reason is because it is very easy to do. However, there are many books on the power of positive thinking and ways to improve your motivation. Like dieting, positive thinking can sometimes be difficult but it does not have to be. Below are my 10 easy ways to improve your mood and outlook on life.

1. REMEMBER THAT THINGS CAN BE MUCH WORSE: No matter what type of situation you find yourself, you can almost always think of a way in which it could be much worse. For example, if you get into a car accident and your door gets dented in, you can be upset about the damage, receiving a ticket, and the inconvenience of filing an insurance claim. It’s easy to focus on these problems but not keep in mind that you and the other driver were not injured in the accident, that you did not need to go to the hospital, that the car is still drivable, and that there was not more expensive damage. When you take the time to recognize that there are so many things you have to be fortunate about, it helps put stressful situations in proper perspective. 

2. REMEMBER THAT THERE IS ALMOST ALWAYS A SILVER LINING: Bad situations happen but there is almost always a silver lining present, even if you can’t see it right away.  For example, when I was first shopping for a house, the deal ended at the last minute because the home inspector found mold in the attic. It was a very bad day for sure, but it caused me to expand the house search and find a much better house in a better development. Try to keep the silver lining in mind when something bad happens.

3. WORK SOME FUN INTO YOUR WEEK: At least a few times a week, you should work some type of fun activity into your week, such as watching a movie or favorite TV show, going to a game, listening to good music or a favorite talk show, socializing with friends, going to a favorite restaurant, etc.

4. HAVE SOMETHING TO LOOK FORWARD TO EACH DAY: While you should at least do something fun a few days a week, try to have something to look forward to each day that you like to do from the section above.

5. HAVE A HOBBY: Hobbies make life interesting and they usually provide a good escape from the doldrums of daily life. Great hobbies include collecting things, doing something creative, video games, sports, reading, and much more.

6. SMILE & LAUGH: Try to find something that makes you smile laugh. It does not need to be public laughter if you are not comfortable with that, but try to watch a comedy, listen to a comedian, listen to a comedic radio show, pick up a joke book, or spend time with someone who makes you laugh. Laughing just makes you feel good.

7.  STAY AWAY FROM PEOPLE WHO BRING YOU DOWN: We all know who these people are. The ones who love to say things to push your buttons, people who are insulting, people who tell you that you are not good enough. Stay away from these people as much as possible and stay near people who are nice, encouraging, and generally have positive things to say.

8. EAT WELL: It is difficult to define “eating well” because by using that term, you may assume all I mean is to eat fruits and vegetables. Actually, what I mean by it is to eat a generally healthy diet with natural foods and avoiding artificial chemicals. Keeping your body as pure as possible helps you feel better. BUT, I also strongly believe people should be allowed to treat themselves and get that pepperoni pizza they have been craving or ending the week with a cookie dough ice cream Sundae. You only live once, should not completely deprive yourself, but should also not overdo it. As the Greek philosophers said, moderation is the key in life.

9. REMEMBER WHO IS IN CONTROL: Always remember that while you cannot always control what happens to you, that you are the only person in charge with how you think about it and react to it. A feeling of loss of control is a major reason why many people develop significant emotional disorders. Remember that the way you choose to think about something will determine how you feel about it.

10. STAY AWAY FROM NEGATIVE LANGUAGE: Remove extreme negative words such as “can’t,” “impossible,” and “must not” from your vocabulary. For example, if you tell yourself that you “can’t” accomplish your goals, that it’s “impossible” to succeed at something, or that you “must not” make a mistake, you will create self-fulfilling prophecies and be very upset when you make an error. The fact is that most goals are attainable with hard work and that everyone makes mistakes. View mistakes as opportunities to learn and improve yourself in the future rather than as long-term sources of grief. Try to move on fast, remember that tomorrow is another day, and that

Is it Bad to Have Undigested Food In Your Poop?

If food appears in the feces looking very similar to how you it was when you ate it, this means that the food has not been digested (broken down and absorbed) by the body. Believe it or not, many foods that we eat cannot be digested by the enzymes in our digestive system. An enzyme is a type of protein that helps produce chemical reactions in the body.

RECOMMENDED BOOK: Everybody Poops 410 Pounds a Year

Foods that cannot be digested by the human body usually contain a high amount of dietary fiber. Dietary fiber is a term for chemical substances in the cells of plants that cannot be digested by the human body. Dietary fiber cannot be digested by the human body because it lacks the necessary enzymes to do so. More specifically, dietary fiber is resistant to hydrolysis. Hydrolysis is a process in which a substance is broken down by splitting its chemical bond and adding water to it. Since dietary fiber cannot be digested, it passes through the body virtually unchanged and cannot be used as an energy source. Although humans cannot digest dietary fiber, some of it is broken down by bacteria to produce gas and acids.

Examples of foods that are not digested well by the human body include corn, peanuts, peas, carrots, cereals, and beans. If the bacteria in the body are successful, some of the carbohydrates in these foods may be broken down. If not, however, we will see these foods in the feces. Carbohydrates are a group of substances present in certain types of foods (such as sugar) that provides the body with energy.

Research also suggests that the more a food is cooked, the more difficult it is for the body to digest it. This is generally true of most foods. The higher the temperature that the food is cooked, the longer it will stay in the digestive system, and the more difficult it will be for the body to digest. Why does this happen? To begin with, all foods are made up of chemicals that are arranged in certain patterns. Our digestive system is generally able to break down foods that fit these general patterns. However, the chemical patterns of all foods can be changed when they are heated past a certain point. Thus, foods that are deep-fried and barbecued often have their chemical pattern changed. As a result, the body does not understand how to deal with these new chemical patterns and the food can pass out of the body undigested because the body does not have the necessary enzymes to digest it properly.
   
If the above reasons are not causing food to be undigested, this could indicate a problem in the digestive system. In a healthy person, it should take between 24 and 36 hours to digest food. If the food comes out of the body faster than this, this usually means that there is a build up of debris (the remains of something broken down) that is preventing the colon from digesting food.

The colon is the major part of the large intestine, that absorbs water and some types of salts from the digested material that passes through it. The intestine is a tube shaped structure that is part of the digestive tract, and is located in the belly. The large intestine absorbs moisture from the matter that is left after it is digested in the small intestine, and releases the waste from the anus (the area that feces comes out of). The small intestine is a part of the intestine that takes in all of the nutrients (healthy substances) that the body needs.

A healthy piece of feces is about one foot long. Shorter sized feces suggest that the colon is not able to process the food correctly and that the feces produced does not have the correct amount of moisture in it.

Does Your Kids’ Cereal Contain BHT or BHA – An Ingredient in Jet Fuels? Mine Did.

When examining the foods in my home, I took a look at the cereal boxes and found that the following cereals contained something called BHT: Rice Krispies, Frosted Flakes, Froot Loops, Apple Jacks, Boo Berry, Frosted Mini Wheats (three types), Raisin Brain Xtra, and even Total. The only cereal that did not have it was Grape Nuts.

So I decided to do a little research into what this BHT stuff is, especially since my kids are eating it. Turns out that BHT is an abbreviation for butylated hydroxytoluene. As someone who has a profession in the neurosciences, the word that jumped out to me was “toluene” because toluene is a solvent that can cause neurological effects when inhaled. BHT is not toluene, but the fact that it shares a chemical name with it was cause for initial concern.
Additional readings in BHT show that it is used as a component in jet fuel, rubber petroleum products, cosmetics, electrical transformer oil, and embalming fluid (the stuff they put in dead people to replace blood) and preserve the body. Anyone hungry yet?

When food is exposed to oxygen, it can spoil. When BHT is added to foods containing fats and oils, oxygen reacts preferentially with BHT as opposed to the fats and oils, which preserves the food from spoiling as fast. So, BHT is an anti-oxidant, but it is an artificial anti-oxidant.

The key question is whether BHT (or the related BHA) is harmful to human health? It depends on what you read and what your source of information is. Some will say that it is used in such small amounts (parts per million or billion) that it is most likely safe. But to me, this is not very reassuring because if someone said they were going to add a miniscule amount of jet fuel into my cereal, I would say no, not matter how small. Some will say that is an anti-oxidant, has been used to treat herpes and other viruses, and decrease cancer risk. However, others can cite information that it increases cancer risk, at least in laboratory animals given very high doses of the substance.
Tired of reading the conflicting accounts, I turned to the only objective source of information I could think of. Every commercial chemical substance that people can be exposed to needs to have a Material Safety Data Sheet (MSDS) which contains detailed information about the substance, including information on human health effects and toxicity. You can find the MSDS for BHT here and read it for yourself. I particularly focus on this section:

Special Remarks on other Toxic Effects on Humans:
Acute Potential Health Effects: Skin: Causes mild to moderate skin irritation. Eyes: Causes moderate eye irritation. Inhalation: May cause respiratory tract (nose, throat) irritation. Ingestion: May be harmful if swallowed. The clinical manifestations of acute are not well known. May cause gastritis, vomiting, hypermotility, diarrhea. May affect behavior/central nervous system (dizziness, weakness, somnolence, slurred speech, ataxia, visual and auditory hallucinations, headache, confusion, temporary loss of consciousness), respiration (respiratory depression), blood (reduced ability to clot) Chronic Potential Health Effects: Ingestion: Prolonged or repeated ingestion may affect the liver, kidneys, thyroid, adrenal gland, behavior/central nervous system and learning ability, blood (reduced ability to clot), and may cause weight loss. Ingestion or skin contact may also cause allergic reaction (dermatitis, asthma).

Special Remarks on Chronic Effects on Humans:
May affect genetic material (mutagenic). May cause cancer based on animal test data. No human data found. May cause adverse reproductive effects and birth defects (teratogenic).
Chronic Effects on Humans:
CARCINOGENIC EFFECTS: A4 (Not classifiable for human or animal.) by ACGIH, 3 (Not classifiable for human.) by IARC. MUTAGENIC EFFECTS: Mutagenic for mammalian somatic cells. Mutagenic for bacteria and/or yeast. May cause damage to the following organs: blood, liver, central nervous system (CNS).

The bottom line for me is that I personally do not want to consume products that contain BHT or BHA much less feed them to my kids. There are other tasty cereals out there that do not contain this substance, particularly in the organic food section. Some of these natural food products have found ways to use natural preservatives that do not use jet fuel ingredients. Typically, they use what are known as tocopherols -- a technical word for a totally natural substance in vitamin E.

The SHOCKING Ingredients In a Mountain Dew

When I wrote the popular blog entry, The SHOCKING Ingredients in a McRib Sandwich, I figured that the chemicals I found were mostly limited to fast food restaurants. I then began to look at some of the foods in my home explored the ingredients. I was shocked at what I found.

FEATURED BOOK ON MOUNTAIN DEW:  Mountain Dew: The History

I believe that we have become accustomed when selecting food to do so based on name brand, taste, type of food, and perhaps a glance at the nutrition label (e.g., calories, fat, salt content). If we do look at the ingredients, we may see some with some long names, shrug our shoulders, and figure they are safe. They may be safe in small quantities, but I have to wonder if consuming large quantities of artificial chemicals over time causes health problems. Most of us are busy and want food that is already prepared to speed things up. But in order for that to happen, many manufacturers also cut corners to deliver foods and drinks in mass because it is much more efficient to do so. This is why all natural products usually cost more money.

I am going to begin documenting on this blog some of the troubling ingredients in foods and drinks I have had in my house, have regularly consumed in the past, and that I have now thrown out and replaced with other natural products. Most people do not have the time or energy to research what these products are, so I will do the work for you. All you need to do is spread the word (email, Facebook, Twitter), consider the information, and make an informed decision about what you want to put in your body. Without further ado, the product I am going to begin with is…

MOUNTAIN DEW: This popular drink is known for its high level of caffeine and fruity taste. But it also contains…

1. EDTA (ethylenediaminetetraacetic acid). This is sometimes uses as a preservative in foods (under the name calcium disodium EDTA) to prevent food discoloration. I remember hearing about it in the OJ Simpson when it was discussed as chemical used in test tubes to prevent blood from clumping together. To be fair, EDTA has some positive health benefits in specific situations (e.g., treatment of lead and mercury poisoning), since it removes metals from the body. However, the chemical is known to be a persistent organic pollutant, which means that they do not naturally degrade in the environment, are capable of accumulating in living tissue, and causing negative health effects. Studies with laboratory animals have found that EDTA is toxic to cells, is slightly toxic to genes, and that consuming the material orally has negative effects on reproduction and development.

2. BROMINATATED VEGETABLE OIL (BVO): This is a perfect example of a tricky ingredient because most people will read it and thing it is not a problem since it is vegetable oil, skipping over the word "brominated." Brominated means that this is vegetable oil that contains the chemical, bromine. It is used as an emulsifier in many citrus-flavored soft drinks. An emulsifier is a substance that allows foods to mix together. It does this by thickening the oil so that it is as dense as the water in the drink. India has banned the use of BVO from its soft drinks and it is not an approved additive in Europe.

Bromine and/or forms of bromine are used in pesticides, disinfectants, flame retardants, as a gasoline additive, and for swimming pool maintenance. Its use has been limited in the U.S. but is still contained in some food products. Bromine has no known essential role in human health.

3. SODIUM BENZOATE: A food preservative that has been inconsistently associated with hyperactivity and is theorized to cause cell malfunction. In response to health concerns, the Coca Cola company is phasing it out of Diet Coke and some of its other beverages.

4. YELLOW # 5: This is a type of man-made chemical food coloring. Many companies try to avoid using it because of potential health effects. First, it is known to cause allergies, particularly among people with asthma and aspirin intolerance. It is associated with anxiety, asthma attacks, hives (fewer than 1 in 10,000 people), clinical depression, migraines, blurry vision, itching, general weakness, heatwaves, feeling of suffocation, purple skin patches, and sleep disturbance. It may also be associated with hyperactivity, irritability, restlessness, thyroid tumors, and chromosome damage. Health effects can occur even in very small doses. About 360,000 Americans are sensitive to yellow #5, which is about 0.12% of the population. Although yellow #5 is associated with the problems above, whether yellow #5 causes some of the more extreme health effects is controversial, especially among people who are not intolerant to it.

In laboratory animals, yellow #5 affects behavior, inflames the stomach lining, and affects and alters chemical in vital organs (e.g., liver and kidney). The latter is true even at low doses. In England, the Food Standards Agency called on the voluntary removal of yellow # 5 from food and drink due to concerns over possible health effects. In the U.S., the Food and Drug Administration is so concerned about yellow #5 that it mandates that it be listed as an ingredient, insists on the batch of coloring be pre-approved by the FDA, and will actually seize products that do not list it in the ingredients when they soon have or did not have the batch pre-approved. Yellow # 5 was banned in Norway, Austria, and Germany but the ban was eventually overturned.

The Rick Perry Brain Freeze Examined

If you did not see the Republican Presidential debate the other night, you have probably heard by now about candidate Rick Perry’s “brain freeze” moment during the debate. No matter what side of the political spectrum you fall on, it was painful to watch.

The point of this entry is not to examine this issue from a political perspective but to look at it from a neuropsychological perspective and present ways to prevent something like this happening to you if you need to give an oral presentation without Powerpoint slides. If you have not seen the video or do not care to, Perry was not able to name the third of three federal government agencies that he stated he would eliminate. The first was the Department of Education. The second was the Department of Commerce. And the third was…ummmm….the third was….Ooops. See for yourself here:

I have done a great deal of group presentations in my life. Most of them involve use of Powerpoint slides in my professional career, which allow you to easily reference information so you do not need to solely rely on your memory. However, sometimes you need to make the off the cuff remarks when responding to questions and other times you need to do a more spontaneous presentation of information in life (e.g., best man speech, accepting an award, presenting to a group over a teleconference).

One thing I try to (unless I know the topic in detail) is avoid citing a specific number of points that need to be made and then try to rattle off those points based purely on memory. This is because if you cannot retrieve one of the points, it will look very bad and is if you do not know what you are talking about. You lose the audience and they lose confidence in you. It looked even worse for Perry because he has a history of poor debate performances due to milder retrieval difficulties, characterized by brief but long enough pauses that they indicate he is struggling with finding the correct information he wants to say.

As alluded to earlier, retrieval of information is enhanced when the person is very familiar with the topic area. This is because brain cells form stronger and stronger connections with each other the more well-known the information is. The technical name for this is having strong synaptic connections. Synapses are the connections between nerve cells and those bridges become strengthened when learning is enhanced, improving the memory trace.

Clearly, Perry did not have detailed and specialized knowledge of this particular topic. It is possible that he may have rehearsed the information ahead of time, even many times, but sometimes pure rote rehearsal is not enough, especially when there are so many other pieces of information being rehearsed at the same time. We have all experienced this when cramming for a test. Something similar is likely the case for Rick Perry who made a last minute decision to run for the Presidency and thus had to try to memorize answers in many different areas.

There are some ways around using rehearsal as a way to improve memory efficiency and retrieval. One of the best methods is called chunking, in which you reduce lengthy pieces of information to remember into small, discrete units. An example is using an acronym. If Perry would have done this, he could have saved himself a lot of grief. For example, he could have used the acronym CEE (pronounced see) for which agencies he would like to “see” eliminated. In this case, the acronym CEE is one unit of information but it stands for three words: Commerce, Education, and Energy. These first letters basically serve as prompts for the department names.

Another technique is to make the information emotionally significant as this contextual significance improves the memory trace. Thus, if he could think of one significant example of something severely wrong with each of these three agencies (preferably personalized as much as possible) it would improve his chances of remembering the three groups.

Sometimes, you can know the material well but anxiety can interfere with performance. However, as a general rule of thumb, anxiety should decrease the more familiar one is with the task at hand. In Perry’s case, there likely was some anxiety due to his poor prior debate performances. He was intimately aware of this as he has been widely criticized in the past, spoke about it openly, and was publicly floating the idea of skipping the debates. While anxiety can lead to a word recall problem, anxiety will then increase further when the recall prolem occurs, which further interferes with coming up with the correct word. It is like a road block exists and that road block needs to be cleared before the frontal lobe (prefrontal cortex) can execute an effective search and help the medial temporal lobe access the correct information. The medial temporal lobe acts as a memory retrieval and storage center.

If anxiety or some other emotion interferes with recall, it is good to have a backup plan, such as notes. Being familiar with the notes is key because you need to remember where to look very quickly if you plan to recover form a brain freeze during a speech. Perry did not do this either because despite exploring his nodes on the podium, he could not come up with the correct word.

Why Neuropsychological Testing Is Helpful in Dementia Evaluations

If you or a loved one is concerned that dementia may be present, a neuropsychological evaluation can be critical to confirming this, specifying the exact type, and guiding treatment. Dementia is a general term referring to a significant loss of intellectual and cognitive (thinking) abilities without impairment of perception or consciousness. There are many different types of dementia, with Alzheimer’s disease being the most common. Most forms of dementia are progressive and irreversible (such as Alzheimer’s disease and fronto-temporal dementia) although some forms are non-progressive (static) and reversible. An example of a static form of dementia is dementia due to severe traumatic brain injury. An example of reversible dementia is dementia due to unrecognized thyroid disease or vitamin deficiency.

Most forms of dementia begin with memory loss but other cognitive difficulties (naming problems, getting lost) can also serve as the initial symptoms. Sometimes, behavioral symptoms are the initial prominent symptom such as the decline in personal and social conduct that is typical of fronto-temporal dementia. Usually, a person with these symptoms will initially be evaluated by a primary care physician. This typically results in sending the patient for blood tests and a brain MRI (magnetic resonance imaging) to search for reversible causes of dementia and determine if there are any visible abnormalities in the brain. The MRI may show tissue loss (atrophy), abnormal areas of tissue (known as lesions), a mass such as a brain tumor, or other types of abnormalities.

The person may also be sent to a neurologist, which is a type of physician specializing in the neurological system. The neurological exam will typically consist of a brief interview and a physical exam focusing on the cranial nerves, reflex testing, and sensory-motor functioning. There will usually be some brief testing of thinking skills. This could merely involve asking the date and/or memory for a few words but can involve the use of a brief formal screening test of thinking such as the Mini-Mental State Examination. These screening measures are broad tests of thinking skills that are designed to pick up on red flags that may prompt a referral for more detailed cognitive testing. While screening measures may detect some difficulties that support a diagnosis of dementia, these tests are fairly easy, are not meant to replace a comprehensive neuropsychological evaluation, and are not good at differentiating between types of dementia.

There are several advantages to a neuropsychological evaluation. First, a neuropsychologist specializes in understanding the relationship between brain functioning, thinking, emotions, and behaviors. This is important because there are psychological conditions that are common in the elderly (e.g., major depressive disorder) that can mimic a neurologically progressive dementia (e.g., Alzheimer’s disease). Thus, an expert in how psychological and neurological conditions present is very important and neuropsychology offers that level of expertise.

Second, neuropsychologists spend hours upon hours with their patients to understand the history, obtain and thoroughly review relevant medical records, perform a detailed clinical interview (with the patient and a close informant[if possible]) and detailed testing. This degree of detail cannot be obtained in a physician’s office due to significant time constraints.

Third, neuropsychologists apply specialized procedures to formally estimate the estimated intellectual status before a suspected dementing condition began. Additional specialized tests include measures of memory, learning new information, attention/concentration, expressive and receptive language (e.g., naming, vocabulary, command following), IQ, visual-spatial and visual constructional skills, motor and sensory functioning, information processing speed, and executive functioning. Executive functioning refers to higher-level thinking skills such as abstract thinking, multi-tasking, planning, judgment, problem-solving, and organizational skills. Test performance is compared to groups of people who are in the same age group as the patient with have no history of brain damage. Some tests are also compared to groups of normal controls with the same/similar educational backgrounds and also for gender. Some tests of personality and emotional functioning can also be administered.

Neuropsychologists review the objective information from the testing and look for areas of impairment, the degree (level) of impairment, and patterns of performance. Specific thinking and sensori-motor skills are controlled by  different areas of the brain. The neuropsychologist then integrates this information with the information obtained from the clinical interview, medical records review, behavioral observations, and knowledge of how various neurological and psychological conditions present. These results can help determine the specific diagnosis, which leads to specific treatment recommendations as not all dementias are treated identically. These recommendations not only may include medication suggestions but also include practical suggestions to improve daily functioning. Treatment is drastically different if dementia is due to Alzheimer’s disease, a reversible thyroid condition, malnutrition, or a severe psychological disorder.

It is also worth noting that neuropsychological testing may not reveal dementia but instead show Mild Cognitive Impairment, which is stage between normal aging and dementia. This is important to know as it also effects treatment and not all of these cases convert to dementia.

One needs to be careful in selecting a neuropsychologist and some guidance on how to do so is offered here.

Living to 106 by Eating Pizza and French Fries

As I pointed out in a prior blog entry entitled "Exercise & Eat Fruits & Veggies All You Want: You're Still Going to Die," the belief that you are going to be able to eat your way to a long wife with healthy foods and that you will die early for eating unhealthy foods does not always hold true. This is likely because genetics plays a major role in determining whether certain abnormal health conditions will develop that can lead to death.  This does not mean that the types of food you consume play no role in your health. But food choices likely interact with genetics to determine risk. If your genetics are strong enough, traditional health guidelines regarding food selection may not apply to you. Also, if your genetics are poor, what you eat may not matter much at all.

In the blog entry noted above, I discussed the death of fitness guru Jack LaLane, who lived to 96 after a life filled with exercise and healthy food. Many cite that lifestyle as the reason for his long life but as I pointed out, there was likely a genetic component to this since his mother lived to age 89. To be fair, if people are going to use Jack LaLane as a model  for how lifestyle choices can lead to a long life, they need to account for another case as well…that of Margaret Moores.

Who is Margaret Moores you ask? Well, she outlived Jack LaLane by 10 years, living to age 106 based on a diet consisting largely of pizza, French fries, sweets, salt beef, and very little water. Apparently, the only medication she takes is Tylenol for arthritis. Other favorite and preferred foods of people known to live over age 100 includes bacon, coffee, red wine, dumplings, chocolate, and honey. To read more, see this article at The Huffington Post. I’m not saying to go out and have a diet consisting largely of these foods, but the point is that traditional health guidelines regarding food clearly do not apply to everyone equally.