Personal Health

News you can use, carefully digested and curated.

Angelina Jolie’s Double Mastectomy: How Times Have Changed

(Alastair Grant/AP)

About five years ago a close friend of mine had a prophylactic double mastectomy to lower her extremely high genetic risk of developing breast cancer, which had killed her mother. She begged me to keep the operations a secret: she didn’t want to worry her two young daughters.

Today, in a New York Times opinion piece that is about as out-there and open as it gets, 37-year-old actress and activist Angelina Jolie, who carries the BRCA1 gene which greatly elevates her risk of breast and ovarian cancer, writes that she recently had her breasts surgically removed to lower that risk.

On April 27, I finished the three months of medical procedures that the mastectomies involved. During that time I have been able to keep this private and to carry on with my work.

But I am writing about it now because I hope that other women can benefit from my experience. Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.

My own process began on Feb. 2 with a procedure known as a “nipple delay,” which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area. This causes some pain and a lot of bruising, but it increases the chance of saving the nipple.

Two weeks later I had the major surgery, where the breast tissue is removed and temporary fillers are put in place. The operation can take eight hours. You wake up with drain tubes and expanders in your breasts. It does feel like a scene out of a science-fiction film. But days after surgery you can be back to a normal life.

Nine weeks later, the final surgery is completed with the reconstruction of the breasts with an implant. There have been many advances in this procedure in the last few years, and the results can be beautiful.

I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer.

Jolie’s mother died of cancer at age 56 and Jolie writes that she didn’t want to put her own kids through that kind of pain if possible. That this highly public figure offers such intimate details about her body and her breasts may be a sign that the taboos around cancer are dwindling. (“On a personal note,” Jolie writes, “I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.”)

Sharon Bober, a clinical psychologist and director of the Dana-Farber Cancer Institute’s Sexual Health Program, who counsels many women who have had similar surgeries, said in an email that Jolie’s honesty is truly refreshing:

Wow!

One thing that strikes me is how times have changed – not that many years ago BRCA carriers would be worried about insurance being dropped, stigma, judgement, (“you are removing healthy breasts?? What are you crazy??”) and now this too is out of the closet. Continue reading →

FILED UNDER: Insurance, Medicine/Science, Personal Health, BRCA, breast cancer, genetics, surgery

May 13, 2013 | 4:16 PM | Carey Goldberg

More Than Mojo: ‘Natural’ Sex Pills May Contain Viagra Or Worse

(Source: FDA)

The patient was not complaining, by any means. He’d just started a new “natural” sex enhancement supplement, and he reported that it was working terrifically.

But Dr. Pieter Cohen’s astute resident at the Somerville Hospital primary care clinic, Dr. Rachael Bedard, had her suspicions, and she brought the patient to his attention. Dr. Cohen, a general internist at Cambridge Health Alliance and a frequent medical mythbuster, sent the pill out to be tested.

“The lab not only found Viagra in it,” he recalled. “They also found Cialis, another erectile dysfunction drug, as well as a brand new designer drug, as well as caffeine.” So in all, “You’ve got two prescription drugs that we would never prescribe together, a brand new drug, and caffeine, all in one pill. And that’s what our patient was consuming when he thought he was taking a natural sex enhancer.” In fact, the supplement, Sex Plus, was “chock full of pharmaceuticals that had nothing to do with nature.”

Dr. Bedard sent the findings to the FDA, which did its own testing and ended up issuing this alert late last month. And Dr. Cohen has just co-authored a paper in the Journal of the American Medical Association Internal Medicine — “Adulterated Sexual Enhancement Supplements,” subtitled “More Than Mojo” — spreading the word that sex-enhancement supplements advertised as natural may in fact be nothing of the kind. And they may contain brand new designer erectile-dysfunction drugs whose potential dangers are anyone’s guess.

His bottom line: “If you want a natural sex enhancer, talk to your doctor about prescription ‘yohimbe,’ but it may have side effects and it’s not very effective. Still, if you want to avoid Viagra, that’s the way to go. When it comes to any supplement sold for sexual enhancement, it should be avoided because it’s either going to be useless or potentially harmful.”

What might be the danger of, say, the drug that Somerville patient was taking? Continue reading →

FILED UNDER: Medicine/Science, Personal Health, safety, sexuality, supplements

May 10, 2013 | 12:28 PM | Gene Beresin and Steve Schlozman

Psychiatrists: Lessons For Parents From Horrific Cleveland Kidnappings

Ariel Castro appears in Cleveland Municipal court on Thursday. Castro was charged with four counts of kidnapping and three counts of rape after three women missing for about a decade and one of their young daughters were found alive at his home earlier in the week. (Tony Dejak/AP)

The news out of Cleveland this week of three young women held captive for a decade of physical, sexual and psychic abuse horrified the world. For parents, the news provoked perhaps a more targeted kind of fear, and raised one of the most fraught questions in parenting: How can we instill in our kids street smarts and an instinct to detect danger without leaving them terrified and fearful of the world? For some answers, we paged child psychiatrists Gene Beresin and Steven Schlozman, both at Massachusetts General Hospital and Harvard Medical School. Here is their professional response:

Every parent has said it: “Now, kids…don’t talk to strangers.”

It’s good advice. However, given the recent horrific events in Cleveland, some parents might very appropriately worry that this particular bit of wisdom is due for re-evaluation. After all, it appears all three young women kidnapped and held hostage for the past decade got into a car with their tormenter. He was known in the neighborhood, after all, and his own daughter was friends with one of the victims.

This is, of course, an extreme example of a particular narrative that we hear repeatedly these days. “We can’t let our kids play outside like we used to — the world has changed too much.”

But where does that leave us? What do we say to our children as we struggle to maintain the shaky balance between ensuring safety and also teaching independence and reasonable trust in the world and in our communities?

This is among the most vexing questions of modern parenthood. We certainly don’t want our kids to see a trusted uncle or coach as a potential villain – that would create an emotionally untenable world where all individuals, no matter how well known, are deemed potentially dangerous.

And yet, the alleged perpetrator in Cleveland was the father of one of the prisoner’s close friends. How do we deal with this dilemma?

There is of course no perfect or straightforward answer. Events like those in Cleveland are indeed extremely rare. Understandable media attention can create the impression that the world is in fact far worse than it actually is. At the same time, though, we have to find a way to increase awareness among our children of the potential dangers inherent in our world.

Know Your Child

So, for children of all ages, what can we do to?

Remember that every child is different; the way you present your words of safety needs therefore to be tailored to your individual child. So, the first principle is to know your child. Parents are good at this. In most cases, no one knows a kid better than the kid’s parents. There are 8-year-olds who will not be particularly bothered that even a well-known neighbor might have somewhat sketchy “issues.” And there are 12-year-olds who will freak out, have nightmares and feel that he or she can never trust anyone ever again. Continue reading →

FILED UNDER: Personal Health, child psychiatry, mental health, parenting

May 9, 2013 | 4:38 PM | Rachel Zimmerman

Report: Many Mothers Say They’re Pressured To Have Birth Interventions

(Listening To Mothers III/Childbirth Connection)

It’s Mother’s Day Sunday — a time for high-calorie brunches and pastel-colored bath products — but an even better time to do some listening.

So, just in time, here’s a new report that does just that. “Listening to Mothers III,” produced by the nonprofit Childbirth Connection, is an in-depth look at women’s pregnancy and birth experiences that covers a huge range of topics, from pregnancy weight gain, breast-feeding and postpartum depression to use of pain medication during birth and paying for maternity care.

The report, the third of its kind, is based on online surveys of 2,400 women who gave birth to a single baby from July of 2011 through June of 2012 in a U.S. hospital. There’s a lot to digest here, but for anyone interested in birth, it’s worth spending time wading through the material.

(popularpatty/flickr)

Here, as highlighted by authors of the report, are some of the more salient findings:

–A quarter of women surveyed experienced three or more of five major medical procedures such as labor induction, drugs to speed labor, and cesarean section, while only one in eight women had none of these interventions.

–Unnecessary interventions — such as inducing labor for convenience or routine repeat cesareans — exposed women and their babies to avoidable risk.

–Most of the women could not correctly identify risks of labor induction or cesarean section, revealing problems with prenatal education.

–One in four who had these procedures reported experiencing pressure from a care provider to do so.

–Mothers expressed a high degree of trust in maternity care providers, with nearly half rating them as “completely trustworthy.”

Maureen Corry, Executive Director of New York-based Childbirth Connection, said in an interview that a perfect storm of forces — including pressure on women and complete trust in their provider — could lead to unwanted outcomes.

“The pressure to have an induction or c-section, a lack of awareness about the risks of those interventions and an unqualified trust in their health care providers is a potent combination that could result in women and their babies being exposed to unnecessary risk and receiving care that isn’t based upon the evidence,” Corry said. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, childbirth, mother's health, pregnancy, women's health

May 9, 2013 | 11:24 AM | By Russ Hannagan

After Losing 322 Pounds, One Man’s Thoughts On Christie Surgery

Russ Hannagan before and after losing 322 pounds. (Courtesy)

As a man who formerly weighed over 500 pounds, I’ve been thinking a lot about New Jersey Governor Chris Christie’s recent announcement that he had lap band surgery. And I’m not alone: The governor’s surgery has also been a hot topic among many of my weight-loss friends on Facebook and Twitter, and my fellow diet workshop participants in Newton.

As a “New Jersey Boy” myself (born and raised in Carteret, Exit 12 on the Turnpike), and because I still have many friends who live in the Garden State, I like to keep tabs on what’s happening there. At first my friends and I felt Mr. Christie was in a state of denial. I believe he was once quoted as saying he was the healthiest “overweight” man you’d ever meet. Many of us who attend diet workshops know this feeling. You are overweight but still feel it’s not a problem. Like an alcoholic who claims they can stop at any time.

We would love to sit down with him and talk with him about “The Good, The Bad, and The Ugly” of weight loss. I mention this because back in November of 2011 I weighed over 533 pounds. In a little over a year, I have lost 322 pounds. I now weigh 210. My goal weight is 200 pounds, so I am only 10 pounds away from reaching it. But it took a great deal of hard work to get to where I am now.

I know this sounds like every other Cinderella story out there but through the years I have tried every diet in the book. From counting calories, to getting food shipped to me, to attending overeaters classes; you name it and I have tried it. Sure, I would lose the weight for a while and I would be healthy, but then it would all come back with a vengeance and I would be even worse then I was before.

Russ Hannagan celebrates his 50th birthday, a year after his surgery. (Courtesy)

My epiphany came when I met a friend I had not seen in a long time. I literally did not recognize her because she’d lost so much weight. I asked her what she’d done to transform herself. That’s when she told me about bariatric weight-loss surgery.

There are two main types of this surgery (and I’m not counting lap band surgery here). With the bariatric procedure they surgically alter your stomach into a small pouch (Roux-en-Y) or a gastric by pass sleeve. I won’t go into all the details — but suffice it to say I got the pouch.

Each month at Newton Wellesley Hospital, I attend these free diet workshops with other patients who are having or have had the surgery. The nurses, nutritionists, doctors, and fellow patients teach each other how to eat right and exercise properly. We all continue to attend the workshops to stay current on what types of vitamins are available and how stay healthy. The surgery is a tool — not a cure and not a goal. In the right hands and used in the correct way this tool can make your life so much better. I am proof of that. Used incorrectly it can be as useless as any other fad diet out there. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, bariatric surgery, lap band surgery, obesity, weight loss

May 9, 2013 | 10:03 AM | Rachel Zimmerman

Mass. Physicians Raise Concerns About Final Medical Marijuana Rules

WBUR’s Martha Bebinger reports that while some Massachusetts physicians are already signing marijuana certificates, others are worried about violating federal drug laws:

Dr. Richard Aghababian, president of the Massachusetts Medical Society says doctors want more research on how much marijuana to prescribe, and what kind, for which diseases.

“There’s not a lot in progress that I’m aware of. Before we treat it like any other medicine like an antibiotic or cardiac antiarrythmia, we’ve got to have some data,” Aghababian said.

The new state law says doctors can certify up to 10 oz. every 60 days for patients with serious medical conditions.

(“Caveman Chuck” Coker/flickr)

Yesterday, the state Public Health Council approved final rules for the use of medical marijuana. The AP reports:

The law also allows the state to license up to 35 dispensaries to provide marijuana for patients who have been certified by their physicians…

The 52 pages of regulations that were approved unanimously by the state Public Health Council will allow patients approved for medical marijuana to receive up to 10 ounces as a 60-day supply, though some acutely ill patients could receive more with permission from their doctors.

In addition to the medical conditions specified in the law, officials agreed to let doctors use discretion in recommending medical marijuana for other, unspecified conditions that are considered “debilitating” in nature. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, medical marijuana, practicing medicine, public health

May 7, 2013 | 4:16 PM | Rachel Zimmerman

Study: Teen Girls Who Exercise Have Lower Risk Of Violent Behavior

A few years back, an acquaintance told me that one of the few mandates he imposed on his daughter was that she play a sport regularly, whether she liked it or not. At the time, I thought it was a bit harsh. But now, with a ‘tween daughter of my own who is happiest curled up on a comfy chair reading, and sometimes needs a nudge to run around, I totally get it.

Girls need to move for so many reasons, among them, mental clarity, physical fitness and confidence, and simply to learn that their own bodies can bring them immense joy. Now, add another benefit to the list: it keeps them out of trouble.

(Rohan Reid/flickr)

Researchers from Columbia University in New York report that teenage girls from inner-city neighborhoods who exercised regularly were less likely to carry a gun and engage in violent behavior and activities.

Here are some of the findings, from the Columbia news release:

–Females who exercised more than 10 days in the last month had decreased odds of being in a gang.
–Those who did more than 20 sit-ups in the past four weeks had decreased odds of carrying a weapon or being in a gang.
–Females reporting running more than 20 minutes the last time they ran had decreased odds of carrying a weapon.
–Those who participated in team sports in the past year had decreased odds of carrying a weapon, being in a fight or being in a gang.
Continue reading →

FILED UNDER: Medicine/Science, Personal Health, exercise, girls health, poverty, public health, violence

May 7, 2013 | 8:04 AM | Karen Shiffman

Reality Check On Those ER Wait-Time Ads: ’19 Minutes’ Could Mean 90

By Karen Shiffman
Guest Contributor

It was just one of those stupid things. I was cutting the stems off of flowers, not really paying attention, and somehow managed to snip my knuckle along with the stems. The blood began to spew.

Karen Shiffman and her injured finger. (Aayesha Siddiqui/WBUR)

I’m not one to panic. I calmly reached for some dish towels and applied pressure, then ran the gash under cold water. A red river flooded the sink. The dish towels soaked through, so I switched to bath towels. Finally, it dawned on me that the bleeding was not just going to stop and I might need some stitches.

I live right near the Longwood Medical Area, but theorized that if I went to one of the major hospitals down the street, I’d be in competition with people needing face transplants and end up waiting 12 hours. I recalled passing a billboard for Saint Elizabeth’s in Brighton advertising how quick the waiting times were in its Emergency Department — under 20 minutes, if memory served. So I wrapped my bloodied hand in Bounty and a fresh bath towel, and drove 15 minutes or so to St. E’s. The posted wait time on the billboard as I passed was 19 minutes.

At the hospital, I left my car with the valet, ran in to the emergency room, walked up to the desk and handed the receptionist my driver’s license for identification. She asked me what had happened and I told her, then I sat down in the waiting room and struck up a conversation with a very terrified 7-year-old who had just taken a tumble on the playground. We compared boo-boos.

About half an hour later, a nurse brought me in to an exam room, took my temperature and blood pressure, and asked me to unwrap my hand. After he had a look at the gash, he handed me some fresh gauze wrapping and sent me back to wait. About half an hour after that, I was taken to another exam room where another nurse looked at my wound, then gave me more gauze and some paperwork to fill out.

A billboard that shows the emergency room wait time at St. Elizabeth’s Medical Center in Brighton, Mass. (Carey Goldberg/WBUR)

“What’s up with that billboard sign?” I asked her. “I thought I was going to be seen within 19 minutes.”

She rolled her eyes and said, “Tell me about it. We get that all the time. It just means that you’re going to get to the receptionist by then. Why don’t you call and tell the marketing people that it’s not true?”

Another half hour after that — so roughly 90 minutes in all after I arrived — a nurse practitioner fixed up my finger.

Everyone was nice. Everyone seemed to know what they were doing. It still was probably faster than if I’d gone to one of the hospitals down the street from my home. But that’s not why I went there. I did get good care, but it strikes me that there’s something missing here — like truth in advertising. I’m left with the feeling that they got me there under false pretenses.

Chris Murphy, spokesman for Steward Health Care System, which includes Saint E’s, responds:

The ED wait time billboard at Saint Elizabeth’s measures a patient’s “door to room” time. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, emergency medicine, hospitals

May 7, 2013 | 7:21 AM | Rachel Zimmerman

Interpreting The Oregon Medicaid Study: Health Is More Than Insurance

Here’s a very clear analysis of a very confusing study that came out last week and was framed in wildly different ways by various media. The Oregon Health Insurance Study was complicated, for sure, but the bottom line, argues physician John Lumpkin, in the current Health Affairs, is fairly simple: “Better health requires health insurance coverage, but it doesn’t end there.”

(stanlyekost/flickr)

Published in The New England Journal of Medicine, the landmark Oregon study by researchers at Harvard and MIT offered a snapshot that compared Oregonians on Medicaid to those not on the public assistance program. (A 2008 lottery among low-income residents established the two groups, which effectively created a treatment and control arm of the experiment.)

The findings were mixed (generally not good for a headline): on the up side, after about two years on the program, patients showed improved mental health with a dramatic drop in depression among the newly insured, and more financial stability. It also found these patients had greater interaction with the health care system, and more preventive care, in general. Continue reading →

FILED UNDER: Insurance, Personal Health

May 6, 2013 | 11:22 AM | Carey Goldberg

Mass. Poll: Health Costs Feel Heavier Than Ever, Yes To Price Tags

Source: Mass Insight / Opinion Dynamics

You may already know all too well that the cost of health care, whether in premiums or co-pays or deductibles, seems to weigh down your budget more heavily with each passing year. But the chart above tells you that if that budgetary load is feeling more burdensome than ever before, you’re not alone.

Every spring, the Boston consulting and research firm Mass Insight runs a health care “affordability” poll, and this year’s is just out today. From the press release:

Since 2004, the Mass Insight / Opinion Dynamics Healthcare Affordability Index has tracked how much of a cost burden residents feel from premiums, co-pays, prescription drugs, and deductibles. Results are calculated into a single Index score, which measures the level of affordability people feel toward their healthcare. Results from the spring 2013 poll show the lowest score ever recorded on the Index, 109, meaning Massachusetts residents feel their healthcare is becoming less affordable and more of a financial burden.

The poll of 450 Massachusetts residents, conducted in late April, found that its “affordability index” dropped 10 points in just the last year.

Might the 2012 Massachusetts health cost-containment law help at all? At the very least, the poll found eagerness among respondents for one aspect of the new law: its promise of greater health care “transparency” to make it easier for consumers to obtain price information. Continue reading →