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Weight Gain, Heart Disease, Back Pain: Longer Car Commutes May Harm Your Health

The worsening traffic in Boston -- or any metropolitan area -- does not just cost drivers time. It may also cost them health. Here's early afternoon bumper-to-bumper traffic on 93 in Milton (Jesse Costa/WBUR)

The worsening traffic in Boston — or any metropolitan area — does not just cost drivers time. It may also cost them health. Here’s early afternoon bumper-to-bumper traffic on 93 in Milton (Jesse Costa/WBUR)

Four years ago, Barbara Huntress-Rather got a great job, as director of quality improvement for a health care company that serves fragile seniors. Just one problem: She lived in Lawrence, and the new job was in Lynn.

“The first day I drove to work and said, ‘Oh, Lord, what have I done?’ ” she recalls. “After having a short commute for quite a few years, I hadn’t done the commute before in rush hour traffic and I was absolutely stunned at how long it took — it was over an hour.”

A harrowing hour, or more, hunched at the wheel, watching out constantly for aggressive or distracted drivers. In the months that followed, the effects on her health were dramatic: “I gained back 40 pounds that I had lost, developed low back pain and high blood pressure,” she says.

Huntress-Rather didn’t immediately blame her commute; she blamed herself for eating too much and feeling too tired to exercise. But she hit a turning point when her nurse practitioner told her she’d need blood pressure medication.

“I had always prided myself in being in good physical shape and meditating and doing all the things that would keep me from having high blood pressure,” she says. “And I immediately made the connection between not working out, spending endless hours in the car and feeling totally stressed most of the time. I was either commuting or worrying about commuting.”

Barbara Huntress-Rather found that her long commute led to weight gain, high blood pressure and back pain. She aims to retire soon and get her good health back. (Jesse Costa/WBUR)

Barbara Huntress-Rather found that her long commute led to weight gain, high blood pressure and back pain. She plans to retire earlier than she would have otherwise and get her good health back. (Jesse Costa/WBUR)

Huntress-Rather is practically a textbook case of what longer car commutes can do to bodies and minds. The evidence has been mounting in study after study in recent years, adding up to strong reason to believe that the worsening traffic in Boston — or any metropolitan area — does not just cost drivers time. It may also cost them health.

Let’s begin with the No. 1 killer of Americans: heart disease. Continue reading

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Buffets One Day, Vomiting The Next — Life With A Rare GI Disease

Melissa Adams Van Houten was diagnosed with a rare GI disorder in 2014. (Courtesy)

Melissa Adams Van Houten was diagnosed with a rare GI disorder in 2014. (Courtesy)

I am going to share some pretty personal information. Not a big deal to some of you, I am sure, but to me, it is huge. I am not the kind of person who does this — or at least I did not used to be. But things have changed.

In February of 2014, I spent a week in the hospital and was eventually diagnosed with gastroparesis, a disorder that slows or stops food from moving from the stomach to the small intestine.

I am guessing most people have never heard of this; I know I had not, prior to being diagnosed.

A Life-Altering Day

My life changed in ways I could not have imagined — overnight.

One day, I was able to eat at buffets, and the next day, I was unable to tolerate all foods and liquids. I was hospitalized with severe pain and vomiting, put through a battery of tests (including one particularly terrible one where they forced a tube down my nose and pumped my stomach). Eventually, I was diagnosed, but was given only a brief explanation of my illness and its treatment before I was sent home.

For the next few weeks, I was on a liquids-only diet, and was told that I had to gradually work my way up to soft foods and (eventually) solids. I am able to eat some soft foods, these days, in tiny amounts, but it is becoming clear to me that I will likely never again be able to eat “normal” foods in “normal” amounts.

Thinking About Food — Always

At first, I told myself that I would not let this stupid disease define or control me — it simply would not be the center of my life. But as time passed, I began to see how foolish this was. Every single day, every second of every day, I think about food. I see it; I smell it; I cook it and feed it to the other members of my household; but I cannot have it myself. Continue reading

A Death, And A ‘Changed Life’: Traumatic Births Take Toll On Health Workers Too

Sarah Jagger and midwife Stephanie Avila were together when Jagger's son suffered a brain injury during labor that led to his death. Here, about a year later, in 2013, Jagger and Avila share a moment of gratitude after the safe arrival of a healthy baby girl. (Courtesy of Orchard Cove Photography)

Sarah Jagger and midwife Stephanie Avila were together when Jagger’s son suffered a brain injury during labor that led to his death. Here, about a year later, in 2013, Jagger and Avila share a moment of gratitude after the safe arrival of a healthy baby girl. (Courtesy of Orchard Cove Photography)

Everything seemed fine until the little boy was born.

He wasn’t breathing, but his heart was strong, recalled Stephanie Avila, the midwife attending the baby’s birth at a Rhode Island hospital back in 2012. But it soon became clear that the boy had suffered a brain injury during labor.

Eleven days later, after an MRI confirmed the severity of the injury and the family withdrew life-support, the child died. His official diagnosis: hypoxic ischemic encephalopathy, a brain injury caused by oxygen deprivation.

“I was prepared to stand by the family through this trauma,” Avila said in an interview. “But I fully expected I’d get sued — and it was going to get ugly, or uglier.”

Of course, the little boy’s family was devastated. “I just went into my own world,” said his mother, Sarah Jagger, speaking about the loss of her son.

But Avila suffered too. “I was a wreck,” she said.

Immediately after the birth, Avila said, she remained on call overnight at the hospital, Women & Infants, in Providence. “I retreated to the call room and curled up in the fetal position and prayed that no other people in labor would show up. I cried, had the worst headache I’ve ever had in my life, and felt like I’d vomit. For days I felt emotionally and physically terrible. I’d be walking down the street and suddenly could no longer move.”

At the time, Avila had two small children of her own. “And whenever my 2-year-old would do this cute thing, I’d think, their baby will never walk around in his mother’s high-heeled shoes. I’d get these terrible thoughts and I’d never know when it would strike.”

The Psychological Toll

After a traumatic birth — or any traumatic medical event — attention, rightly, turns to the grieving family. But research has been mounting in recent years that health care providers, sometimes called “the second victims,” also sustain long-lasting emotional damage following such a trauma.

A new study published by Danish researchers underscores the phenomena: Midwives and obstetricians who experienced a traumatic birth — one involving severe injuries or death — report that the psychological toll of such an event is deep and long-lasting.

More than one third of those surveyed said that they always would feel some sort of guilt when reflecting on the event, researchers report. Nearly 50 percent agreed that the traumatic birth had made them think more about the meaning of life. “This tells us that health care professionals are affected, not only professionally, but also at a personal and even existential level,” said Katja Schrøder, the study’s first author and a Ph.D. fellow at the University of Southern Denmark.

‘Changed My Life Forever’

This was indeed the case for Avila. “I feel as though that day — even to this day — changed my life forever in many ways,” she said. And while the “acute” nature of the trauma has passed, she said, the enormity of it continued to grip her, sometimes unexpectedly and at random times.

In the Danish study, published in Acta Obstetricia et Gynecologica Scandinavica, a journal of the Nordic Federation of Societies of Obstetrics and Gynecology, more than 1,200 Danish obstetricians and midwives responded to a survey on the aftermath of a traumatic birth. Of those respondents, 14 were selected for a followup interview.

Many of the providers spoke of not being able to shake the trauma, whether they were blamed for the bad outcome or not. “Although blame from patients, peers or official authorities was feared (and sometimes experienced), the inner struggles with guilt and existential considerations were dominant,” researchers report.

From the paper:

One mid-wife explained that even now, 12 years after the event, she would still think about that particular mother and child when passing through their town…

Most participants described having spent many hours agonizing and wondering whether they could have prevented the adverse outcome. One midwife said that her sense of guilt would never disappear because she knew that the parents would have to live with the consequences of her handling of the delivery.

Still, the researchers found that for many providers, “the traumatic childbirth had given rise to personal development opportunities of an emotional and/or spiritual character …for instance by achieving a more humble and profound understanding of both professional roles and of life as a whole.”

A Meaningful Meal

About a month after her infant son’s death, Jagger did something unusual: She asked Avila to meet for lunch. Up until then, the two women had been in touch — Avila had called to check in often, offering to help out and attend followup medical appointments with Jagger.

But the lunch date marked a turning point, the women agreed. First, it became clear that Jagger didn’t blame Avila for the boy’s death, and did not want to focus on the tragedy going forward.

“We had this little boy who had a such a short life,” Jagger said. “I didn’t want his life to be clouded in anger. I wanted his life to be about love…and not focus on the horrible part.”

But the meeting also underscored the growing bond between the women. When it was over, they walked outside and Jagger posed a question: “I said to her, ‘If I have another baby, would you deliver it?’ And I think she was horrified. But I think because I trusted her so completely, through the birth, and his death, and her calls and the followup, I felt like she was there with me, like this was our loss, it wasn’t just my loss.”

The Danish research paper quotes Donald Berwick, a pediatrician who served in the Obama administration and is also a patient safety guru of sorts. In a 2009 interview published in the Journal of Patient Safety, Berwick speaks about those “second victims”:

Health care workers’ egos can be big. But believe me, their superegos are a lot bigger. You carry into work — as a nurse, or doctor, or a technician or pharmacist– the intent to do well. And when something goes wrong, almost always you feel guilty, terribly guilty. The very thing you didn’t want to happen is exactly what happened. And if you don’t understand how things work, you feel like you caused it. That creates a victim. My heart goes out to the injured patient and family, of course. That’s the first and most important victim. But health care workers who get wrapped up in error and injury, as almost all someday will, get seriously hurt too. And if we’re really healers, then we have a job of healing them too. That’s part of the job. It’s not an elective issue, it’s an ethical issue.

In the past decade or so, various institutions and nonprofits have emerged with tools and systems to better support medical professionals who have endured a traumatic event.

One of those groups, MITSS, or Medically Induced Trauma Support Services, based in Massachusetts, provides trauma tool kits used around the country.

Linda Kenney, the founder of MITSS, was herself the victim of an anesthesia error that nearly killed her. She said that for her, connecting with the anesthesiologist who caused her injury (he called her afterwards to express his regrets) and creating the nonprofit to help others, helped her heal.

But for health care providers, sometimes talking to peers at a hospital, or others in the institution, isn’t enough and can actually feel isolating, Avila, the Rhode Island midwife, said. Because of the omnipresent fear of lawsuits, and also due to patient privacy laws, she said, “there are very few environments where we can freely discuss what happened.”

A Second Chance

In 2013, a few days shy of what would have been her son’s first birthday, Jagger went into labor with her second child, and she called on Avila to attend the birth. By that time, Avila was no longer working for the same midwifery group, but the practice arranged for her to have insurance during the birth, and Avila left a family gathering on Block Island to get to Providence on time.

Jagger’s little girl is now a healthy 2-and-a-half-year-old who considers Avlia her “auntie.”

“It was this amazingly cathartic experience for all of us,” Jagger said.

Avila is now a family nurse practitioner and attends births less frequently as part of her work. These days, she and Jagger are extremely close: They’ve vacationed together, bake each other birthday cakes and talk almost daily.

“I never would have expected our relationship to evolve to this point,” Avila said. “But despite how close we are now, I would sacrifice it in a moment if I could change the outcome of that first birth.”

Related:

Narrating Medicine: The Long Lasting Impact Of Child Abuse

One day when we were in first grade and sitting on a rickety wooden bench under a large oak tree in her backyard, my best friend’s mother called her to come inside.

A few minutes later, I heard wailing like an animal being gutted. Squinting my eyes and looking perplexed, I turned to my friend’s younger sister who was sitting beside me. She whispered, “She’s just getting beat.” Beat? What’s that, I wondered. She explained. Depending on the severity of their perceived wrongdoings, they were administered one of three levels of physical punishment: a stick, a belt or a big slab of wood. Their parents had moved from Ireland to our small suburb in New Jersey.

The Catholic schools the parents had attended as children in Ireland were very strict and the nuns reportedly beat them until their knuckles bled. Here, as parents in New Jersey, they told their daughters to strip naked and mercilessly receive corporal punishment. (I learned this from her sister, and over the years, from my friend.)

This was not a onetime event. These were repeated, deliberate acts. Continue reading

She Wiped Her Nose, Then Prepped My Biopsy. Still, It's Hard To Ask The Nurse To Wash Her Hands

Hand washing before and after touching a patient is mandatory. And before and after walking into a patient’s room or touching medical equipment. (Arlington County/Flickr)

Hand washing before and after touching a patient is mandatory. And before and after walking into a patient’s room or touching medical equipment. (Arlington County/Flickr)

I was lying on my back on a gurney, getting my abdomen washed by the nurse.

She dipped Q-tip-like sticks into the brown antiseptic and then swirled them on my skin where the physician would make his incision. He would penetrate layers of skin and muscle to get into my liver and extract cells. He would send the cells to the laboratory to assess what kind of cancer I had. Eight days earlier, I had learned I had masses in my abdomen and chest. Three days earlier, I had learned the masses were cancer. That day I was on the gurney getting prepped for a liver biopsy, to find out what kind of cancer it was.

While one nurse washed my incision site, another nurse prepared the room. She was adjusting the lights, surgical equipment and my gown. And she rubbed her nose with her hand. Everyone rubs their nose. Humans unconsciously touch their nose or mouth more than 3.6 times per hour.

When we do this, we spread germs into our body from whatever we were touching before and spread germs from our body onto whatever we touch next.

I laid there and wondered if I should say something to her.

In medical school in the early ’90s, I had learned about the risk of normal nose bacteria infecting surgical sites. While on the gurney that day, I remembered a story about a patient with a massive infection in his surgical wound site. The hospital searched for the source of his Staph aureus. They found it in the surgeon’s nose. This story was told to us to remind us of the dangers of what we were seeing on the wards in medical school — which was still full of old-school clinicians who drew blood without gloves and washed their hands only intermittently.

Today things are supposed to be different. Hand washing before and after touching a patient is mandatory. And before and after walking into a patient’s room or touching medical equipment. The compulsory annual online classes for all clinicians include specific directions on how to wash your hands. There are signs on the walls and screen savers on the hospital computers reminding us to wash our hands.

But there I was, flat on my back, wondering if I should say something to the nurse. I was afraid she’d be upset with me if I said something — I was all but naked, lying on my back and pretty much in her hands. The hands that had just wiped her nose. I didn’t say anything. I tried to get my courage up to say something — but couldn’t. A few minutes passed. I decided it was too late to say anything. But I told myself if she did it again, I would say something to her.

And then she did. She rubbed her nose with her hand and then reached for the equipment table with that same hand. The equipment that would be in my liver in a few minutes.

I called her on it. Continue reading

Yes, We’re Mammals, But Is It Wise These Days To Promote Breast-Feeding As ‘Natural’?

Public health officials should think twice about the unintended consequences of calling breast-feeding 'natural,' the authors of a new paper argue. (Michael Sawyer/AP)

Public health officials should think twice about the unintended consequences of calling breast-feeding ‘natural,’ the authors of a new paper argue. (Michael Sawyer/AP)

Hippos do it. So do orangutans. There’s no question that for us mammals, nursing is one of those defining behaviors in nature. The question is whether public health officials, in promoting breast-feeding among human mothers, should deploy the term “natural.”

Two academics pondering these and other linguistically charged questions sparked an online frenzy recently with a paper on the unintended consequences of promoting breast-feeding as a “natural” practice — and relating it to the anti-vaccine movement.

University of Pennsylvania ethicist Anne Barnhill and medical historian Jessica Martucci, writing last month in the journal Pediatrics, suggest that by using the word “natural” in campaigns endorsing breast-feeding, public health officials and medical professionals may be inadvertently fueling other groups that reject public health efforts — like anti-vaxxers. Continue reading

Commentary: I Needed Help With My Autistic Son. Others Need Help Too

The author, Susan Senator, and her son, Nat (Courtesy of Ned Batchelder)

The author, Susan Senator, and her son, Nat (Courtesy of Ned Batchelder)

The winter my son Nat broke our playroom window with his head was an endlessly snowy one. He was home on school break and on sensory overload — rocking too wildly on a rocking chair, too close to the bay window. A nauseating shatter, like the crack of thin ice underfoot.

Miraculously, he was not hurt.

Nat has fairly severe autism, and back then he struggled with all the unstructured time and the oppressive indoors of a New England winter. We all did. The season of days spent inside wears on all families. But if you are also living with a child with a complex developmental disability, who is nearly non-verbal and with sensory issues, it can mean that he will likely need extra help staying safe.

Back then I didn’t realize just how sensitive Nat was to confusion and unorganized days, or how his anxiety roared inside him, jangling his nerves, forcing him to pace, to scream, or to pinch. I understand now that autism wasn’t the enemy — lack of help was. We needed someone trained in autism education, who could work directly with Nat on activities of daily living, self-calming, social skills and how to behave out in the community; someone who could also work with us on how to organize Nat’s time at home to comfort him with a better sense of order. Continue reading

Should Docs Ask Patients About Guns? AG Healey, Mass. Medical Society Take Up Issue

“For God’s sake, you mean, physicians should be precluded from asking about the most lethal consumer product out there: a gun? That’s just wrong," Attorney General Maura Healey, seen here in a file photo, said at a forum Tuesday. (Jesse Costa/WBUR)

“For God’s sake, you mean physicians should be precluded from asking about the most lethal consumer product out there: a gun? That’s just wrong,” Attorney General Maura Healey, seen here in a file photo, said at a forum Tuesday. (Jesse Costa/WBUR)

Every year, the Massachusetts Medical Society picks an important public health topic of the day and tries to figure out how to make a difference.

This year, it’s guns.

Dr. Georges Benjamin, director of the American Public Health Association, warned physicians at a forum here Tuesday afternoon to be ready for pushback.

“‘Cause you will be asked, ‘Why do doctors care about this?’ I’d love for you all to say: ‘It’s mine, because it hurts people or kills people, it’s a physician’s prerogative,’ ” he said.

According to the Centers for Disease Control, about 90 Americans are killed with guns every day.

Attorney General Maura Healey hopes to partner with the medical society to reduce gun deaths.

“Now’s the time for us to seize this and take it back and reframe this issue,” Healey said. “We can begin to treat gun violence as the public health crisis that it is.”

Healey and the medical society plan to craft uniform questions doctors would ask patients about guns. But, the answers may create new problems for doctors. Continue reading

Endometriosis Linked To Heart Disease, And Why Lena Dunham Might Care

Earlier this year, the writer, actor and deliciously self-deprecating starlet Lena Dunham announced that health problems would prevent her from promoting her award-winning HBO series “Girls.”

“As many of you know I have endometriosis,” she wrote on Instagram (with the photo below). “I am currently going through a rough patch with the illness and my body (along with my amazing doctors) let me know, in no uncertain terms, that it’s time to rest.”

More recently, television host and cookbook author Padma Lakshmi cited her battle with endometriosis as “a major reason” her marriage to writer Salman Rushdie failed.  

“Once diagnosed, I was relieved to know that I wasn’t crazy and that there was a reason for all this pain,” Lakshmi writes in the introduction of a new book by her doctor, Tamer Seckin, “The Doctor Will See You Now.” “Endo is not a life-threatening disease, but it does take away your life.”

Now, it turns out, new research suggests endometriosis, which afflicts about 10 percent of all reproductive-age women in the U.S., may be even more damaging than previously thought — indeed potentially life-threatening. 

Doctors at Brigham and Women’s Hospital in Boston report that women with endometriosis — abnormal growth of uterine tissue outside of the uterus that can cause extreme pain and lead to infertility — have a 60 percent increased risk of coronary heart disease.

What’s more, the researchers found, the association between endometriosis and heart disease is strongest in women 40 or younger. Among them, there were 65 cases of heart disease per 100,000 women with endometriosis, compared with 19 cases in women without the condition.

“That’s a threefold increased risk” of having a heart attack, chest pain or requiring treatment for blocked arteries, said senior study author Stacey Missmer, director of Epidemiologic Research in Reproductive Medicine at Brigham and Women’s.

Many patients with endometriosis report that it can take years of suffering with the disorder before finally getting a proper diagnosis and adequate treatment. Even then, they say, their pain and distress is often minimized.

Linda Griffith, a professor at MIT and director of the institute’s Center for Gynepathology Research, said that even with growing awareness about the disorder, endometriosis isn’t always taken seriously. There’s still an attitude that endometriosis is “a women’s problem” she said, and that sufferers should simply “buck up” and deal with their “bad cramps.”

“To me, this study is a clarion call that we can’t just sit idly by,” said Griffith, who has undergone numerous surgeries for her own endometriosis. “This paper is important because the message is that women with this disease go on to have serious health problems, and their increased risk is high. …It should make people stop and think and stimulate more studies.” 

So what’s the connection between endometriosis and heart disease? Continue reading