Author Archives: Karen Weintraub

Foggy Days, Sleepless Nights: When Alzheimer’s Care Goes Nocturnal

(Ronel Reyes/Flickr via Compfight)

(Ronel Reyes/Flickr via Compfight)

By Jessica Alpert

Marion Tripp was what you might call a quintessential “Yankee.” From impeccable pie crusts to crackshot deer hunting, she regularly impressed people with her wide range of skills. When her daughter and son-in-law started an organic farm in rural Maine, she’d bundle up in a snowmobile suit and sell their rutabagas at the local farmer’s market. I never knew Marion but her grandson — my husband — loves to remember her this way.

Not the way she was at the end.

Alzheimer’s ravaged Marion’s brain and left her confused, “mean,” paranoid, and violent. The last three years of her life, she had round-the-clock care since she rarely slept more than a few hours at a time. Her nocturnal habits were not unique. Indeed, in the world of Alzheimer’s, this tendency toward nighttime wakefulness is known as “sundowning.”

“Several things go awry with Alzheimer’s that affect the person’s brain chemistry and changes their circadian rhythm,” says Dr. Paul Raia, vice president of clinical services for the Massachusetts/New Hampshire chapter of the Alzheimer’s Association. He says there are various reasons for this nocturnal shift including lack of melatonin, diminished access to natural light and less rapid eye movement or REM sleep.

But it’s not just about being unable to sleep for long stretches of time. Like Marion Tripp, many Alzheimer’s patients are often agitated, angry, even violent. “During that period [of REM sleep], you are ridding the toxins from your brain and you’re stabilizing memory and you’re dreaming and essentially you are paralyzed with your body in a relaxing mode,” says Raia. “[The patients] may take a series of small naps throughout the day and when they wake up, they may not be fully awake. They can’t navigate well or negotiate well in their environment.” Continue reading

French Kissing For Science And Sharing More Than Romance

Photo: Compfight

(.craig/Flickr via Compfight)

That kiss last night? You may have left with more than butterflies. According to Dutch researchers, the average 10-second french kiss can result in the exchange of around 80 million pieces of bacteria.

And they have the data to prove it.

Twenty-one couples recently volunteered to kiss for science. This all went down at the Amsterdam Royal Artis Zoo in 2012. The Dutch researchers studying bacteria surveyed the kissing habits of each partner in each couple with questions like, “How often do you kiss? and “When did you last kiss?” Researchers then swabbed each partner’s tongues for “salivary microbiota,” before and after a “controlled kissing experiment” (read: a tightly timed 10 seconds).

Then there was a second kiss. One member of the couple was asked to swig some probiotic yogurt beforehand. This made it easier to look at the bacteria from the yogurt both on the tongue of the person who drank it — and the tongue of the person who didn’t.

So what do we learn?

Turns out shared microbiota can actually survive on another person’s tongue. Samples of oral flora from the partner were more similar than those drawn from randomly selected passersby. Continue reading

Teen Birth Rate In Mass. At Historic Low

The birth rate among teens in Massachusetts is at its lowest recorded level in the state’s history, a report out Friday says.

The birth rate of teens ages 15-19 fell 14 percent last year, from 14 births per 1,000 women in 2012 to 12 births per 1,000 women in 2013, the Massachusetts Department of Health reported.

“This is terrific news for all Massachusetts families, and a dramatic indication that our decisions to invest in our young people — through education, support and resources — can have a real and lasting impact on their lives and in their communities,” Gov. Deval Patrick said in a statement.

According to the report, there were 2,732 babies born to teen mothers between 15 and 19 years old in 2013, down from 3,219 the previous year. The number of children born to teen mothers in that age bracket is significantly lower than the 7,258 births reported in 1990. Continue reading

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Why You Really Need A Flu Shot (Even Though The Vaccine Isn’t Great)

(WFIU Public Radio/Flickr)

(WFIU Public Radio/Flickr)

By Richard Knox

This flu season is shaping up to be a bad one. And this year’s vaccine doesn’t work very well against the most common flu virus going around. So should you even bother getting a flu shot?

Yes. Putting it a different way: My wife, my daughters and I will. And the evidence says you’d be somewhere between slightly foolish and dangerously blasé if you don’t — depending on your personal risk factors.

I know there are naysayers — the Internet is full of them. “I recommend that my patients of all ages not take these incessantly promoted immunizations, primarily because of their lack of effectiveness,” writes blogger Dr. John McDougall. He says he’s not one of those across-the-board vaccine deniers but just doesn’t think flu vaccines (of any given year) are worth taking.

To understand why I think he’s wrong — even this year, when vaccine effectiveness is expected to be even lower than usual — you need to know something about the situation we’re all in.

Several viruses circulate during any given flu season. And flu viruses are always changing — sometimes not so much from year to year; sometimes in a bunch of little ways (a phenomenon called genetic “drift”); and sometimes in a big, sudden way, called a “shift,” which touches off pandemics.

Drifts Or Shifts?

Public health researchers constantly monitor flu virus mutations. But even the smartest flu dudes can’t know in advance when they’ll happen, or whether mutations will be drifts or shifts.

This year, one of the flu viruses outwitted them. Or, since viruses can’t have intentions, it’s better to say that random genetic drift in that viral strain, called H3N2, happened in late March. That’s a bad time in the annual cycle of vaccine production.

Just a few weeks earlier, leading flu specialists gathered at the World Health Organization in Geneva and decided that this season’s vaccine (for the Northern Hemisphere) should contain the same viruses as last year’s — two type-A viruses (an H1N1 that caused the pandemic of 2009 and has stuck around since, and an H3N2 that first appeared in Texas two years ago) and two type-B flu viruses.

Late-Breaking Mutant

Making each year’s flu vaccine is a complicated business that waits on no virus. The recipe has to be decided in February to get the chosen viruses growing in hundreds of millions of special chicken eggs, the first step in vaccine production. Continue reading

Culture Clash: U.K. Embraces Homebirth As Best For Some Women

Sarah Parente shortly after the homebirth of her daughter Fiona (Courtesy of Leilani Rogers)

Sarah Parente shortly after the homebirth of her daughter Fiona (Courtesy of Leilani Rogers)

By Jessica Alpert

Sarah Parente, an Austin, Texas-based doula and mother of four, gave birth to her first child in the hospital with no complications. But then she decided to make a shift: Parente delivered her next three babies at home. “For women with low-risk pregnancies, home birth can be a great choice,” she says. “You have less stress because you are in your own home surrounded by a birth team of your choosing.”

Though home birth has recently gained cache in the U.S. — with some celebrities trumpeting the benefits of having their babies at home  — the practice remains uncommon and the majority of pregnant women give birth in a hospital setting. Still, Parente may be getting a little more company, albeit slowly. Data released by the Centers for Disease Control (CDC) earlier this year shows the rate of homebirths in the U.S. has increased to 0.92 percent in 2013 and the rate of out-of-hospital births (including home) has increased 55 percent since 2004.

Experts in the United Kingdom are saying that’s a good thing.

The London-based National Institute for Health and Care Excellence (Nice) recently released recommendations that homebirths and midwife-led centers are better for mothers and often just as safe for babies as hospital settings, the BBC reports. Of the 700,000 babies born in England and Wales each year, nine out of 10 are born in obstetric-led units in hospitals. Continue reading

Mass. Officials Say Most Have Yet To Pay For Health Plans

State officials say about 150,000 people have determined eligibility for insurance plans on the state’s overhauled Health Connector website. But less than 1 percent has paid for 2015 coverage with a deadline fast approaching.

The connector rolled out its new website on Nov. 15 to replace the one that was crippled by technical problems, forcing hundreds of thousands of people into temporary Medicaid coverage.

Residents eligible to buy insurance through the connector have until Dec. 23 to make their first payment. The Boston Globe reports that few have sent checks so far, but state officials aren’t worried because people historically wait until the last week to pay.

The head of the Massachusetts Association of Health Plans has expressed concern about the low enrollment and the prospect of many people going uninsured.

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Pathologist’s View On Prostate Cancer Grey Zone: ‘What Do My Numbers Mean?’

Prostate cancer, circled. (Photo courtesy Dr. Michael Misialek)

Prostate cancer, circled. (Photo courtesy Dr. Michael Misialek)

By Dr. Michael Misialek
Guest Contributor

We don’t like to admit it but cancer is rarely black and white. Increasingly a cancer diagnosis means living in a murky morass of constantly reassessing risk.

Here’s one man’s story of living on that precarious line. His saga, seen through a pathologist’s filter, illustrates the uncertainties surrounding prostate cancer. And, as the number one cancer in men, it is increasingly becoming a familiar story for many. Questions like, ‘What do my numbers mean?’ ‘Should we treat or not?’ and if so, ‘Which treatment is best for me?’ inevitably arise.

Mr. B. is a 64-year-old man who was found to have an elevated PSA four years ago on his routine physical exam. Obviously, prostate cancer was the first thought that came to mind, particularly since his father had the disease. What he soon learned is that prostate cancer is a complex diagnosis — one that requires the careful integration of the physical exam, biopsy results, radiographic studies and lab results.

And, of course, it’s a diagnosis that comes with many decisions and choices; choices that depend upon understanding the grey zone of medicine. Prostate cancer is rarely clear cut. As much as numbers like the PSA and Gleason score (the sum of the two most predominant grades in a patient’s tumor) guide diagnosis and treatment, they also contribute to the uncertainties on the best course of action.

When Mr. B’s elevated PSA was first detected, his primary care physician referred him to a urologist at Newton-Wellesley Hospital. His prostate was normal on physical exam and they elected no biopsy at the time. Over the next couple of years the PSA slowly continued to rise, still with no change in his physical exam. Last year a biopsy was done and was negative. No cancer, a relief. What was found was some inflammation. Could this have contributed to the rise in PSA? It certainly could have, but a negative biopsy did not rule out cancer. The journey of watching numbers continued.

This year Mr. B.’s PSA rose yet again, and his urologist ordered an MRI which was negative. Mr. B. underwent another biopsy. (Not an easy process since he takes the blood thinner Coumadin and any invasive procedure needs to be carefully coordinated with stopping and restarting this medication.) The biopsy is also uncomfortable: his first biopsy involved six needles, but this time it was twelve.

The slides came to me. I put them on my microscope and carefully studied each of them. As I scanned at low magnification I found two tiny foci of abnormal glands which qualified for a diagnosis of cancer. Continue reading

Audit Questions $35M In State Medicaid Payments

A state audit has identified $35 million of what were called “questionable and unallowable” payments by the state’s Medicaid program.

Massachusetts State Auditor Suzanne M. Bump (Josh Reynolds/AP)

Massachusetts State Auditor Suzanne M. Bump (Josh Reynolds/AP)

Auditor Suzanne Bump said Wednesday that her office and MassHealth disagree in their interpretations of federal and state rules that govern the program.

The audit focused on MassHealth’s Limited Program, which covers eligible non-citizens.

While federal land state rules are supposed to restrict coverage under the program to emergency medical services, Bump says auditors found that MassHealth often paid claims even when a provider indicated that a service was not of an emergency nature.

She says MassHealth “regularly substituted its own judgment for that of the medical profession.”

State officials strongly disputed the findings, saying they disagreed with the auditor’s definition of emergency medical services.

Tufts Medical Center And Boston Medical Center In Merger Talks

The wave of Massachusetts hospital consolidations is building.

Tufts Medical Center and Boston Medical Center (BMC) issued statements Wednesday night confirming that the two not-for-profit institutions are discussing a merger.

“Tufts MC is our neighbor, we know them, we respect them, and we share a common geography and a commitment to providing high quality care to all patients,” said Jennifer Watson, chief of staff at BMC. “Like the rest of the health care community we have considered strategic partnerships, and with Tufts MC we have recognized that the combination of our individual strengths could create a partnership uniquely positioned to improve health care in Massachusetts.”

“Our organizations share a commitment to high quality, lower cost health care and to serving every patient with the greatest respect and compassion,” Tufts Medical Center Vice President Brooke Hynes said in a statement. “We also share a mutual commitment to our academic missions of clinical excellence, teaching and research.”

It’s not clear how close the hospitals are to an agreement. They have separate medical schools that would not be part of the deal. The buildings are just over a mile apart (Tufts in Chinatown, BMC in the South End). Their missions have traditionally been somewhat different, with BMC as a major trauma and safety net hospital and Tufts striving to model the low cost, high quality alternative to other, more expensive Boston hospitals.

But it sounds like the talks are going well. Continue reading

Ethics: How Could Doctors Help With Harsh CIA Interrogations, ‘Rectal Feeding’?

(Source: NPR)

(Source: NPR)

It was a stomach-turning morning read. The Boston Globe, reporting on the new Senate report on harsh CIA interrogations, writes: “With the approval of the CIA’s medical staff, some CIA prisoners were subjected to medically unnecessary ‘rectal feeding’ or ‘rectal hydration’ — a technique that the CIA’s chief of interrogations described as a way to exert ‘total control over the detainee.'”

The question immediately arises: How could medical professionals be involved in this? Doesn’t it violate the Hippocratic oath and other tenets of medical ethics?

Dr. J. Wesley Boyd, a Cambridge Health Alliance psychiatrist who’s affiliated with Harvard Medical School’s new Center for Bioethics, has published research papers on relevant ethics awareness among medical students and, this summer, among psychology grad students.

“These actions fly in the face of every ethical standard physicians are held to.”
– Dr. J. Wesley Boyd

He discusses the ethical side of doctors’ and psychologists’ involvement in harsh CIA interrogations on Radio Boston today, and points out that while the American Medical Association and American Psychiatric Association have clearly banned participation in harsh interrogations, the American Psychological Association has not been so definitive.

Some excerpts from what he tells co-host Lisa Mullins:

[Referring to the ethics-awareness study on medical students:]”We had, with that study, objective evidence that medical students were not being taught about any of these issues. The problem with that is that if you end up in military service as a physician, in all likelihood you have no prior instruction about how you should comport yourself if what you’re being asked to do butts up against international codes of conduct and morality more generally.”

“In the early days after 9/11, physicians were being asked to, and expected to, participate in torture…In some instances, they would advise interrogators about the psychological weaknesses of a person. They would advise interrogators about whether or not the person could take a little more punishment or maybe they’re up against death and we need to stop right here. Continue reading

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