Author Archives: Carey Goldberg

12 Tips For Nurses And Doctors Treating Transgender Patients

(Alex E. Proimos/flickr)

(Alex E. Proimos/flickr)

Transgender medicine is a concept that is just now taking shape.

Massachusetts is drafting rules that will define the transgender services insurers will be required to cover. The Association of American Medical Colleges (AAMC) has just released guidance on training doctors to treat lesbian, gay, transgender and gender nonconforming patients. And Boston University Medical School has what Dr. Joshua Safer, a professor there, says is the nation’s first transgender medicine curriculum focused on the biology of gender identity.

Transgender medicine is a concept that is just now taking shape.

Like I said: brand new stuff. But what do all these new rules mean for the doctor or nurse, in an examination room, who meets their first transgender or gender-fluid patient?

MA Transgender Guidelines

Here’s some advice from Dr. Safer, associate professor of medicine at Boston University Medical School, and Dr. Jennifer Potter, associate professor of medicine at Harvard Medical School. (Dr. Potter is a co-author of the AAMC guidelines.)

1) When greeting a new patient, or one you haven’t seen for some time, you cannot assume anything about their gender identity based on the masculinity or femininity of their appearance or the timbre of their voice. To avoid making mistakes, ask each new patient how they identify, what name they prefer to be called and what pronouns they want you to use. Note: Pronouns may be male (he), female (she), they or another gender-neutral option. Continue reading

Til Stress Do Us Part: Marriage Angst Can Be Hard On Your Heart

(Neil Moralee/Flickr)

(Neil Moralee/Flickr)

By Alvin Tran
Guest Contributor

Marriage is hard even in the best of circumstances. But new research suggests that if things are particularly hard, the stress can take a toll on your heart — especially if you’re older and female.

In a study published this week in the Journal of Health and Social Behavior, researchers found that older couples in bad marriages have a higher risk for heart disease compared to those in good marriages. This link between the quality of a marriage and the risk of heart-related problems, such as high blood pressure, is even more pronounced among female spouses.

“The strain and stress from the marital relationship has a strong negative effect on people’s heart,” said Hui Liu, an associate professor of sociology at Michigan State University and the study’s lead author. “If the marriage is very stressful, it’s really hard on your heart.”

Liu, along with co-author Linda Waite of the University of Chicago, analyzed data from an ongoing nationally representative project that followed nearly 1,200 older men and women, ages 57 to 85, for a period of five years.

After comparing participants at the beginning of the study to the end of the five-year follow-up period, they found a significant link between an increase in negative marital quality with higher risk of hypertension among women. Not-so-hot marriages were marked by less spousal support and with husbands and wives spending less time with each other.

“The effect of marriage quality on cardiovascular risk is stronger for women than for men. It also becomes stronger as people get older,” Liu said during an interview. “We think marriage is one of the social factors that may affect the risk of cardiovascular disease.” Continue reading

Westminster Pulls Tobacco Ban Proposal

The Westminister Board of Health is withdrawing a proposal to ban tobacco sales in town after staunch opposition.

According to the Telegram & Gazette, board member Edward Simoncini Jr. made the motion to withdraw the proposal Wednesday and the board voted 2-1, with Peter Munro voting for and chairwoman Andrea Crete voting against the motion.

Many residents criticized the proposed ban — which would have been the first such sweeping measure in the country — saying it would violate their civil rights. Opponents had begun the process of trying to remove the health board members from office.

Continue reading

New MGH-MIT Partnership Marries Medicine And Tech

From left: MIT graduate student Matthew Li, MIT engineering professor Michael Cima and MGH nephrologist Dr. Herbert Lin with the portable device they’re developing to measure hydration state and blood volume using nuclear magnetic resonance (NMR). (Jesse Costa/WBUR)

From left: MIT graduate student Matthew Li, MIT engineering professor Michael Cima and MGH nephrologist Dr. Herbert Lin with the portable device they’re developing to measure hydration state and blood volume using nuclear magnetic resonance (NMR). (Jesse Costa/WBUR)

Major cuts in federal medical research funding have prompted scientists to find new ways to collaborate and pay for their studies.

Now, the Massachusetts Institute of Technology and Massachusetts General Hospital have formed a partnership to put millions of dollars into new research that brings scientists and engineers from the two institutions together. The goal: to develop better technologies and methods to diagnose and treat disease.

MIT engineering and materials science professor Michael Cima is one of the first researchers to get a grant under the partnership. We met him recently in his lab at MIT, where he showed us the diagnostic tool he’s developing.

“This particular project deals with what I think is an important measurement of health, which is hydration state. There aren’t really good ways to do that,” Cima explained to us.

His device will measure if someone is dehydrated or holding too much water. Continue reading

Project Louise: Trying Not To Hate Steve Brown For Easily Losing 30 Pounds

(Duncan via Compfight)

(Duncan via Compfight)

In 11 months, I’ve lost 15 pounds.

In three months, Steve Brown lost 20 pounds.

I am trying very hard not to hate him.

It helps that we’re colleagues; he’s a longtime anchor and reporter at WBUR. And it helps even more that he has been telling me for months that I’m his “inspiration” for this success. Flattery will indeed get you everywhere.

So I had to ask him: How’d you do it?

And it turns out that the answer is, well, just a little bit despicable too. He used an app. That’s it. He used an app, and he lost 20 pounds.

Actually, Steve tells me, once he reached his goal of losing 20 pounds, he decided to keep going and lost another 10. And, he says, “it was kind of fun.” He lost 30 pounds! And it was fun!

What have I been doing wrong? Or, more constructively, what has he been doing right?

The joy of the Hershey’s kisses was extended.
– Steve Brown

Coincidentally, a recent study found that just knowing about a weight-loss app won’t necessarily help you lose weight. But Steve insists that downloading — and using! — this app was really the only thing he did. The app he used is called Lose It!, and it’s developed by a company right here in Boston. It’s free, although you can also get a premium version with more features.

The free version, Steve explains, is basically a calorie tracker. You tell it how much you weigh now and how much you’d like to weigh; it then tells you how long it will take to get there based on how quickly you want to lose – a pound a week? Two?

And then you start telling it everything you eat, and it keeps track of how many calories you have left to “spend” each day. It can also factor in any exercise you do – and it will even give you credit for whatever steps your phone tells it you’ve taken that day.

It seems so … simple. Can it really make you lose weight? Surely there’s more to it than that. So what exactly did this app make Steve do? Continue reading

Suit Over ‘100% Natural’ Label On Nature Valley Granola Bars Settled

(AP Photo: Matt Rourke)

(AP Photo: Matt Rourke)

The non-profit Center for Science in the Public Interest has made me a hopeless cynic about the glowing verbiage on food packaging. Among the center’s other work, it acts as a sort of truth squad for food claims, outing many “good for you” labels and ads for the shameless distortions that they are.

“I guess I knew that was too good to be true,” is my usual reaction when I find out that yet another hyper-palatable “healthy” snack or entree is actually packed with sugar or fat or salt.

Now, the center reports the settlement of a suit it brought against General Mills for calling Nature Valley granola bars and other products “100% Natural” even though they contained highly processed sweeteners. (Wait, you mean “high-fructose corn syrup” doesn’t just count as corn?) From it’s press release:

WASHINGTON—A settlement agreement announced today prevents General Mills from claiming that its Nature Valley granola bars, crispy squares, and trail mix bars are “100% Natural” if those products contain high-fructose corn syrup, high-maltose corn syrup, dextrose monohydrate, maltodextrin, soy protein isolate, or several other artificially produced ingredients. The agreement, which is effective immediately and applies to labeling and marketing for 30 Nature Valley products, settles a 2012 lawsuit brought on behalf of consumers by the nonprofit Center for Science in the Public Interest and two law firms.

CSPI privately raised its concern with General Mills over its “100% Natural” claims as early as 2005. The company began phasing out its use of high-fructose corn syrup in some products, but at the time of CSPI’s lawsuit was still using high-maltose corn syrup and maltodextrin. While those ingredients are derived from corn, they are produced by treating corn starch with acids, enzymes, or both before being refined into a substance that does not occur in nature.

The center notes that a bill introduced in Congress in 2013 “would prohibit the use of the word ‘natural’ on a food that includes any synthesized ingredient, or any ingredient that has undergone chemical changes such as corn syrup, high-fructose corn syrup, high-maltose corn syrup, maltodextrin, chemically modified food starch, or alkalized cocoa.”

The Wall Street Journal reports that some Nature Valley packaging had apparently already been changed. Continue reading

AG Hasn’t Ruled Out Legal Action To Prevent Closure Of Quincy Medical Center

Attorney General Martha Coakley’s office hasn’t ruled out court action to prevent Quincy Medical Center from shutting down.

Steward Health Care, the hospital’s parent company, announced this month that it would close the 124-year-old facility at the end of the year. The hospital has since moved the closing back to Feb. 4.

Bob Ross, head of the attorney general’s business and labor bureau, said Tuesday in a letter to a Steward lawyer that the closing could violate an agreement the company signed when it purchased the hospital in 2011 to keep it open for at least 10 years.

Ross said officials were willing to discuss Steward’s claim that the agreement should be altered.

Steward has said the hospital, with nearly 700 employees, is losing $20 million a year in the face of increased regional competition.

‘Silent Trauma': Hearing Loss, Ear Damage Linger Long After Marathon Bombing

Emergency responders comfort a woman on a stretcher who was injured in the Boston Marathon bombing on April 15, 2013. (Jeremy Pavia/AP)

Emergency responders comfort a woman on a stretcher who was injured in the Boston Marathon bombing on April 15, 2013. (Jeremy Pavia/AP)

After two bombs exploded at the Boston Marathon in April of last year, the initial focus was on the lives and the multiple limbs lost in the attack. But ear damage was the most common physical injury. A new report finds that many victims are still suffering from hearing loss and ear damage related to the blasts.

A team of Boston researchers report on the lingering impact of those ear and hearing problems in a new study published in the journal Otology and Neurotology.

The report’s conclusion

Blast-related otologic injuries constitute a major source of morbidity after the Boston Marathon bombings. Orthopedic and soft tissue trauma was sustained by many, but far more incurred ear-related damage. This represents much of the silent trauma that requires continued evaluation and treatment…

More specifically:

Among the 94 study participants, researchers found that 90 percent of the hospitalized patients sustained “tympanic membrane perforation,” basically a ruptured ear drum, following the bombings. From the study:

Proximity to blast and significant nonotologic injury were positive predictors of perforation. Spontaneous healing occurred in 38% of patients, and tympanoplasty success was 86%…Hearing loss, tinnitus, hyperacusis, and difficulty hearing in noise remain persistent and, in some cases, progressive complaints for patients. Otologic-specific quality of life was impaired in this population.

Notably, it took many blast victims some time to realize the extent of their hearing problems, researchers report. Alicia M. Quesnel, an otologic surgeon at Massachusetts Eye and Ear and Harvard Medical School, a senior author of the study told The Washington Post:

“I saw patients who were traumatized by what had just happened, and there was a lot going on emotionally,” Quesnel said. “We were seeing people coming into the clinic in the days and weeks after the bombing. They realized that they can’t hear very well.”

“A bomb going off — that loudness results in some temporary deafening. It may have taken people a few days or weeks to realize ‘I can’t hear from one ear or both ears.'”

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Memo To Gov.-Elect: Include Pain Sufferers As You Seek Opiate Solution

(tudedude via Compfight)

(tudedude via Compfight)

By Cindy Steinberg
Guest contrbutor

Cindy Steinberg is the policy chair for the Massachusetts Pain Initiative and the national director of policy and advocacy for the U.S. Pain Foundation.

Charlie Baker vows to tackle state opiate problem,” was the Boston Globe headline two days after Election Day.

It’s good to hear from our newly elected governor that he plans to take steps to curb the ongoing problem with illegal use of prescription medication in our state. There’s little doubt that too many lives are being harmed by drug abuse and addiction.

But in a quest to fix one problem, policymakers need to consider the potential unintended negative consequences for the patients for whom these medications are a lifeline.

Cindy Steinberg (courtesy)

Cindy Steinberg (courtesy)

Gov.-elect Baker said in that Globe interview that he plans to convene a coalition of lawmakers, health care providers and labor leaders to confront the opioid crisis in our state. Representatives of the pain community — an estimated 1.2 million Massachusetts residents live with chronic pain — must be included in these discussions as well.

For many with chronic pain, the right medications mean the difference between a life worth living or not.

But despite these legitimate needs, more and more I’m hearing from residents of our state who are unable to access treatment that their doctors say they need and that they depend on. These are not addicts; these are people who are trying to manage their lives with debilitating conditions such as cancer, diabetic neuropathy, sickle cell, daily migraine, fibromyalgia, severe back pain and many others.

These are not addicts; these are people who are trying to manage their lives with debilitating conditions such as cancer, diabetic neuropathy, sickle cell, daily migraine, fibromyalgia.

Not including members of the pain community in discussions about how these medications are prescribed, regulated and controlled marginalizes the lives of thousands of Massachusetts citizens who live with pain caused by a myriad of conditions and serious injuries.

There is not a silver bullet solution to solving the abuse of prescription drugs. We need to take a thoughtful, multifaceted approach to ensure that those who need pain medication have access to it, and that those who choose to abuse these medications are stopped. There is no group more invested in making sure that medications are responsibly controlled than members of the pain community. Continue reading

New Mass. Health Connector Website Works, But Some Enrollees Have Problems

Updated November 16, 2014, 9:26 a.m.

State officials and the folks at the Massachusetts Health Connector call the first day of the new health insurance website a success.

“The website was stable and available throughout the entire day,” said Maydad Cohen, a special adviser to Gov. Deval Patrick on the website project. “Response times were averaging under half a second. Throughout the day, no complaints about an inability to get on, no slowness, no issues at all with our performance and usage of the site, which was fantastic.”

  • 5,967 residents were able to put in their income information and figure out what kind of coverage assistance, if any, they could receive.
  • 2,660 of those people qualified for free coverage through the state’s Medicaid program, MassHealth.
  • 1,704 people chose a plan but have not yet paid.
  • 60 people paid and are awaiting confirmation from their insurer.

Roughly 1,600 people did not complete their application. They may still be weighing their plan options, they may have run out of time, or they may have had trouble using the site. And 1,713 people dialed the Connector’s call center number seeking help with their application.

The Connector does not know how many people received error messages, got stuck, had to start over or were told they must fill out a paper application.

But unlike last year, the website is working.

The Connector highlights a Facebook comment from Dianne Anagnos, who says, “My enrollment went smoothly. I am a happy customer and the website was very user friendly.”

Some people were able to enroll with few, if any problems.

But there were also more than a dozen complaints posted to Facebook, Twitter and other social networking programs. These people reported problems verifying their identity, their immigration status or their income. They had trouble enrolling family members. When they dialed the Connector’s call center for help, some people reported wait times of 50 minutes or more. Some were told they would have to fill out a paper application.

Linda Mederios says she was told she would have to fill out a paper application because the site could not verify her identity.

“Not working any better than the old website did,” Medeiros wrote on Facebook, “trying to register & it says ‘cannot verify’ @ this time … been ON HOLD w/phone center for the past 40 mins. UGH !!!!!!!!!”

Medeiros says she started her application at 8 a.m. Saturday. Sometime during the day, she says, a team of Connector staffers called and helped her through the website. By 4:45, she and her husband were enrolled in subsidized coverage.

The Connector will be issuing daily reports in an effort to be transparent about the website. It’s not clear how those reports will measure trouble people have using the site.

The Connector does not know how many people received error messages and had to start over. But here’s a sample of complaints posted to the Connector’s Facebook page:

Continue reading