Author Archives: Carey Goldberg

Instead Of Therapy, Put A Little Thanksgiving Into Regular Family Dinners

Mark's postcards from Beloit/flickr

Mark’s postcards from Beloit/flickr

Anne K. Fishel, Ph.D.
Guest Contributor

When a colleague recently told me about her Thanksgiving tradition, it got me thinking about family dinners — a topic I consider every night around 7 pm and with every patient I see in family therapy.

Indeed, as a mental health provider, I sometimes feel I’d go out of business if families had regular dinners with one another. Truly. There are dozens of research studies that show that frequent family dinners promote kids’ mental and emotional well being — by lowering rates of depression, anxiety, eating disorders and substance abuse, for starters. Family meals also strengthen children’s resilience, self-esteem and sense of connectedness to their parents. Isn’t that exactly the goal of therapy?

It’s no wonder that I often have to stifle the urge to say, ‘Stop wasting your time here. Go home and eat dinner together.’

But, I’m well aware of how hard it is for busy, harried families to find time to sit down to dinner, and I’m always looking for new ways to unlock the benefits without adding any guilt or pressure. So, that is why my colleagues remarks sparked my interest. Here’s what she said:

“My sisters and I love Thanksgiving so much that our father makes a Thanksgiving-like meal throughout the year that he dubs ‘Harvest Dinner.’ We just can’t get enough of his mashed potatoes!”

I love the idea of bringing the special quality and spirit of Thanksgiving dinner to everyday meals. Two elements could easily translate to everyday dinners: sharing the workload, and focusing on more than just food. Continue reading

Brain Science, Dangerous? Not So Fast, Says Poverty Expert

Back in June, we wrote about a novel program in Boston that seeks to lift women and their families from poverty, in part by using the latest research in neuroscience. Specifically, the program (developed by the nonprofit Crittenton Women’s Union) takes into account recent studies that reveal how trauma, and poverty, can rewire the brain and potentially undermine executive function.

In an Op-Talk piece in this week’s New York Times headlined “Can Brain Science Be Dangerous?” writer Anna North cites our story, and then goes on to question whether this type of approach might be problematic. In the article, North refers to sociologist Susan Sered:

Dr. Sered…says that applying neuroscience to problems like poverty can sometimes lead to trouble: “Studies showing that trauma and poverty change people’s brains can too easily be read as scientific proof that poor people (albeit through no fault of their own) have inferior brains or that women who have been raped are now brain-damaged.”

She worries that neuroscience could be used to discount people’s experiences: “In settings where medical experts have a monopoly on determining and corroborating claims of abuse, what would happen when a brain scan doesn’t show the expected markers of trauma? Does that make the sufferer into a liar?”

We asked Elisabeth Babock, president and chief executive officer of Crittenten Women’s Union, to respond to the Times piece. Here, lightly edited, is what she wrote:

Moving out of poverty in the U.S. today is an extremely complicated and challenging process. It involves trying to maintain a roof over your head when the minimum wage doesn’t cover the minimum rent; and trying to get a better paying job when almost all those jobs require education beyond high-school and the costs of that education, in both money and time, are well beyond the means of most low-wage workers. It involves trying to care for a family while filling in the gaps in what the minimum wage will buy with increasingly-frayed public supports. It involves a lot of juggling.

We at Crittenton Women’s Union (CWU) understand this process all too well because we work with hundreds of people trying to navigate their way out of poverty every day: homeless families living in our transitional housing and domestic violence shelters, and people who are living on the edge of homelessness, struggling to make ends meet. What we at CWU see is that the stress of this everyday struggle creates an additional set of monumental challenges for those we serve.

Our families often describe themselves as feeling “swamped” by their problems to the point that they can only think about how to deal with the crisis of the moment. And in those moments, they may not have the mental bandwidth to strategize about how to change their current circumstances or help them get ahead.

One of the most valuable things brain science research does for this struggle is that it validates what our families share about the way being in poverty affects them. Instead of saying that stress leaves people “irrevocably debilitated”, or worse still, that people should somehow rise above this crippling stress to “just move on” the science actually suggests something much more important. It calls upon all of us to understand that poverty, trauma, and discrimination are experiences whose cumulative effects impact our health, decision-making, and well-being in tangible and predictable ways, and because of this, we as a society can and must do our best to remediate it. Continue reading

Quadruple Amputee Gains New Arms, From Donor Who ‘Gave Best Hugs’

Will Lautzenheiser looked down at his rosy, fleshy new arm at a Brigham and Women’s Hospital news conference this week and exclaimed, “It’s the most beautiful arm!”

For three years, Lautzenheiser — a quadruple amputee in the wake of a virulent bacterial infection in 2011 — had lived without arms. Now, he and his Brigham and Women’s Hospital transplant team have just revealed, he has two new ones, the gifts of an anonymous donor. A medical team of 35, including 13 surgeons, operated on him for nine hours last month to attach them.

Lautzenheiser, 40, spoke with us last year in the video above about his “sit-down” comedy career: “Did You Hear The One About The Comedian With No Arms And Legs?” That armless footage is now outdated.

It will take months for the new arms and hands to gain sensation and function, but Lautzenheiser, a former film professor at Boston University, says he’s already putting them to good use, hugging his partner, Angel Gonzalez. “To be able to hold my love in my arms again is really the best,” he said.

Arm transplant recipient Will Lautzenheiser uses his new arms to hug his partner, Angel Gonzalez, at a Brigham and Women's Hospital press conference. (Photo courtesy BWH)

Arm transplant recipient Will Lautzenheiser uses his new arms to hug his partner, Angel Gonzalez, at a Brigham and Women’s Hospital press conference. (Photo courtesy BWH)

The late donor put those arms to similar use, as described in a message from his family that New England Organ Bank President Richard Luskin read aloud to Lautzenheiser: “Our son gave the best hugs. We pray that you make a wonderful recovery and that your loved ones will be able to enjoy your warm embrace.”

Thus far, Lautzenheiser says, his new arms have little sensation, mainly just a bit of feeling in the skin right below where they’re joined to his own body. As for moving them, “If I really focus, I can occasionally move my thumb just a little bit, a few millimeters. It bends. I can pronate and supinate my wrist on my right arm. I have a little bit of wrist motion, a little bit of forearm motion.” Continue reading

‘Vladimir Pootin’ To Poop Pills: Saga Of First Stool Bank Goes On

Bottles of frozen human stool for fecal transplants at the nation's first stool bank, OpenBiome, in this file photo (Gabrielle Emanuel/WBUR)

Bottles of frozen human stool for fecal transplants at the nation’s first stool bank, OpenBiome, in this file photo (Gabrielle Emanuel/WBUR)

Coming up in the next issue of The New Yorker: “The Excrement Experiment,” a sweeping disquisition on the history of fecal transplants for treating intestinal ills. It includes the delightful tidbit that at the nation’s first stool bank, begun in an MIT lab and now located in Medford, donors are given nicknames like “Winnie the Poo” and “Vladimir Pootin.”

We posted the back-story of the stool bank, by Gabrielle Emanuel, here in April: “MIT Lab Hosts Nation’s First Stool Bank, But Will It Survive?

The existential threat to the stool bank loomed from the FDA, which said it considered stool to be a drug, and thus potentially subject to regulations rigorous enough to send the costs of fecal transplants soaring and probably kill the bank. More recently, the agency has seemed to signal that it will allow some fecal transplants — at least for now.

The New Yorker story reports that orders for OpenBiome’s stool supplies have been growing at 18 percent a month for the last year, spurring complaints from companies that are working on competing products — pills and enemas.

The prospects for poop pill prospects are looking promising, The New Yorker reports, and the stool bank is involved in those efforts as well:

Even if OpenBiome were to stop shipping stool to hospitals, it could presumably continue to operate as a resource for researchers. When I visited in October, there was a tray of shiny white capsules on [co-founder Mark] Smith’s desk—“poop pills that we’ve been working on,” he explained. Doctors at Massachusetts General Hospital had just announced the results of a study showing that capsules were as effective as colonoscopes for treating C. difficile, and the field was abuzz with the news, since, as Smith pointed out, “everyone would rather swallow a pill.” He had hit on a way to improve on the doctors’ methods: lining capsules with cocoa butter, which is solid at room temperature, thus insuring that they won’t disintegrate prematurely—on the shelf or in someone’s mouth.

Meanwhile, for Boston-area residents interested in becoming the next Vladimir Pootin, boston.com reported last month that the bank, which now ships to fecal samples to 122 hospitals, is paying $40 “per dump:”

Are you under 50 years old, willing to make daily trips to Medford, and have regular bowel movements? You, my friend, could be earning $40 a day—just for pooping.

And for the more altruistically motivated:

“These donors may seem very mild-mannered and think going to the bathroom is a humble thing,” said Smith, “but each sample they bring in can treat four or five patients.”

Baker Taps Marylou Sudders To Lead Health And Human Services Department

Gov.-elect Charlie Baker is choosing someone he worked with in the Weld administration to lead the largest agency in the state — the Department of Health and Human Services. Baker said Friday he tapped Marylou Sudders for the post in part because of her collaborative spirit.

Marylou Sudders (Jesse Costa/WBUR)

Marylou Sudders (Jesse Costa/WBUR)

Several groups are praising his choice, citing Sudders’ work as the former state mental health commissioner and former head of the Massachusetts Society for the Prevention of Cruelty to Children.

WBUR’s Deborah Becker spoke with Sudders and started by asking her why she wants to take over an agency facing several challenges. Their lightly edited conversation is below.

——

Marylou Sudders: I’m a public servant at heart. In many ways I feel like my entire professional career has been preparing me for a position such as secretary of Health and Human Services. I believe in the tremendous opportunities in the commonwealth. I’ve never shied away from challenges and I have tremendous faith in really good people fixing these problems.

Deborah Becker: Let’s talk about some of those problems, some of which were raised in a recent survey from the National Alliance for Mental Illness. They want to know what the Baker administration will do about hospital emergency rooms holding patients with a mental illness because they can’t find beds in treatment facilities, or over incarcerating folks with mental illness. Are those your priorities?

These are issues I’m very familiar with. I have every confidence that this administration will be looking at the full health needs, and health will be defined as both the physical and behavioral health needs in this administration.

With the many challenges in this field, what do you hope to accomplish?

Continue reading

Parent Dilemma: When A Kid’s Concussion Lingers On

When Eli Davis was 15, his ski popped off in the middle of a steep, bumpy slope and he went suddenly airborne, then landed hard, the back of his head slamming down against unyielding ice. That was his first concussion.

A few months later, at soccer camp, he was defending the goal when a breakaway player took a shot from just five feet away and it rocketed right into his face. He finished the game, but he remembers thinking, “Oh…That was not a normal hit.” Another concussion, a worse one.

So far, so familiar. Efforts to expand awareness about the risks of concussion have exploded in the last few years, changing youth sports that had long been more cavalier about hits to the head. Coaches and parents take courses on identifying and treating concussion. Most know to err on the side of caution with head injuries — “When in doubt, sit ‘em out” — and watch for the telltale symptoms that may follow, from dizziness to headache to brain fog.

What fewer know, however, is that while most concussions clear within several days or weeks, a small minority of cases last much longer — like Eli’s.

“He looked at the two of us and said, ‘I don’t care about soccer. I care about the rest of my life.'”
– Al Davis, about his son, Eli

For months after the soccer injury, he suffered a mild headache that would not subside; grogginess and fatigue; sensitivity to light and noise; an inability to think hard that made learning impossible. He found himself stuck on the couch at home, feeling ever more “cabin sick,” when he wanted desperately to be back at school and on the soccer field.

“You can only watch so many seasons of ‘Lost,’ ” he says.

Dr. Neal McGrath, a neuropsychologist and nationally known expert on concussion, estimates very roughly that perhaps 10 to 15 percent of kids with concussions have “longer, tougher recoveries,” often when they’ve accumulated too many concussions, or their injuries have come too close together. That probably amounts to thousands of American children living through prolonged concussion recoveries each year, he says.

Now, Eli’s parents, Robin Friedman and Al Davis of Brookline, Massachusetts, are creating an online venue where those kids and their families can connect, learn from each other and from authorities like Dr. McGrath, and gain support for the long haul they may face.

Professional Web and video content creators who specialize in patient education sites, Friedman and Davis are in the midst of shooting videos like the one above and the others in this post for a site they’ll call Connect2Concussion. They’re trying to fill a void they found as parents groping their own way through post-concussion recovery and all the dilemmas it entails.

Though Eli is thriving now as a sophomore at the University of Massachusetts, his parents still vividly remember how frightening and confusing his condition was in high school. They were worried at first by each day of school Eli had to miss, Friedman says, then scared by how long his symptoms lasted.

“We just didn’t get it,” she says. “With a broken bone or a sprain, you can take an X-ray and you can see it’s healed, and then you know what to do,” she says. “With concussion, they just send you home. It could really be two days or it could be two years, and everything in between, because every child is different, every injury is different and every recovery is different.”

“It gets crazy,” Davis adds, “because every day that goes by, it’s like sand going through an hourglass. You have no idea. You don’t know if he’s going to be OK on Friday, next Monday or two months from now. And what we’ve learned subsequently is that two months from now is actually a reality for people. A year from now is a reality for people. Or it could be three days and everything is good to go.”

Continue reading

Mystery Ills: Are Older Americans Sicker Than Those In Other Countries?

By Richard Knox

Americans over 65 are apparently sicker than their counterparts in 10 other developed countries, according to a new international comparison.

But this raises a big question. Are American elders really sicker than those in other rich nations? Or are their illnesses just more likely to be diagnosed (or over-diagnosed) than elsewhere?

The mystery is deepened by another fact: As a group, the rising demographic of Americans over 65 are younger on average than elderly populations in the other 10 countries. But they’re three times more likely to have two or more chronic conditions than those in the United Kingdom.

(Medisoft via Compfight/Flickr)

(Medisoft via Compfight/Flickr)

Also, American elders are 21 percent more likely to have multiple chronic diseases than those just across the border in Canada, and 40 percent more likely than Germans.

What gives?

“Fourteen percent of the U.S. population is over 65, versus 21 percent of the German population,” study author Donald Moulds says. “This is really quite a difference, So the fact that we have a younger population with more chronic conditions is particularly alarming.”

Alarming, he says, because of what it means for the future of Medicare, the federal program that pays medical bills for the elderly and disabled, as the U.S. population continues to age. Already, nearly half of Medicare’s $300 billion-plus budget is spent on the 14 percent of beneficiaries with six or more chronic conditions.

The new numbers come from a survey of nearly 16,000 over-65 citizens in 11 nations conducted by the Commonwealth Fund and published online Thursday by the journal Health Affairs. Other than the U.S., the U.K., Canada and Germany the countries studied are Australia, France, the Netherlands, Sweden, Norway, Switzerland and New Zealand.

Moulds says the study can’t answer why American elders report more chronic illness than those in other peer nations. Partly it may be due to the spotty access to medical care that many Americans have had before they turned 65 — and before the Affordable Care Act began to expand coverage.

“If you think about chronic conditions like diabetes and heart disease, these aren’t conditions that people wake up when they’re 65 and suddenly get them,” says Moulds, who is executive vice president of the New York-based Commonwealth Fund. “They develop over a lifetime.” Continue reading

Baker Names Sudders As His Health And Human Services Chief

Marylou Sudders is poised to be named Gov.-elect Charlie Baker’s new head of health and human services, a Baker aide has confirmed to WBUR.

Marylou Sudders (Jesse Costa/WBUR)

Marylou Sudders (Jesse Costa/WBUR)

Sudders is the state’s former mental health commissioner.

State House News Service reports:

Sudders, an associate professor of health and mental health at Boston College’s Graduate School of Social Work, was recruited by Baker to state government in the mid-1990s and served as commissioner of mental health under Republican Govs. William Weld, Paul Cellucci and Jane Swift from 1996 until 2003. She held a similar position in New Hampshire.

Health and human services is the state’s largest executive agency.

The formal appointment is expected later Friday.

12 Tips For Nurses And Doctors Treating Transgender Patients

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.

Dr. Joshua Safer and Dr. Jennifer Potter (Courtesy photos)

Dr. Joshua Safer and Dr. Jennifer Potter (Courtesy photos)

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?

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