Personal Health

News you can use, carefully digested and curated.

RECENT POSTS

Aid-In-Dying Loophole: Advocates Want You To Know You Can Stop Eating And Drinking

Lee J. Haywood/flickr

Lee J. Haywood/flickr

By Nell Lake
Guest contributor

One sunny day in the spring of 2012, Kathleen Klein sat in a car by the California coastline with her 84-year-old mother, Jackie Wilton. The two women had been quietly gazing at the view, watching seagulls along the shore. “I’m ready to go,” Klein recalls her mother saying. “Not go home…Go.”

Klein didn’t need the clarification. Her mother had been speaking of wanting to die for years, ever since Wilton was diagnosed with an unspecified dementia a few years before. Wilton’s memory had become significantly impaired. But even before her diagnosis, Wilton was clear: She wanted to die before she became severely incapacitated.

Not long after the conversation by the water, Wilton asked Klein explicitly for help in ending her life. In interviews and a recent blog post, Klein remembers wanting to help her mother, but of being unwilling act illegally.

Even if Wilton had lived in one of the five states with an aid-in-dying law, she would not have qualified for such aid from a physician. That would have required a doctor’s determining that she would likely die within six months. Given the usual course of chronic, progressive dementia, Wilton would likely have lived much longer.

So Wilton needed another option for ending her life. Soon Klein heard a radio interview about “the possibility of helping someone die by letting them stop eating and drinking,” she wrote. “The way I understood it, it was the only legal form of assisted suicide.”

Klein mentioned the scenario to her mother. Wilton said she would think about it. A few days later, Wilton again mentioned wanting to die. “I asked her if she remembered the idea I had run by her. She didn’t, so I told her again. I suggested we give it a try (a ‘dry run,’ we called it) for a day and see if she wanted to continue.”

Wilton began the “dry run” on April 28, 2012.

No Food, No Drink

Most often referred to as VSED — voluntary stopping of eating and drinking — the practice of giving up food and drink in order to hasten one’s death is being increasingly publicized by aid-in-dying advocates as a legal alternative to physician-assisted suicide.

VSED is legal everywhere, even in states without aid-in-dying laws, and in cases in which a person, like Wilton, would not qualify for assistance with dying even in those states.  Compassion and Choices, a leading “death with dignity” organization, is beginning to more actively promote VSED as an option because “it’s something that patients can openly pursue, in open dialogue with their physicians, with the support of hospice,” says Barbara Coombs Lee, the group’s director. “We do want to make it more public. We want to make it more visible because it upholds the truth that ultimately patients should be and are in charge. That’s kind of a consciousness-raising task. Continue reading

Project Louise: When The Best Thing To Do Is … Nothing

Stress can get in the way of doing the right thing. But stopping to breathe can help. (skyseeker via flickr)

Stress can get in the way of doing the right thing. But stopping to breathe can help. (skyseeker via flickr)

By Louise Kennedy
Guest contributor

Some days, all you can do is keep breathing. At least that’s what it feels like this week.

Both my work and home lives chose this particular moment to ratchet up the pressure by about 100 percent; I had some completely unbreakable deadlines, with a ton of work to be done in order to meet them. The professional ones I’ve (mostly) met, and the home-front ones I’m still working on, but so far things are more or less under control.

Meanwhile, the Project Louise commitments – you know, exercising three days a week; eating well at least five days a week; learning to love, trust and respect myself all the time – well, something had to give. And, as seems to be my lifelong pattern, when I have to choose between my obligations to others and my obligations to myself, it’s Louise who has to give.

I confess there’s a big part of me that considers this the right way to live. Selfishness is one of the sins I find hardest to forgive in others, so it’s also one I strive hardest to avoid myself. But I do know – and coach Allison Rimm keeps reminding me – that there’s a difference between selfishness and self-care. Continue reading

What Teens Say Teens Should Know About Sexually Transmitted Diseases

(Planned Parenthood)

(Planned Parenthood League of Massachusetts)

By Joey Boots-Ebenfield
Guest contributor

I’ve gotten used to hearing myths and misinformation when I talk about sex with fellow teens.

And I talk about sex often in my role as an 17-year-old peer educator with the Planned Parenthood Get Real Teen Council (GRTC) — a year-long high school sexual health program for 10th-12th graders who are trained to facilitate sex education workshops and serve as resources for peers, families and communities.

If teens are uncomfortable talking about topics related to sex and sexuality, or don’t have a trusted source of information about their health, it’s easy for all kinds of misinformation to spread. And of course, there’s the Internet, where bad information is often rampant, so it’s not always a reliable place to find accurate health information.

The subject of sexually transmitted diseases (STDs) is no exception. I’ve heard some pretty interesting misconceptions about what STDs are and what it’s like to get tested. One myth is that STDs have obvious symptoms, like localized pain or some other physical sign.

In fact, this is quite the opposite! STDs often show NO symptoms. This myth is especially dangerous because it means that someone can have an STD and not even know it. As a result, many STDs go untreated, which can cause cause some pretty nasty complications. Continue reading

My Mother’s Surgery And One Doctor’s Substance Abuse

By Karen Shiffman
Guest contributor

USA Today reports more than 100,000 doctors, nurses, technicians and other health professionals struggle with abuse or addiction. This wasn’t news to my family.

Some 20 years ago, my mother was mauled by a dog. She was on vacation in Florida and went over to a friend’s house for dinner. To understand what happened next, you need to know a few crucial facts about her: She is afraid of dogs and barely five feet tall. When her friend opened the front door, her daughter’s dog — an Akita- tore out of the house and lunged . My mother turned away quickly. The dog lunged again. Because of her short stature, his teeth sunk into her calf. He all but ripped it off.

(Alex E. Proimos/flickr)

(Alex E. Proimos/flickr)

Blood everywhere. Screams. Tears. Ambulance. Thirty-nine stitches at the ER. She would need a skin graft.

And then there was the drama with the friend. Turns out, this wasn’t the first time the dog had bitten someone. Still, the family didn’t want the dog put down. Eventually, he was. My mother and her friend of 30 years never spoke again.

Back home in Boston, my mother was referred to a plastic surgeon at what is now Beth Israel Deaconess Medical Center. He was kind and I agreed with my mother that he should do the surgery.

The operation went well. I went with her to the post-surgery checkup. We both thanked the surgeon for doing such a great job and for taking such good care of my mother.

So, imagine my shock, in 2008, to read in The Boston Globe that my mother’s surgeon was fired for being impaired in the OR. And that he had been struggling with substance abuse for the past six years. Continue reading

Opinion: Why Zohydro Ban Is A Tough Call

Update 4/15:

The AP reports that a federal judge blocked Massachusetts from banning the powerful new painkiller Zohydro.

U.S. District Court Judge Rya Zobel on Tuesday issued the preliminary injunction after the maker of the drug, Zogenix, said in a lawsuit that the ban ordered by Gov. Deval Patrick was unconstitutional.

Zobel said in issuing the injunction that Massachusetts appears to have overstepped its authority in banning the drug, which had been approved by the U.S. Food and Drug Administration.

Patrick ordered the ban after declaring a public health emergency in light of widespread prescription drug abuse in the state.

The judge said federal law preempted the state’s order.

By Judy Foreman
Guest contributor

U.S. District Court Judge Rya W. Zobel today disappointed anyone who expected her to quickly strike down Gov. Deval Patrick’s ban on the sale of the new pain reliever Zohydro. She declined to rule on the drugmaker’s request to quickly but temporarily lift the ban, and is continuing to consider whether to lift the ban permanently.

Judge Zobel faces a difficult decision but not because Zohydro, as many media reports have said, is more potent than anything else on the market. It’s not, and we’ll get to that in a minute.

(wikimedia commons)

(Wikimedia Commons)

First, the legalities. It should be up to federal health officials, including the U.S. Food and Drug Administration, not governors, to make decisions about the safety (or lack thereof) of drugs. For better or worse, the FDA, after a long 2013 review, and against the vote of its own advisory committee, did approve Zohydro in October of last year.

Legally, and logically, it also made little sense in the first place – except politically — for a governor to focus on one particular drug when the whole class of drugs to which it belongs — opioids, also known as narcotics – is controversial precisely because that whole class of drugs has such a complex mix of risks and benefits.

In truth, Zohydro is probably not the wonder drug that its manufacturer, Zogenix, claims, nor is it the menace that critics assert. The furor over Zohydro is simply the latest example of how difficult it is to balance the legitimate needs of people in chronic pain who need long-acting opioids and the also-legitimate need to protect vulnerable people from getting their hands on drugs they might abuse.

The unique feature of extended-release Zohydro is that it contains the opioid hydrocodone, and only hydrocodone. Continue reading

Second Opinion: Doc Says Blue Cross Opioid Policy Is Flawed

Amidst concerns over a massive national increase in the use and abuse of prescription painkillers, health insurer Blue Cross Blue Shield of Massachusetts instituted a new policy to reduce pain medication addiction and misuse.

This week The Boston Globe reports that as a result of the new policy, Blue Cross has cut prescriptions of narcotic painkillers by an estimated 6.6 million pills in 18 months.

But Daniel P. Alford, MD, an associate professor of Medicine and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) Program at Boston University School of Medicine and Boston Medical Center, calls the policy “flawed and irresponsible.” Here’s Alford’s response:

By Dr. Daniel P. Alford
Guest Contributor

The Blue Cross Blue Shield of Massachusetts opioid management program was implemented to provide members with “appropriate pain care” and reduce the risk of opioid addiction and diversion.

In a recent Boston Globe report they claim “very significant success” with this program after 18 months because they have cut opioid prescriptions by 6.6 million pills.

Dr. Dan Alford

Dr. Dan Alford

Is this really a measure of success and if so, for whom? It likely saves Blue Cross money but has it successfully achieved their program’s stated goals? Does decreased opioid prescribing mean more appropriate pain care? Does decreased opioid prescribing reduce the risk of addiction or diversion, or does it decrease access to a specific pain medication (opioids) for treating legitimate chronic pain? Is the observed decrease in opioid prescribing evidence that opioids have been overprescribed, as Blue Cross claims, or is it proof that instituting a barrier to opioid prescribing (prior authorization) will decrease prescribing even for legitimate need? Are patients with chronic pain really benefiting from this program? I doubt it.

Adding yet more paperwork for physicians will not improve pain care, decrease addiction or the numbers of accidental overdoses from prescription opioids. Those physicians who are unwilling (or ambivalent) to prescribe opioids even when indicated will use the prior authorization requirement as an excuse to continue not prescribing. Those who are overly liberal in prescribing will figure out the most efficient way to satisfy the insurance requirements for approvals. Physicians who responsibly prescribe opioids – that is, prescribing them only when the benefits outweigh any risks — will be saddled with more administrative burdens to justify their well thought-out treatment decisions.

Some physicians may ultimately decide that prescribing opioids isn’t worth the trouble despite known benefits for some patients. Continue reading

Newton Deploys Relaxation Experts To Help De-Stress Community

Screen shot 2014-04-07 at 1.45.34 PM

As of today, the high-achieving suburb of Newton begins a new effort to combat stress in teens: helping their parents relax.

The town is hosting four seminars for parents to help them “relax and reboot” and learn some strategies to better take care of themselves and their stressed-out teenage kids.

In case you live in Newton and are thinking of attending, sorry. They’re already full. But the town is offering several related programs, including An Open Conversation on April 30 for parents to talk about “how we define success in a high achieving community and how that impacts the stress on our teens.”

National statistics suggest that teenage stress is at an all-time high, with kids apparently adopting adult-levels of stress, according to the latest American Psychological Association report on stress in America.

In Newton, the issue is particularly poignant because three Newton high school students took their own lives during the current school year.

But even before the suicides, Newton had decided to take a somewhat novel approach. It applied for and received a “mental health and well-being” grant — $30,000 over three years — to, in effect, allow students, parents and teachers to take a massive exhale and figure out ways, large and small, to take the edge off growing up.

One solution was to contract with the Benson Henry Institute of Mind-Body Medicine, based at Massachusetts General Hospital, and offer the stress-reduction sessions.

The town was already aware of its stress-related problems: Continue reading

The Grandma Effect: A Little Caregiving Sharpens Brain, A Lot Dulls It

(Douglas/flickr)

(Douglas/flickr)

There’s an old saying in medicine: “The dose makes the poison.”

Personally, I find the adage holds true in many contexts, from nutrition to exercise to parenting: often too much of a good thing turns toxic.

Here’s the latest twist: A new report finds that grandmothers who care for their grandkids once a week experience a boost in mental sharpness. But if that one day of cozy caregiving expands to five or more days a week, it can put grandma on edge, and her brain can grow duller, with more memory and other cognitive problems.

Here’s what the researchers conclude, from the abstract:

The data suggest that the highest cognitive performance is demonstrated by postmenopausal women who spend 1 day/week minding grandchildren; however, minding grandchildren for 5 days or more per week predicts lower working memory performance and processing speed. These results indicate that highly frequent grandparenting predicts lower cognitive performance.

And here’s more info on the study (via news release) published online in the journal Menopause:

Taking care of grandkids one day a week helps keep grandmothers mentally sharp, finds a study from the Women’s Healthy Aging Project study in Australia…That’s good news for women after menopause, when women need to lower their risks of developing Alzheimer’s disease and other cognitive disorders.

On the other hand, taking care of grandchildren five days a week or more had some negative effects on tests of mental sharpness. “We know that older women who are socially engaged have better cognitive function and a lower risk of developing dementia later, but too much of a good thing just might be bad,” said NAMS Executive Director Margery Gass, MD. Continue reading

Project Louise: Music Makes The Heart Beat Faster

You may be relieved to know that working out to music does not require wearing any of these 1980s styles. (ShinyFan via Wikimedia Commons)

You may be relieved to know that working out to music does not require wearing any of these 1980s styles. (ShinyFan via Wikimedia Commons)

By Louise Kennedy
Guest contributor

So it turns out this kid thing really works. I did not do great workouts on all three days that I promised to exercise, but I did get myself moving. Even better, having made this promise caused me to think about taking care of myself for my kids’ sake every single day. Being here for my children turns out to be a really great motivator.

And – who knew? – my kids are helping with Project Louise in other ways, too. The 5-year-old got me running around outside on Sunday; it didn’t even feel like a workout, but it was. (That’s my new goal: workouts that feel more like “playouts.”) And the 16-year-old has given me another boost: music to listen to while I walk or bike.

Carey Goldberg, who co-hosts CommonHealth, has been telling me for a while that I need to add music to my workouts; she was even kind enough to lend me some of her favorite CDs. She also shared some great information about why music helps, and I’ve also tracked down a bit on my own. So here’s the scoop.

First, Carey pointed me to a post on The New York Times’ Well blog in which Gretchen Reynolds summarizes a lot of the research into the connections between music and movement. The link is “fascinating and not fully understood,” Reynolds says, but “no one doubts that people respond to music during exercise.” The question is why.

A recent Scientific American article provides a few answers: “Music distracts people from pain and fatigue, elevates mood, increases endurance, reduces perceived effort and may even promote metabolic efficiency.” Continue reading

Life Lessons From An Ultra Rare, Potentially Fatal Disease

Sue Levy and her family on vacation in Buenos Aires fall 2013. (Courtesy)

Sue Levy and her family on vacation in Buenos Aires fall 2013. (Courtesy)

By Dr. Annie Brewster
Guest contributor

What if you were suddenly diagnosed with a potentially fatal disease just when your life, work and marriage were on track and your plans to start a family were underway?

That’s what happened to Sue R. Levy.

In 2008, at age 37, she was diagnosed with Pulmonary Lymphangioleiomyomatosis, otherwise known as LAM, a rare, chronic, progressive lung disease in which the lungs fill up with cysts. The result is gradual destruction of the normal lung architecture, compromised breathing and, in many cases, an eventual lung transplant — a procedure with major risks. The LAM Foundation reports 10-year survival, following a lung transplant, at 47 percent.

Fueled by estrogen, LAM primarily affects women in their childbearing years. With only 1,300 documented cases in North America, LAM is poorly understood; currently, there are a few experimental medications in use, but no proven treatments exist.

Prior to the diagnosis, Sue, who lives in Brookline, Mass., had a successful career as a marketing executive, she was happily married, and she and her husband had decided to have kids. Though they struggled with infertility, undergoing six unsuccessful rounds of IVF, Sue still felt that this would work out eventually.

“My whole life I thought the way the world worked is that if you were a good person and you worked hard you could avoid bad things,” she said. LAM changed everything.

Suddenly, Sue was forced to redefine herself as someone with a chronic disease and squarely face her own mortality. In addition, she had to let go of some of her dreams, notably, her desire to get pregnant, as the high levels of estrogen associated with carrying a child would accelerate her lung destruction.

Initially, she was angry. But the disease helped her focus on what she really cares about: she went to school to study nutrition and became a natural foods chef. In 2011, inspired by her own healthier lifestyle changes, she quit her marketing job and started Savory Living-Healthy Eating, a nutrition and health company that provides online healthy eating and cooking classes.

In addition, Sue and her husband now have two young daughters, conceived using egg donors and a gestational carrier.

Listen to Sue’s story here:

Interview highlights:

From ‘Healthy’ To ‘Terrifying’

If you had asked me before my LAM diagnosis I would have told you that I was a healthy person, that I am living a healthy life. There isn’t a disease in my family. This is something I don’t have to worry about and I’m doing great. What was so interesting is that the signs couldn’t have been clearer that I wasn’t. I was heavier, the energy wasn’t great. I had a lot of digestive problems and I faced infertility. But I just thought that was the way life was. I had had a lot of pain and it felt almost like this boa constrictor was around my midsection squeezing my rib cage.

So I went to the doctor and he said ‘You know I’m worried that maybe you have a blood clot in your lung, I want to go get a CT scan.’ And they did the scan and on our way back to our house I got a call from the doctor and he said ‘You need to come in right away,’ and I said ‘Oh, is it a blood clot in my lung?’ And he said no. And I said ‘Oh great!’ And he said ‘No, you need to come in right away.’

We got into the office and he actually said to me because he knew we were trying to conceive, and he said, ‘Life as you know it is about to change considerably. Continue reading