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Tuesday, September 30, 2014

Water Safety at the Jersey Shore

As the summer season winds down, we’re heading away from the many beaches, and toward drier fall activities. Although we’re heading away from the water, we shouldn’t lose sight of the dangers that can lurk on the many beaches along the Jersey Shore. New Jersey has roughly 130 miles of coastline that offer everything from boardwalks and fishing to swimming and surfing, and with all those activities come the risk of drowning. This is not to say that the beaches are dangerous, but safety should always be a concern whenever you get near the water.

The CDC reports that ten people die each day from unintentional drowning, and roughly two in ten are children aged 14 and younger. Additionally, drowning is the fifth leading cause of unintentional injury and death in the US. Roughly 81 percent of water incidents are attributed to riptides – strong, narrow currents that form as waves and travel from deep to shallow water. Riptides move away from the shore and anyone getting caught in one could be easily pulled into deep water. Although many beaches have lifeguards on duty, it is important for you to understand what to do if you, or someone you know, are caught in a riptide, as well as how to administer CPR in the event of drowning.

Responding to a Riptide

For many people, the first response is to fight against the tide to remain close to shore. While this might seem like a reasonable reaction, doing so can actually make the situation worse. Riptides are so strong that even a Michael Phelps-level swimmer can be easily overcome. Fighting against the current will actually tire you out, making you unable to return to shore once you are out of the current’s grip. That exhaustion will make you more prone to drowning. The following steps can actually increase your chances of escaping the riptide safely:

1.  Remain as calm as possible. Panic can lead to poor decision making;

2.  Riptides are shaped like a funnel with a wide base at the shore that tapers to a narrow neck, then widens to a head at the deep end. Swim along the coastline, which will take you across the current instead of against it, and eventually out of the riptide. Keep your eye on the coastline to make sure you are swimming in the right direction;

3.  When you are out of the riptide, swim toward the shore.

If you are unable to swim across the riptide, remain calm and float on your back or tread water and let the tide carry you out until you either exit the tide naturally, or are able to start swimming across. Always keep your eyes on the coastline.

If you are unable to escape the tide at all, draw attention to yourself by waving your arms and yelling to shore.

If you see someone else stuck in a riptide, do not attempt to enter the water to help. Call 911 or find a lifeguard.

It’s also a good idea to be aware of the conditions that could cause riptides, such as offshore storms.

Finally, you should always take care never to swim on a beach that is deserted or does not have a lifeguard on duty.

Learning CPR

CPR, or Cardio-Pulmonary Resuscitation, is not only handy in drowning situations, but in any situation where someone might stop breathing. You can find several online CPR references for adults and children, but they won’t give you all the information you need. CPR is a delicate procedure that you can only really learn through practice and there are several CPR classes in NJ that can teach you the correct way to administer adult, child, and even infant CPR.

The great thing about these classes is that they are offered year-round, which means you can earn your CPR certification during the off-season and be prepared when you head back to the beaches in the summer.

If you do choose to get CPR certification, you will need to keep it up to date by taking refresher courses every year or so. This is because the America Red Cross is constantly updating the procedure to make it safer, more efficient, and save more lives

This is a blog post by Nancy Evans.

Thursday, September 11, 2014

The Woman Who Claimed She Urinated a Bullet

While urinating a worm is physically possible as described in a recent blog post, there is an early medical report from 1668 of a woman urinating something even more incredible…a bullet. The story goes like this.

A large, pale, woman by the name of G. Eliot in Suffolk, England was tormented with intestinal problems for many years. She was persuaded by a neighbor who had similar problems to swallow two bullets.  It is not stated what the logic was behind how swallowing bullets would supposedly help. The woman claimed that she felt better initially after swallowing the bullets but that the pains returned and increased.

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After 15 years of continued symptoms, she presented to Dr. Nathan Fairfax’s pharmacy.  He prescribed her something called Lady Hollands powder that was mixed into a hot drink. She vomited over night.  When using the bathroom the next morning (which was referred to as the chamber pot), she urinated when a thwang was heard on the side of the vessel.  This reportedly surprised her and led her to wonder what it could be. So she poured the urine and saw a heavy gravelly stone that was yellow-red in color and as big as the end of a thumb. However, this is based solely on self-report.  She reportedly took a hammer, knocked off the outer crust, and found a bullet enclosed in it. She then reportedly cut it a little with a knife and found lead within it.

Dr. Fairfax asked her if she had ever urinated bullets before and she said no, including the other bullet. Recollecting back to when she swallowed the two bullets, she stated that she checked her feces slightly for days afterwards and never found the bullets and so she gave up. She stated that the bullet was smaller compared to when she originally swallowed it.  Before and since that time, she stated that she urinated an abundance of red gravel.

Ms. Eliot stated that when she voided the bullet that it felt like a kidney stone but that it lasted longer (i.e., weeks),  caused her to bow forwards, and led to vomiting.  She claimed to feel it move lower from the kidney to the bladder.  Dr. Fairfax asked her if she was sure that the bullet came from the urine and she assured him that it was and that she was not mistaken. Dr. Fairfax stated that the bullet did have a gravelly coat. Since she passed the bullet, she stated that she still had kidney stone pains but not as bad as before.

Dr. Fairfax stated the tale strengthened his belief that there must have been a passage from the stomach to the bladder but in reality, there is no such passage.  He believed that nature had found a way to finally rid the body of something it found offensive. Basically, his argument was that the body works in mysterious ways.

This story is a good lesson that highlights the problem that arises when health care professionals rely on self-report , despite claims that the self-report is definitely not mistaken. What this woman described is actually anatomically impossible. There is no known mechanism by which someone can swallow a bullet or any other foreign object and have it passed from the stomach to the kidneys. When solid objects and liquid enters the stomach from the esophagus it goes directly to the small intestines. The blood picks up excess fluid and is filtered by the kidneys but there is no way for the blood to transfer a solid object from the small intestine to the blood and into the kidneys.

Thus, either Ms. Eliot made the story up and showed the doctor a bullet that was not the one she swallowed or she or Dr. Fairfax misperceived the middle of a kidney stone as a bullet. Incidentally, there is no report in the modern medical literature of a foreign object being passed out of the body through the urine.

Fairfax, N. (1668). An Extract of a Letter, Written by Dr. Nathan. Fairfax to the Publisher, about a Bullet Voided by Urine, Philosophical Transactions, 40, 803-805.

How a Flower Can Kill a Rattlesnake: The Medical Dangers of Pennyroyal Oil

While doing some historical medical research from the 1600s, I recently came across a fascinating account of how people in Virginia used a common flower to kill rattlesnakes. The story was relayed by Captain Silas Taylor to members of the Royal Society in England, who were always interested in hearing new discoveries from places overseas.

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Captain Taylor spoke about how colonists in Virginia used a plant known as pennyroyal (pictured below) to kill rattle snakes. He noted that the leaves of this plant produced a very hot sensation when placed on the tongue.  So the colonists took some of the pennyroyal leaves, tied them to the end of a long stick, and held them by the nose of the rattlesnake.


When exposed to the pennyroyal leaves, the rattlesnakes would turn and wiggle and do whatever they could to avoid it. But the colonists were persistent and eventually the rattlesnake died in less than 30 minutes from the scent of these leaves.

How is this possible? Medical science has the answer. As it turns out, the essential oil in pennyroyal is very high (up to 90%) in pulegone. This oil is highly toxic, particularly to the liver, even at very low levels. (e.g., one ounce). The rest of the oil is made up of similar toxins. Human consumption of just a half a teaspoon of the oil can result in death.

The high toxicity of pulegone is mainly due to methofuran, an organic chemical that the body converts the oil into. Pennyroyal oil can cause seizures, fainting, failure of multiple organs, acute (sudden) kidney and/or liver failure, brain damage, hallucinations, paralysis of respiratory muscles, failure of the heart and lungs, coma, and as mentioned, death. In humans, the toxicity usually occurs a few hours after ingestion, but if one held the flower over the rattlesnake for 30 minutes, the constant exposure to the oils in the flower could explain why death occurred during that time frame.

Pennyroyal oil causes damage to organs by depleting levels of glutathione, a natural chemical in the body that prevents damage to cells. Thus, when not enough glutathione is present, cellular damage occurs quickly.
Humans need to make sure not to ingest pennyroyal oil. For example, in 1996, two infants died because they drank a tea that was made with pennyroyal.  Dogs have died after licking this oil off of their fur. A college student who drank two teaspoons of pennyroyal oil in teas died two days later in 1994. Thousands of years ago, pennyroyal oil was actually used to terminate unwanted pregnancies. It is also used as a powerful insect repellent.

Reference: 1665 (author unknown). Of A Way of Killing Rattle-Snakes. Philosophical Transactions, 3, 43.

Tuesday, September 09, 2014

Worms in the Urine: Strange Facts

Many people have heard of parasitic worm infections in their animals and even in humans. In those cases, people generally are familiar with worms being found in the fecal matter. However, many people are unaware that people can actually urinate worms. The reason is because some types of worms can infect the urinary tract.

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One type of worm infection is trichomoniasis, but these worms are microscopic. Another worm infection is schistosomiasis, which is caused by a worm called a fluke. This can cause severe kidney failure, blood in the urine, blockage of urine flow, and can eventually result in bladder cancer. In cases of fluke infection, worm eggs are released in the urine from the worms that live in blood vessels around the urinary bladder.

 Another parasitic worm infection is filariasis, which is threadworm infection. This can cause lymph fluid to enter the urine and a severe enlargement of tissues (elephantitis).  Yet another parasitic worm infection that can rarely present in the urine is strongyloidiasis which is caused by a type of roundworm.  Sometimes, the worms are living and swimming freely in the urine.  Identification of worms such as these in urine samples can sometimes prevent fatal health outcomes as these conditions are often treatable and reversible with medication.

Another type of roundworm infection that can rarely present in the urine is Ascaris lumbricoides (see picture above, image copyrighted by the Journal of Postgraduate Medicine).  These worms can live in the body for 12 to 18 months and can produce 240,000 eggs.

One of the earliest accounts of a worm present in the urine occurred in 1677 by a man named Matthew Milford. Mr. Milford noted that worm he passed was snake-headed and alive. He noted that it was small at the tail. He noted being very ill before hand and that since that time he had blood in the urine. He reportedly probably had urinary retention for some time. The worm presented on the second urine, leading the writer of the article to hypothesize that it descended from the kidney to the bladder initially and then out into the urine stream. The worm was then noted to be dead, dry, and a dull red color, with a thickness of 1/12th of an inch. It is unclear exactly what type of worm this was.

Reference : Ent and Milford (1677). A Relation of a Worm Voided by Urine; Communicated by Mr. Ent: to Whom It Was Sent by Mr. Matthew Milford. Philosophical Transactions, 140, 1009.

Monday, September 08, 2014

Babies that Turn to Stone: Meet the Lithopedions

Stone Baby from 1897

Earlier this year, an 84-year old woman in Brazil was found to have a 44-year-old fetus inside her (of 22 to 28 weeks gestation). The fetus had become calcified to protect the mother from the fetus’s dead tissue and possible infection. The calcified fetus is known as a Lithopedion, which is Greek for “stone child.” Lithopedions are commonly referred to as Stone Babies. They occur when a fetus develops outside of the womb, dies, is too large to be absorbed by the body, and calcifies inside the abdomen when medically undetected.

Stone Babies are extremely rare, occurring in 0.0054% of all pregnancies.One is pictured above from 1897 (copyright Bulletin of the Johns Hopkins Hospital).

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Women who carry a calcified fetus for decades generally do so unknowingly, as incredible as this may sound. See the case from 1677 discussed at the end of this article, for an exception. Although a Stone Baby can develop from any time between 14 weeks and full-term, the larger it is the more likely it is to be discovered. Age of diagnosis in the mother of a Stone Baby can vary across the life span, from 20 to 100 years.

Women can have additional future uncomplicated pregnancies while the Stone Baby is present because the uncomplicated pregnancy develops inside the womb unlike the presence of the Stone Baby outside of the womb.  However, the presence of a Stone Baby has been known to interfere with fertility by distorting the structure of the pelvis, impairing the pick-up of the egg cell.

While such women can have stomach pains from the calcified fetus, the pains usually go away at some point or are intermittent and can improve with pain medication. If the woman seeks medical care and an imaging study (e.g., x-ray) is not performed, then the real source of the problem goes undetected. If imaging is performed, a Stone Baby or a tumor may be suspected. Stone Babies are more common in counties where there is limited access to healthcare and in settings where health care providers are unaware of their existence. 

Various features of Stone Babies, including the face, can still be recognized even 44 years later. A 40-year-old Stone Baby was discovered in 2013. The oldest Stone Baby known was 60-years-old, found inside a Chinese woman in 2009. The youngest was less than 18 months in 2014. Ultimately, surgery is needed to remove it.

Fewer than 300 cases of Stone Babies have been reported in the past 400 years of medical literature, although the Arabic physician, Albucasis, described one for the first time in the 10th century. The earliest known Lithopedion dates to 1100BC. The first “modern” reported case dates back to 1582 when a 68-year-old French woman named Madame Colombe Chatri was found to have had a 28-year-old Stone Baby. Early physicians used to think that the cause of Stone Babies was a mystical force as they had not yet developed the scientific knowledge to explain their development.

In 1880, the German physician, Friedreich Kuchenmeister, published a review of 47 cases of Lithopedions, beginning in 1582. However, he missed a case from 1677, which is now summarized and referenced below. The case involved a Lithopedion that remained in the mother (Margaret Mathew) for 26 years. She was in the 9th month of her pregnancy and her water broke, but the baby did not come forth. Over the next 20 years, she had the perception that the child was still inside of her along with unspecified “troublesome symptoms.” She desired a surgeon to open her abdomen and relive her of the problem. However, over the next six years, she did not perceive the child to move.

The woman eventually passed away at age 64 and the surgeon then opened her abdomen. At this point, the Stone Baby was discovered, weighed 8 pounds, was 11 inches long, and was not joined to the mother. The head was downward and the skull was broken into several pieces. The brain and the flesh was red or yellow. The tongue was pink. The heart was red but contained no blood. The inner organs were blackish, The back part of the child was covered with a membrane that could only be separated with a knife. When this was done, barely any blood came forth. The forehead, eyes, ear, and nose were covered with a callous substance. The teeth were like those of an adult. Three days after it was removed, no bad smell was noted.

Reference: Bayle, M. (1677). A Relation of a Child which Remained Twenty Six Years in the Mothers Belly. Taken out of the Journal Des Scavans; Being the Extract of a Letter Written from Tolouse 22. June to the Author of That Journal, by Monsieur Bayle, M.D. Philosophical Transactions, 139, 979-980.

What Was It? The "Monstrous Birth" from 1677

Conjoined twins are identical twins who are joined together in the uterus. They have the appearance of one body with two heads.  If the faces are pointed in opposite directions, they are referred to as janiceps, although those can rarely survive due to severe brain abnormalities. Conjoined twins are rare, occurring between 1 in 49,000 to 189,000 births.  Most are stillborn (deceased at birth) and a smaller percentage dies soon thereafter.

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Conjoined twins are three times more likely to be female than male. Some are successfully separated through surgeries. Other live connected together throughout their lives. Some hypothesize the condition is caused by a fertilized egg not completely separating. Others believe the fertilized egg completely separates but that stem cells from one twin find similar cells on the other twin, fusing them together.  Most conjoined twins are fused from the upper chest to the lower chest although some are joined via other body parts.

The earliest known depiction of conjoined twins dates back to ceramics from the Moche culture in Peru from around the year 300 AD. St. Augustine of Hippo also wrote about conjoined twins in 450 AD in his book, City of God. It is unclear, however, if these descriptions and depictions were fictional or not. The earliest known documented case of conjoined twins dates to 942 AD when a pair was brought from Armenia for medical evaluation in Constantinople. 

Some other early descriptions of conjoined twins exist, such as from Arabia and England but the vast majority of case have been documented in the 20th century and beyond. This includes Chang and Eng Bunker (1811-1874) who were born in Siam (now Thailand) and thus became known as “Siamese twins.”

The Famous Siamese Twins
Because early documented descriptions of conjoined twins are hard to come by, I wanted to present how a London doctor in the late 1600s described a pair of conjoined twins he delivered (on 12/20/1667) when writing in a medical journal.

One of the most interesting descriptions is the title, “A Relation of a Monstrous Birth.” Such a description, while likely apt to the doctor who delivered the baby, would never be allowed in medical journals today because it would be considered offensive and pejorative.  Because English was written and spelled differently back in the 1600s, I will offer a modern translation of some parts of the article.

The first thing the author noted is that “It had two heads,” which sounds more like a sci-fi movie title to describe a monster (e.g., “It Came From Beneath the Sea”) rather than the opening line of a medical article. Modern journals would stick to using the gender, which in this case was female. Also interesting is that the name of the mother (Joan Peto) is listed, which would never be allowed today due to confidentiality protections.  She is also described as the wife of a butcher.

Both of the heads were described as very well-shaped, which is not unusual if this was a full-term delivery.  The left face looked swarthy (dark-skinned) and did not breath. The right head was perceived to breathe but not cry. Thus, one side appeared to be a stillbirth with the other side surviving to birth. The left head was bigger. This type of discordance between the left and the right is not uncommon in conjoined twins, likely due to genetic, environmental, and abnormalities in the placenta and/or in the circulation of the fetus.

The author says that between the heads was a protruberance, like another shoulder. The clavicles and breast were very large, about seven inches wide. The conjoined twins were of the parapagus variety, meaning they were fused side by side with a shared pelvis. There were two hands and two feet, although other conjoined twins are known to be born with four hands and feet.  The brain in each head was described as very large, indicating that the heads must have also been quite large, perhaps macrocephaly (abnormally large head), which is a known malformation in some conjoined twins. There were also two spinal cords, two pairs of lungs, and two hearts (on each side of the chest, the left heart being bigger). The lungs on the left were blackish and the other lungs looked well. 

The esophagus was divided into two branches, with one branch projecting to each throat. There was one aorta (the main artery in the human body) and vena cava (two large veins that bring blood to the heart).  The aorta and vena cava were divided into two parts, bringing blood to both hearts in the shape of a Y.

There were also two stomachs. One was shaped naturally but the other was shaped like a “great bag,” resembling what would be found in a cow or sheep.  The intestines contained a substance like meconium (early feces), similar to newborns.  The intestines were also large, as was the liver, spleen, uterus, and left kidney. Overall birth weight was 8 pounds. It is unknown what happened to the conjoined twin who was breathing.

Reference:  Morris, S. (1677). A Relation of a Monstrous Birth, Made by Dr. S. Morris of Petworth in Suffex, from His Own Observation: And by Him Sent to Dr. Charles Goodall of London; Both of the Colledge of Physicians, London, Philosophical Transactions, 138, 961-62.

Friday, August 08, 2014

Why Exercising Outdoors is Better

Gyms are awesome. They’re climate-controlled environments with machines that can work every body part, and a place to shower at the end of your workout. Some even have snack bars where you can buy smoothies, cold-pressed juices and supplements to boost the effects of your workout. If you belong to a 24-hour facility, you can work out at any time, day or night.

The thing is, as awesome as gyms are, there are a lot of reasons why exercising outside is actually better.

You’ll Get a Better Workout

One of the biggest problems with the cardio machines at the gym is that they are predictable. Even if you can set them to a random program, it’s still a program and it’s not nearly as random as you think. In fact, if you do the same “random” program at the same level and for the same duration every time you use the machine, you will notice that there is definitely a pattern. Your body gets used to these patterns and will adjust to perform those motions more efficiently. This means that you will no longer be getting as much out of your exercise routine.

Doing your cardio outdoors brings that element of unpredictability back to your exercise routine. Even if you travel the same route very day, weather conditions, the texture of the road surface and other factors can make subtle changes to the route from day to day.

Outdoor exercise also causes you to use your muscles differently than you would on a machine. People tend to flex their ankles more, when running outdoors. Also, studies have shown that people who run on a treadmill expend less energy than those running outside, because they don’t have to deal with wind resistance and other factors.

Similarly, with the right set of rollerblades, you will expend more energy exercising outdoors than on a flat, indoor track.

You’ll Exercise Longer

Exercising outdoors can actually make the exercise seem easier, allowing you to do it longer. Some of this is attributed to studies that indicate people feel a greater sense of happiness and well being when exercising outdoors. In one study, two different groups of volunteers were asked to walk for the same duration or distance – one indoors on a treadmill, and one outdoors; the group that walked outdoors shows significantly higher levels of vitality, enthusiasm, pleasure and self-esteem than the indoor group. They also showed lower levels or depression, tension, and fatigue.

You’ll Make More Vitamin D

Your body makes vitamin D from sunlight. People who live in colder climates often have lower vitamin D levels than people from sunny areas. For this reason, it’s crucial to get a little direct sunlight whenever it’s available, and outdoor exercise can do that for you. The vitamin D has two major benefits, it helps strengthen your bones and it can actually help elevate your mood.

The best part is that a little goes a long way. A mere 15 minutes of unprotected sun exposure is enough to jump start vitamin D production, after which you can apply sunscreen to protect your skin.

It’s Cheaper

Exercising outdoors not only saves you on the cost of your gym membership, it can also save you transportation costs. For example, if you hop on a bike or strap on a pair of rollerblades, instead of driving your car, you'll save gas when running small errands. If your city has a good transportation system, you can walk and bus to and from work and save money on gas and parking.

Also, because you’re using your car less often, and not using the gym’s electricity, heating and cooling, and water, you are reducing your environmental impact with fewer emissions, less use of non-renewable energy.

It’s Healthier

Believe it or not, gyms can be hot-beds of germs, bacteria, and other infectious materials. Colds, flu, jock itch, athlete’s foot, and even MRSA can be found at any gym.

While gyms do have staff members who clean the equipment, there is no way they can keep up with everyone. Additionally, because the air is often recycled, even if you religiously clean every piece of equipment before you use it, there’s still a chance you could get sick just from someone sneezing – like you would in the enclosed environment of an airplane.

You can actually avoid a lot of that by exercising outdoors.

Conclusion 

All of this is not to say that you should completely ditch your gym membership. As we stated before, there are a lot of reasons why gyms are awesome. Also, people like the elderly and the ill need gyms because they are safe and controlled environments. However, even those who need the safety of the indoors can benefit from getting outdoors once in a while.

So, if you want to be healthier and get more out of your exercise routine, get yourself outside.

This is a blog post by Nancy Evans.

Tuesday, August 05, 2014

Anorexia Nervosa and Treatment

Anorexia nervosa is a type of eating disorder in which purposely restricted food intake causes significantly low body weight compared to what would be expected based on the person’s age, gender, and height. The significantly low body weight can result from weight loss or failure to gain weight. People who are anorexic fear gaining weight or becoming obese and they have a distorted view of their body. For example, an anorexic would incorrectly view oneself as overweight whereas an objective observer would view the person as significantly underweight.

Whereas some patients with anorexia lose weight by restricting the amount of food they eat, others engage in binge eating and purging behaviors. In binge eating, excessive amounts of food are consumed over a short period of time. The food is then purged (released) through vomiting or through the use of laxatives and/or diuretics. Although anorexia has been traditionally associated with women, men can be anorexic too.

For those suffering from anorexia, the condition has serious health risks due to poor nutrition and can lead to death in extreme cases. People who are anorexic usually deny that there is a problem with being so underweight or make excuses for it. As a result, family members and friends often feel helpless when watching someone they care for who suffers from anorexia.

Fortunately, many excellent anorexia treatment programs exist, such as Rader programs. These programs often involve inpatient stays at a specialized treatment facility. Length of stays vary, with shorter stays typically focused on medical stabilization and longer stays typically focused on weight restoration.

Some programs try to involve the family with a formal family-based treatment approach, although not all patients allow family members to be contacted. Family based treatment programs are known to be effective treatments for anorexia in medically stable patients. Individual counseling for co-occurring mental health conditions (e.g., major depressive disorder. may also be needed. Medications are sometimes used as part of treatment. Due to the diverse healthcare needs of patients with anorexia, many treatment programs have multi-disciplinary care teams available.

After an inpatient stay, follow-up outpatient treatment sessions are common. As with all therapies, treatment works best when the patient is motivated to attend the sessions and to make positive changes.
In severe cases of anorexia when the patient refuses life-saving treatment, compulsory (forced) treatment may be needed. This involves compulsory re-feeding, which can be beneficial in the short-term but does not appear to worsen the therapeutic relationship.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manualof mental disorders,
5th edition: DSM-5. Arlington, VA: American Psychiatric Publishing.

Elzakkers, I.F. et al. (2014). Compulsory treatment in anorexia nervosa: A review. Int J Eat Disord. doi: 10.1002/eat.22330. [Epub ahead of print]

Maden, S. et al. (2014). A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. Psychol Med.. [Epub ahead of print]


Monday, July 21, 2014

Choosing the Right Hospital

Depending on several factors, including your geographic area and your insurance plan, you could have a broad or narrow number of hospitals to choose from. Additionally, you choice of hospital could also hinge upon where your personal physician has hospital privileges.

However, if you ever have to change insurance plans, you might have a choice of plans that don’t include your preferred hospital on their provider lists. There’s a chance you might never use the hospital benefit, but it’s important to make the right choice in case you ever do.

Hospital Ratings

The official hospital site can tell you a lot about the services they offer, the doctors they have on staff, and other things associated with their brand. Unfortunately, these don’t often have patient-centric information. In fact, Becker’s Hospital Review indicates that there are only 10 top hospital websites with patient-centric information.

Ratings by an independent evaluator, like Consumer Reports and The Agency for Healthcare Research and Quality, are the best way to evaluate future hospitals. These companies evaluate patient-centric factors like patient experience and outcomes, hospital practices, their safety score, and heart surgery.

Patient Experience: 

The patient experience rating reports the likelihood that patients would recommend this hospital to others. It is based on a government survey of patients across the country and includes such criteria as pain control, room cleanliness, room quietness, staff helpfulness, and communication with nurses and doctors.

Patient Outcomes:

The patient outcomes rating reports how well hospitals prevent hospital-acquired infections, and how many patients have to be readmitted within 30 days of being discharged, based on data that the hospitals submit to state or federal agencies.

The patient outcomes rating also measures surgical mortality rates – including mortality from post-surgical complications, like deep vein thrombosis – and medical mortality rates, based on Medicare patients admitted for heart failure, heart attack, or pneumonia.

Hospital Practices

The hospital practices rating is based on the number C-sections performed at the hospital and the appropriate use of scanning.

The C-section rates in the US are considered too high and the American College of Obstetrician and Gynecologists have guidelines for preventing unnecessary C-sections. The C-section measurement uses state-based billing data and calculates to calculate the score.

Appropriate use of scanning refers to the number of CT scans performed twice on a patient – once with dye and once without. These double scans have been deemed unnecessary and also potentially dangerous because they expose patients to extra radiation. The appropriate use of scanning measurement uses billing data submitted to CMS to calculate the score.

Safety

The safety rating refers to multiple categories regarding patient and hospital safety many of which overlap with the previously listed ratings. The criteria for the safety rating include: hospital acquired infections, mortality, patient-medical staff communications, readmission rates, and appropriate use of scanning. Some rating systems may pull this information from the patient outcome and hospital practices scores, or they may have a separate data collection system.

Heart Surgery

The heart surgery rating is based on coronary bypass procedures and aortic valve replacements. Both categories measure patient survival rates, and the rate of post-surgical complications. The coronary bypass category also rates used the best surgical technique, which improves long-term survival, and it rates whether or not patients received the correct medications before and after surgery.

Some rating services might require you to have a subscription to access hospital rating information. However, some insurance companies can also provide hospital ratings to both current and potential customers.

This is a blog post by Nancy Evans.

Wednesday, July 16, 2014

Vital Signs and the Brain

Vital signs are an important measure of basic bodily functions and are part of most physical examinations. The main vital signs typically reported are body temperature, blood pressure, pulse (heart rate), and respiratory rate (breathing rate). Vital signs fluctuate throughout the day but a significantly high or low deviation from normal indicates the presence of some type of medical problem or situational stressor.

Many times, these medical problems or stressors are relatively mild and can be easily managed or treated. Sometimes, however, abnormal vital signs can indicate a problem with the brain or spinal cord.

Although many people may think that vital signs are solely controlled or influenced by the heart , blood vessels, and lungs, it may surprise you to know the brain plays a major role in regulating vital signs. For example, core body temperature is largely regulated by the preoptic area of the anterior (front) hypothalamus (see picture below). The brain communicates to the rest of the body through the spinal cord and vice versa, which establishes an important and continuous feedback loop.


Another area you will see in the above image and below is the brainstem. The brainstem is an area in the lower part of the brain that connects to the spinal cord. The brainstem consists of three parts: the pons, midbrain, and medulla (from top to bottom).


The brainstem contains structures that regulate arousal and the most basic of life functions such as breathing rate. More specifically, there is an area in the pons and medulla that contains special nerve cells that regulates blood pressure control. This area is known as the lateral tegmental area and is located towards the back of the brainstem. The pons, medulla, and spinal cord also contain nerve cell projections that help regulate breathing rate and temperature control.

But wait, you say, I thought that part of the hypothalamus was involved in temperature control. It is, but there are actually multiple areas within the brain and spine that help regulate vital signs. As another example, there is a group of nerve cell bodies known as the solitary nucleus of the medulla that helps regulate heart rate, breathing rate, and blood pressure by sending messages through other parts of the brainstem and spinal cord.

For this reason, the solitary nucleus is also known as the cardiorespiratory nucleus. This nucleus is a good example of the feedback system that takes place between the brain and spinal cord. That is, in addition to sending out information, the solitary nucleus receives information from special sensory receptors located in major blood vessels that are excited by stretching of blood vessels. The stretching generates a nerve impulse that results in information being communicated to the brain.

This basic tutorial shows the importance of the brain for vital sign functions. The next blog entry on this topic will discuss types of damage to the brain and/or spinal cord that can cause abnormal vital signs.

Thursday, June 19, 2014

Barriers to Healthcare: Difference in Disease Mortality Rates Between Social Groups

While it is understood that, by and large, diseases don’t differentiate between hosts – that is, one warm body is about the same as another to a virus or bacterium – there are certain illnesses that seem to be more prevalent within specific groups.

For example: Caucasians show higher instances of Crohn’s disease, cystic fibrosis, osteoporosis, skin cancer, and celiac disease.; while African Americans show higher instances of type 2 diabetes, sickle cell anemia, systemic lupus erythematosus (SLE), heart disease, and hypertension.

Disease prevalence isn’t the only issue. Certain ethnic groups also have vastly different survival rates when it comes to certain diseases. For example, African Americans tend to have lower cancer survival rates than other segments of the population; and women have more heart attack fatalities than men. While we can understand some of the genetic factors associated with disease prevalence, what are the factors that contribute to the difference of survival rates?

A Difficult Topic

When discussing the health differences between certain groups – be they ethnic, racial, or gender-based – it’s impossible to do so without also discussing ethnicity, race and gender. All human being bodies are basically the same and should respond similarly when confronted with disease. That is, a body with diabetes should have the same response to the disease, be it male, female, African American, Latino, Caucasian or anyone else.

However, that does not seem to be the case; and that may have more to do with several external factors.

Access to Care

Even as the Affordable Care Act (ACA) is making it possible for more people to have access to care, people are still falling through the gaps. In states that refuse to expand Medicaid, thousands of poor are unable afford coverage. Additionally, individuals who don’t meet the economic qualifications for Medicaid, or for a subsidized plan, might still be unable to afford an individual ACA-compliant plan. While insurance companies like USHealth Group Private are working hard to make their services accessible and reach those who have been overlooked, there are still people without healthcare coverage.

Lack of healthcare coverage means people are less likely to seek medical care when they initially become sick, may postpone treatment when diagnosed, or may only be able to do partial treatments – all of which can lead to higher mortality rates.

Bias Among Healthcare Practitioners

In a 2003 report, called Unequal Treatment, the Institute of Medicine concluded that some healthcare professionals hold unrecognized biases against members of certain social groups, such as the obese and ethnic minorities; and that these unrecognized biases often negatively affect the quality of care given to these groups.

One example of an unrecognized bias affecting patient morality is the case of Lisa Smirl. Ms. Smirl was a 37-year-old college professor who began experiencing lung symptoms in the Fall of 2010. Over the course of a year she saw several physicians who diagnosed her with several un-related illnesses including asthma, migraines, and depression. In November of 2011, after taking 10 times her prescribed asthma medication did not resolve her symptoms, she was finally diagnosed with Stage IV adenocarcinoma with extensive metastasis to the bones, brain, and liver. She died in February 2013.

Shortly before she died she stated: “I can’t prove it, and this is just my opinion, but I have no doubt in my own mind that my misdiagnosis was in large part due to the fact that I was a middle aged female and that my male doctors were preconceived towards a psychological rather than a physiological diagnosis.”

Since that 2003 report was released there have been several other studies on unconscious bias and health disparities with an eye toward fostering awareness of these biases, and finding solutions to better care.

Cultural Factors

Doctors and the insurance industry are not the only factors when it comes to discrepancies in patient care. The patient’s own cultural framework can also play a part.

For example, in some cultures certain illnesses may carry a stigma that prevents individuals from seeking care. Patients who are ethnically, culturally, or racially disenfranchised may also feel a large measure of distrust toward the medical establishment, especially if there is a history medical mistreatment.

The combined factors of lack of access, health provider bias, and cultural mistrust of the medical establishment causes people to neglect their health, which results delayed diagnoses and reduced standards of care – all of which lead to higher mortality rates for certain social groups.

This is a post by Nancy Evans

Thursday, June 12, 2014

Women Favoring Permanent Hair Removal Over Home Kits

Scorching summer weather and the call of the beach or the pool has many women considering their options for hair removal. Generally speaking, that means one of two things: waxing, which is a somewhat temporary fix, or laser removal, which has much longer-lasting results.

Since waxing can be done at home, women are sometimes inclined to go this route for the sake of convenience. Others prefer the longer-term solution. Most women who opt for permanent hair removal methods have made that decision based on several key factors.

Hair Removal Isn't Seasonal

While the bikini area sparks hair removal plans in the summer, many women have cosmetic needs that last year-round. A few rounds of temporary removal are no big deal for swimsuit season, but when women are working to shape eyebrows or keep clear skin around the lips or on the forearms, the weather is irrelevant.

They want those areas hair-free year-round. As a result, they decide that a single trip to their local center can take care of summer along with the other three seasons, greatly reducing the inconvenience of maintaining their appearance year-round.

There Are Different Kinds of Convenience

Social media is full of funny stories about home waxing mishaps, and there’s a good reason. It happens a lot. Attempting to do something like this to yourself with no experience and mediocre equipment, all performed with the rudimentary instructions that came folded up in the box, is a recipe for laughs at best and pain at worst.

The temptation to go this route is driven by either money or convenience. Women feel like a spontaneous weekend trip to the coast is more easily managed with a home kit, but they later find that the subsequent day at the pool, afternoon at the spa, or big date with the husband are sending them to the store time and again to buy another kit, resulting in another comedy of errors in the bathroom. Tired of all this hassle, many women just make an appointment and get something done once and for all.

There Are Different Kinds of Safe, Too

Other women harbor concerns about the safety of laser systems, thinking there could be permanent damage to their skin or their eyes if they seek out a laser treatment. While the image of a goggled technician zapping you with something that looks like a prop from “Star Wars” can be a little scary, the fact is that the devices are FDA-regulated and approved. So why is the worker taking such pains to protect herself? A good technician is closely watching each point of treatment with the laser. A day’s work doing that can be very bad for their eyes because they are looking directly at the affected area. The client, meanwhile, is comfortably facing away, and even if she’s watching, it’s only for a few minutes. Any work done on the face will involve eye protection for the client.

The point of reference from home is the awkward maneuvering of your body in the tub, on a stool, or wherever you choose to do it yourself. The twisting and contorting you do while trying to steadily handle the wax is a serious danger for burns and falls, two good ways to ruin your vacation.

What’s Your Threshold For Pain?

Again, laser removal generates some degree of fear among would-be recipients, because we can’t seem to shake that word “laser”. But the process doesn’t involve futuristic weaponry trained on your body, and it won’t blow a smoldering hole through you. Keep in mind that you probably know a dozen people who have undergone laser eye surgery. Eye surgery! Lasers, for all the sci-fi fantasy we’ve seen or read in our lifetimes, are not painful, they aren’t destructive, and they are in the hands of skilled people. Most women who give laser treatment a chance now measure that as a polar opposite to the results they saw from their escapades with a popsicle stick, a pot of hot wax, and a foot up on the vanity.

Results, Results, Results

Ultimately, that’s what women are searching for. They are willing to pay good money for good results. Shaving, home wax, and all the other alternatives ultimately don’t produce the great look, lasting results, and ease of permanent removal with a laser system. That conclusion is what’s driving the proliferation of such salons, making the procedure ever more affordable and convenient for consumers in almost any location.

This is a post by Nancy Evans.

Tuesday, May 27, 2014

The Health Benefits Associated With Massage Therapy

Massage therapy has long since been considered a luxury therapy: one designed to soothe, but not provide any substantial health benefits. However, in recent years, it is becoming more and more common to see massage therapy being practiced in hospitals, clinics and other medical establishments.

The reason for this influx is due to the many advantages for the body associated with this specific treatment. In fact, massage therapy has been shown to improve symptoms in a number of conditions, as well as promote overall healing while simultaneously preventing healing complications.

The word "massage" is a general term for rubbing, kneading, pressing or otherwise manipulating the skin, muscles and underlying tissues. Depending on the type of massage, as well as on the practitioner, pressure and targeted areas can vary. Typically, a massage involves the use of a specialized massage table and on occasion creams and oils specifically for the targeted massage. Sites like Massage Table Outlet have these available for you if you feel that you could benefit from massage therapy.  Here is a list of physical ailments that have shown improvement when treated by massage.

1. Anxiety

Massage and tissue manipulation have been shown to reduce certain symptoms of anxiety, including insomnia, restlessness, headache, pain in the joints and muscles, nausea, loss of appetite and more.

2. Stress

Like anxiety, stress is often approached with massage therapy. Since massage can relieve stress, it may also play a role in treating and preventing complications like high blood pressure, insomnia, headache, weight gain and more.

3. Digestive Disorders

In patients with IBS, chronic constipation and other digestive disorders, massage can provide relief and stimulate healthy digestive function.

4. Fibromyalgia

The widespread pain associated with fibromyalgia is often treated through tissue manipulation. Deep-tissue massage has been shown to increase the brain's production of "feel good" chemicals called endorphins, which can reduce pain, fatigue and other symptoms of fibromyalgia.

5. TMJ

TMJ disorders can be extremely painful, and can also interfere with eating, speaking, sleeping and other aspects of everyday life. However, facial massage can help ease pain and tension, thus improving quality of life for sufferers of TMJ.

6. Injuries

Sprained ankles, broken bones, injuries to the muscles or joints are commonly treated with massage. In addition to relieving pain and discomfort, tissue manipulation has been shown to promote healing, which can result in quicker, healthier recoveries.

7. Migraine

Migraine headaches can be extremely painful and, in some cases, debilitating. And since tension often plays a role in the development of migraine headaches, massage is a great way to reduce pain and prevent flare-ups.

8. Spinal Misalignment

Spinal misalignment is associated with dysfunction or misalignment of the vertebra, or bones of the spinal column. This condition can lead to pressure on the nerves, discs or soft tissues of the spine, which often results in pain, numbness, tingling and other uncomfortable effects. Massage can be used to correct spinal misalignment, as certain techniques are designed to safely and effectively guide the vertebra back into place.

In conclusion, massage therapy can provide significant benefits for individuals suffering from various illnesses and complications with their health. Speak to a doctor to see if massage is right for you!

This is a post by Nancy Evans.

Friday, May 23, 2014

Is There Any Treatment For Optic Nerve Atrophy?

Optic Nerve Atrophy results from damage or degeneration to the optic nerve. The nerve is responsible for transporting visual information from the eye to the visual center of the brain for processing. The visual cortex of the brain then interprets the signals produced by the retina light stimulation through the optic nerve as visual images.

Signs & symptoms

Some of the leading symptoms of optic nerve atrophy include:

•  Reduced brightness of one eye

•  Decrease in side vision (peripheral vision), contrast sensitivity, sharpness, and/or clarity of vision (visual activity)

•  Optic disc changes

•  Degree of color vision impairment

•  Decreased pupil reaction to the light

•  Loss of retina ability to see fine detail

Individuals facing one or more of these symptoms may not necessarily mean they have optic nerve atrophy, but seeing an ophthalmologist is strongly recommended for a complete assessment.

What causes optic nerve atrophy?

This condition can occur without a proven cause, but the following are the known causes that may lead to optic atrophy:

Hereditary eye disease: this disease mostly occurs in the early 20s or late teens. It is diagnosed by the development of painless, but serious visual loss in one eye, followed by the same impairment in the other eye.

Sight swelling is normally experienced in the beginning, but eventually the optic nerve atrophied leads to permanent vision loss in most instances.

Inflammation of the optic nerve: eye pain which becomes severe upon the movement of the eye. Inflammation may cause optic neuritis in women young to middle-age. Some individuals suffering this condition may develop multiple sclerosis with age.

Nutritional deficiencies: this may be caused by vitamin deficiencies, vitamin B group deficiencies in particular. These deficiencies could result from a poor diet, frequent starvation, problems with absorption or alcoholism. Usually vitamin B12 deficiency is the leading cause of nerve damage. According to glaucoma.org, this condition is accountable for 90% of glaucoma cases. It develops slowly and has symptoms and damage that may not be noticed in the early stages.

Toxins and poisons: may cause optic neuropathy. The condition results from tobacco or alcohol amblyopia, which is known to be caused by cyanide exposure from smoking tobacco, and by vitamin B12 deficiency. Exposure to lead, carbon monoxide, moonshine (methyl alcohol) and antifreeze (ethylene glycol) may also lead to optic neuropathy.

Treatment options

Optic nerve atrophy info from Natural Eye Care explains that, at the moment, there isn’t any effective treatment for this condition. This is because the nerve fibers in the optic nerve never heal or grow again once they are lost. The best defense is an early diagnosis because detection of the root cause can prevent further damage. 

For example, if increased fluid pressure around the spinal cord and the brain is detected early and reduced, it may prevent further damage. A specialist may prescribe spectacles to correct refractive error, and tinted lenses may keep visual function healthy.

Studies

There is no specific research on this condition, but there are studies on nutrients like zeaxanthin, lutein and bilberry that have been found to have a positive effect on the health of the optic nerve. There are some studies going on about the transplantation of limbal stem cells from a healthy eye, which can repair the patient’s cornea and give back sight, according to a research report. But most of these studies are still in the early stages.

This is a post by Nancy Evans.

Thursday, May 22, 2014

How to Help a Drug Addict

Drug addiction is unfortunately a very real and serious problem in our society today. Whether it be alcohol, prescription medication or illegal substances, the reality is that we will encounter at least one person in our lives who is battling with a drug addiction of sorts.

One thing we all wish we could do is help our friends and loved ones in these times of need, offering help, support and treatment in order to get them back on track. This can be intimidating and overwhelming if you don’t know where to start.

Initially, everyone thinks of rehab and the sort of shows like Celebrity Rehab which people often turn to, when seeking help and recovery. However there are many other things which can be done to help a drug addict which can both complement and in some cases be employed instead of rehab.

Signs/Symptoms

The first step in helping a drug addict is spotting the signs. These can be different from person to person and vary depending on which substance they use, but ultimately they are the initial step in recognizing that somebody may have a problem.

Common physical signs of addiction to drugs include a decline in physical appearance and grooming, sudden weight loss or gain, dilated pupils and bad dental hygiene. Of course not all symptoms will be purely physical, and sometimes may not even present in this way at all.

There are other behavioral signs to consider here too. An addict’s problem is all-consuming, almost completely taking over their lives. Often, finding the next high becomes the most important thing in that person’s life, and they will do anything to get it. This is where you may notice a change in behaviors such as skipping work or school commitments, neglecting family life and friends, and becoming withdrawn or distant.

In addition to this forgetful, blasé and uncaring attitude, other behavioral signs may come into play helping you to recognize addiction. For instance if the addict is suffering financially, he or she might result to stealing to fund their habit, or carry out violent threats, actions or blackmail in order to lead them to their next high.

Of course these behaviors and appearances are not exclusive, but are the most common displays of symptoms that someone is a drug addict.

Show Compassion

Sometimes this can be the most difficult thing to do if you have just learned that somebody close to you has a drug habit, but it is one of the best things you can do in this situation. Try not to become angry, sad or show signs of hurt, and where possible avoid any conflict with the addict.

Addicts can become easily angry and are often irrational, especially whilst under the influence of their chosen drug. The key is not to upset  them or creating a situation which makes the addict feel uncomfortable, threatened or undermined. Don’t be confrontational – if you can, be comforting, understanding and offer support.

Seek Treatment

After you have spoken to the addict about their problem, and both recognized together that help is needed, the next step in the process is to seek treatment.

Sometimes, if an addict is reluctant to recognize that they have a problem, or does not want to seek help, an intervention may be more appropriate at this stage. There are plenty of intervention specialists who can help you plan this and work out how to approach the situation, who should be involved, what needs to be said and so forth.

If, however, that stage was not necessary and your friend or loved one has reached out to seek help, you will need to go through the range of treatment options available. This can of course vary depending on the addictive substance, and how bad the addiction itself is.

Sometimes, an addict may benefit from attending therapy sessions, and attending anonymous group meetings periodically. It can also help if they have a sponsor to lean on and relate to, in order to help them recover. This can quite often be the help process employed for alcohol addicts, but again the level of addiction, substance consumed and impact on the person’s life has to be taken into account here.

Usually, the logical treatment process is to enter a rehabilitation center which will keep patients in the facility for a minimum period of time, allowing the patient to detox, learn, talk and recover. Again in these situations, programs can vary dependent on the addiction in question, though it is possible in some cases and in some facilities, to enroll in a program which combats multiple addictions.

It can be a bit of a tough choice searching through programs and facilities at different centers to decide on the best appropriate treatment, especially if you have never had any dealings with such facilities before.

Hopefully this list of how to help a drug addict proves useful to you, in the instance that you ever need to approach a friend or loved one about an addiction, and look to seek them some help.

This post is by Timothy Lon.

Thursday, April 24, 2014

10 Recent Inspirational Cancer (and Other) Survival Stories

Recently, a 15-year-old boy survived as a stowaway in a wheel well during a 5-hour flight from California to Hawaii, despite being exposed to subzero temperatures and oxygen depletion. Here are 10 other recent inspirational cases of improbable survival based on a review of published scientific data.

These cases show that one should never give up no matter what the diagnosis is. Be sure to send this to any friends or family with serious medical problems for inspiration. The numbers of the references below correspond to the numbers of the cases cited. Links to the free articles are provided when available.

FEATURED BOOK: The Cancer Survivor's Companion

1. BREAST CANCER: A 55-year-old woman with recurrent breast cancer survived long-term (about 5 years) after developing abnormal fluid and pressure buildup around the heart due to inflammation of the sac-like covering around the heart, which was caused by the spread of cancer cells there. Such long-term survival is usually rare. A surgical procedure that created an opening to drain the fluid around the heart likely helped extend her life.

2. MENINGITIS: A 6-year-old boy survived a battle with a rare and more than 95% fatal form of meningitis caused by an amoeba (Naegleria fowleri ). He received immediate treatment, which is believed to central to saving his life. He was discharged home in 3 weeks.

3. MALE REPRODUCTIVE CANCER: A 45-year-old man survived a rare form of blood vessel cancer in the reproductive system after receiving chemotherapy, radiation, and surgery. He has been cancer-free for 6 years since therapy ended, the longest ever reported. The multi-modal therapy was considered to be a factor in his survival.

4. STOMACH CANCER: An 84-year-old man with advanced stomach cancer that spread to the liver and lymph nodes achieved long-term progression-free survival with a new individualized treatment approach: use of Avastin (which slows the growth of new blood vessels that feed tumors) combined with low-dose S-1 (chemotherapy).

5. NO LIVER FUNCTION: A 66-year-old man survived after 66 hours (odd coincidence) of no liver functioning due to severe bleeding complications during a liver transplant while awaiting a second suitable donor organ.  There were no known neurological complications, which is also unusual.

6. INTESTINAL CANCER: A 45-year-old man with a rare form of recurrent cancer of the small intestine has been disease free after 8 years following surgery and multiple forms of chemotherapy.

7. MULTIPLE ORGAN SYSTEM DYSFUNCTION (MODS): A 55-year-old man is the oldest man known to survive MODS, which is the leading cause of death in intensive care units. Prognostic indicators indicated certain death in his case yet he survived, recovering almost all organ function after 6 weeks. He had developed MODS after suffering a stroke.

8. THYMUS CANCER: A 73-year-old man with a rare form of cancer of the thymus obtained long-term (greater than 4 years) of progression free survival and good quality of life. The thymus is an organ located in the upper part of the chest and is very important in producing substances that protect the body against disease. The patient achieved his long-term survival after treatment with S-1 when first-line chemotherapy and radiation failed.

9. MULTIPLE BRAIN TUMORS: A 51-year-old woman survived for three years after developing two different types of brain tumors at once: glioblastoma and meningioma. This is the first known case of its kind to have survived this long.

10. HEART ATTACK AND HYPOTHERMIA: A 65-year-old woman survived without any problems after suffering a heart attack from deep accidental hypothermia.

References:

1. Ikeda H, Kikawa Y, Nakamoto Y, Takeo M, Yamamoto M. (2013). A patient with recurrent breast cancer showing long-term survival after developing pericardial effusion and cardiac tamponade caused by carcinomatous pericarditis. Breast Care (Basel). 8(1):71-3. Free article here.

2. Sood A, Chauhan S, Chandel L, Jaryal SC. (2014). Prompt diagnosis and extraordinary survival from Naegleria fowleri meningitis: A rare case report. Indian J Med Microbiol. 32(2):193-6. Free article here.

3. Chang K, Sio TT, Chandan VS, Iott MJ, Hallemeier CL. (2014). Angiosarcoma of the seminal vesicle: a case report of long-term survival following multimodality therapy.Rare Tumors.6(1):5202. Free article here.

4. Fang J, Wang H, Xu Q. (2013). Bevacizumab combined with low-dose S-1 as maintenance therapy with a long progression-free survival in an elderly patient with heavily pre-treated advanced gastric cancer: A case report. Biomed Rep. (2):239-242. Free article here.

5. Photi E, Crawford M, Pulitano C. (2014). Long-term survival after 66 hours of anhepatic time with no neurological deficit. Ann Transplant. 19:93-5.

6. Nagaraj G, Zarbalian Y, Flora K, Tan BR Jr. (2014). Complete response and prolonged disease-free survival in a patient with recurrent duodenal adenocarcinoma treated with bevacizumab plus FOLFOX6. J Gastrointest Oncol. 5(1):E1-6. Free article here.

7. Kleiman DA, Barie PS. (2014). Survival in Fully Manifest Multiple Organ Dysfunction Syndrome. Surg Infect (Larchmt). (epub).

8. Tanaka H, Morimoto T, Taima K, Tanaka Y, Nakamura K, Hayashi A, Kurose A, Okumura K, Takanashi S. (2013). The long-term survival of a thymic carcinoma patient treated with S-1: a case report and literature review. Onco Targets Ther. (2013). 7:87-90. Free article here.

9. Linhares P, Martinho O, Carvalho B, Castro L, Lopes JM, Vaz R, Reis RM. (2013). Analysis of a synchronous gliosarcoma and meningioma with long survival: A case report and review of the literature. Surg Neurol Int. 4:151.

10. Meyer M, Pelurson N, Khabiri E, Siegenthaler N, Walpoth BH. (2014). Sequela-free long-term survival of a 65-year-old woman after 8 hours and 40 minutes of cardiac arrest from deep accidental hypothermia.(2014). J Thorac Cardiovasc Surg. 147(1):e1-2.

Saturday, April 19, 2014

Weight Loss: 10 Recent Scientific Findings

Below is a summary of 10 of the most recent scientific findings on weight loss. The numbered references at the end correspond to the numbered sections below. Links to free versions of the full articles are provided when available if you are interested in reading more.

FEATURED BOOK: The DASH Diet Weight Loss Solution

1. Barriers and Help for Women: The two main barriers of weight loss include a) struggling with self such as poor self-control, insecurity, health problems, and difficulties changing food habits and b) problems implementing a diet. Self-determination (which was associated with having clear goals) and social support from friends and family helped achieve weight loss.

2. Telephone support: People who received 4 telephone wellness coaching calls and completed a weight loss program reported losing three pounds. This was more weight loss than people who were not targeted for wellness coaching and people who did not complete a weight loss program. Telephone support appeared to provide a small weight loss benefit but reliance on self-reported weight is a limitation of the study.

3. Predictors of Weight Loss Maintenance: Based on a survey of 450 people, the best weight loss maintenance predictors were weekly weighing, decreased evening snacking, decreased portion size, and being physically active each day.

4. Psychological Problems: In 138 obese women, 77% had symptoms of anxiety, 61% had moderate to major depression symptoms, and half had low assertiveness. The prevalence of these problems increased with the degree of eating disorders. Feelings of ineffectiveness were common among the women’s psychological profiles.

5. Zonisamide: A case study of an obese adolescent showed that when treated with Zonisamide, weight loss decreased from 279.5 pounds to 234 pounds, a 16.25% reduction. The authors discuss the possibility of using this medication, which is normally used to treat seizures, for weight loss in adolescents. Clinical trials are ongoing to study this medication for weight loss.

6. Effects on Offspring: Dietary interventions are important during pregnancy because maternal obesity has long-term consequences for the offspring’s ability to metabolize of lipids (fats) in the liver.

7. Benefits of Lap Bands: The first 10% weight loss from the lap band procedure, which involves partial clamping of part of the stomach to slow down food consumption, is associated with improved kidney function, metabolism, blood flow, and sympathetic nervous system functioning. The sympathetic nervous system is the part of the nervous system that generally excites the body by doing things such as increasing both the heart rate and blood pressure.

8. Urinary problems: Weight loss in obese women helps reduce episodes or urinary incontinence, urine leakage, and quality of life.

9. Benefits of a Revised Gastric Bypass Surgery: A revised gastric bypass surgery that is performed after the first failed or when converting stomach stapling to a gastric bypass surgery provides less weight loss and more health complications compared to if gastric bypass surgery was performed initially and was successful. However, the revised gastric bypass surgery provides an excellent opportunity to reduce other diseases related to obesity.

10. Low Intensity Weight Loss Programs: Even low intensity weight loss programs in the workplace can lead to clinically significant weight loss (5 or more % of body weight) in a significant number of participants. Weight tracking tools through a website were most predictive of weight loss. Other helpful weight loss predictors were eating more fruits and vegetables, increased physical activity, and reducing stress.

References

1. Hammarström A, Wiklund AF, Lindahl B, Larsson C, Ahlgren C. (2014). Experiences of barriers and facilitators to weight-loss in a diet intervention - a qualitative study of women in Northern Sweden. BMC Womens Health.14(1):59.

2. Tao M, Rangarajan K, Paustian ML, Wasilevich EA, El Reda DK. (2014). Dialing in: effect of telephonic wellness coaching on weight loss. Am J Manag Care. 20(2):e35-42.

3. Abildso CG, Schmid O, Byrd M, Zizzi S, Quartiroli A, Fitzpatrick SJ. (2014). Predictors of Weight Loss Maintenance following an Insurance-Sponsored Weight Management Program. J Obes. FREE article here.

4. Panchaud Cornut M, Szymanski J, Marques-Vidal P, Giusti V. (2014). Identification of psychological dysfunctions and eating disorders in obese women seeking weight loss: cross-sectional study. Int J Endocrinol. FREE article here.

5. Nguyen ML, Pirzada MH, Shapiro MA. (2013). Zonisamide for weight loss in adolescents. J Pediatr Pharmacol Ther. 2013 Oct;18(4):311-4. FREE article here.

6. Nicholas LM, Rattanatray L, Morrison JL, Kleemann DO, Walker SK, Zhang S, Maclaughlin S, McMillen IC. (2014). Maternal obesity or weight loss around conception impacts hepatic fatty acid metabolism in the offspring. Obesity (Silver Spring).

7. Lambert EA, Rice T, Eikelis N, Straznicky NE, Lambert GW, Head GA, Hensman C, Schlaich MP, Dixon JB. (2014). Sympathetic Activity and Markers of Cardiovascular Risk in Nondiabetic Severely Obese Patients: The Effect of the Initial 10% Weight Loss. Am J Hypertens. (epub ahead of print).

8. Gozukara YM, Akalan G, Tok EC, Aytan H, Ertunc D. (2014). The improvement in pelvic floor symptoms with weight loss in obese women does not correlate with the changes in pelvic anatomy. Int Urogynecol J. (epub ahead of print).

9. McKenna D, Selzer D, Burchett M, Choi J, Mattar SG. (2014). Revisional bariatric surgery is more effective for improving obesity-related co-morbidities than it is for reinducing major weight loss. Surg Obes Relat Dis. (epub ahead of print).

10. Carpenter KM, Lovejoy JC, Lange JM, Hapgood JE, Zbikowski SM. (2014). Outcomes and utilization of a low intensity workplace weight loss program. J Obes. FREE article here.

Friday, April 18, 2014

Mothers Who Kill: 10 Scientific Facts about Infanticide

On April 13, 2014, Megan Huntsman from Utah was arrested after admitting to killing 6 newborns, placing them in plastic bags, and storing them in boxes inside her garage.  This occurred over a 10-year period from 1996 to 2006. Her estranged husband made the discovery the day prior to her arrest after cleaning out the garage and noticing a strange package with a strong and foul odor. Police then discovered other dead infants that were allegedly strangled or suffocated. One infant, a seventh, was reportedly a stillborn.

FEATURED BOOK: Infanticide: Psychosocial and Legal Perspectives on Mothers Who Kill

The murder of infants (known as infanticide), neonatocide (killing an infant within 24 hours after birth), and/or filicide (a parent killing their own child) are some of the most reviled crimes in society. It naturally leads most people to ask how and why someone can do such a thing. In Hunstsman’s case, the answer could not be that she did not have a safe way to get rid of children she did not want because Utah has a Safe Haven law that allows infants that parents do not want to be dropped off anonymously at a hospital without any legal consequences.

The following is 10 facts about infanticide based on a recent scientific review of the literature (reference below).

1. STATISTICS: The killing of infants and newborns is one of the most common forms of murder by women. In industrialized countries, for every 100,000 infants, 2.4 to 7 are murdered. The true incidence is likely under-reported because the existence of some deceased babies is unknown until the bodies are discovered. Up to 10% of sudden infant death syndrome (SIDS) cases are actually undetected homicides. Most murdered infants and newborns are killed by the biological mother.

2. DIFFERENT CHARACTERISTICS: Women who murder newborns tend to be younger than age 25, single, live with their parents, unemployed or attending school, do not seek prenatal care, and are no longer involved with the child’s father. Women who murder infants older than one day of age tend to be older than 25, are often married, well-educated, and commit the crime as a form of retaliation (e.g., against an abusive spouse).

3. MENTAL ILLNESS: Many to most women who kill infants are not formally designated as mentally ill. Other factors associated with infanticide besides illness include less education (e.g., dropping out of school), anger, youth of the mother, and not wanting to invest personal time in child rearing. Personality styles and hormone levels have not been found to differ between women committing infanticide and those who did not vomit infanticide. Psychosis (detachment from reality) and clinical depression is rare in mothers who commit infanticide, although some mild emotional disruption may be present.

4. LANGUAGE: The perpetrators of infanticide often use language to deflect personal responsibility  (e.g., “when my baby died” instead of “when I killed my baby”.)

5. SYMBOLISM: The infant victim is typically viewed by the mother as an object rather than as an independent living person.

6. CAUSE OF DEATH: Most women use their hands in the murder (e.g., suffocation, drowning, strangulation) instead of using external weapons.

7. GENDER OF VICTIM: Most murdered infants are male in Western nations whereas in some Eastern countries (e.g., India, China) most murdered infants are female. The male preference in Western cultures may be because the male is more symbolic of the female’s reproductive partner. (In Eastern countries it may be because females are viewed as less desirable).

8. CONCEALMENT: As in the Huntsman case, most cases of infanticide involve the mother trying to conceal it in some way (e.g., placing in garbage cans, refuse sites). This is similar to the Hunstsman case, with the infants stored in boxes in a garage. In neonaticide cases, the mother typically tries to make the pregnancy and birth a secret.

9. RECIDIVISM: The rate of recidivism of infanticide is unknown but there have been other cases of repeated infanticide, as high as eight. In some of these cases, the deaths had previously been attributed to Sudden Infant Death Syndrome.

10. PRIOR ARRESTS: Most women who murder infants do not have a prior arrest record.

Reference: Porter and Gavin (2010). Infanticide and neonaticide: a review of 40 years of research literature on incidence and causes. Trauma Violence Abuse. 11(3):99-112.

Tuesday, April 15, 2014

Advances in Medical Testing that Just Might Save Your Life

Here's a shocking fact. One of the most important elements of a doctor's lifesaving decision making process has absolutely nothing to do with medicine. It has to do with logistics. Medical testing takes on many forms.

Blood tests are what immediately spring to mind for most of us. You go to your doctor because you are having symptoms of a high fever and chills. The doctor suspects some type of infection. She orders a blood culture that will detect bacterial and fungal germs in the blood. What happens next is not medicine, but logistics. The samples she ordered has to be sent off to a lab for testing. The proper handling and transport of those samples could make all the difference in the quality of your treatment.

Lab relocation and transport of samples between patients, doctors, labs, and scientists is one of the most critical aspects of a good diagnosis. It is not just a matter of putting in in a box and shipping it FedEx. Among other things, it involves expertise in:

The science of cryo-preservation
The countless state and federal regulations governing shipping and transportation, and...
The products and equipment needed to preserve materials at ultra-low temperatures

Get the cryo-preservation a little bit wrong, and the lab does not have a usable sample for an accurate reading on which your doctor can base a proper diagnosis.

Of course medical testing consists of a lot more than simple blood cultures. Recent advances in medical testing are yielding results that may appreciably extend the human lifespan in your lifetime. Just consider the advances we have made with regard to some of the most common life shorteners:

New technology advances cancer detection through blood testing.

One of the big challenges of cancer research is the ability to isolate CTCs. Circulating tumor cells are rare and difficult to categorize. New technologies have made it possible to address cancers of epithelial origin: prostate, breast and colorectal. There is reason to believe that more effective treatments are within our grasp thanks to advances in medical testing.

Future devices may eliminate the need for invasive glucose monitoring.

In the span of a single lifetime, we have already seen diabetes go from a death sentence with inevitable complications, to a manageable condition that does not have to hinder or shorten a normal life. For many, the most inconvenient part of having diabetes is the finger pricking necessary for frequent glucose monitoring.

Today, we can test glucose with a tiny implant under the skin that sends information to an external device. Currently, it does not replace the finger prick entirely. But it will in time, just as the finger prick replaced urine samples. Though current technology has not yet caught up to the vision, researchers are looking to wrist-worn devices to perform the task of persistent glucose monitoring. It is rumored in some quarters that Apple is working on such a feature in its upcoming iWatch wearable.

There are new methods of detecting heart disease.

Right now, heart disease is the number one killer. We are devoting a great deal of research to push it down in the rankings. One of the best ways to do that is detecting it early enough to do something about it. One of the newer tests is engineered to detect the presence of cardiac troponins which are only found in the heart. Another more recent test helps to diagnose patients who present with chest pain. It can more accurately determine if a heart attack has occurred. By using these and other advanced methods, we are able to greatly reduce the damage cause by heart disease.

This is a post by Nancy Evans