CommonHealth

May 8, 2013 | 10:49 AM | Carey Goldberg

Weight-Loss Surgeon: Christie-Style Secrecy Common, Stigma Lingers

New Jersey Gov. Chris Christie is surrounded by security and journalists in 2012. (Getty Images via NPR)

I’m not sure which is grabbier news: That New Jersey Governor Chris Christie underwent weight-loss surgery in February or that he felt compelled to keep the operation secret until The New York Post was about to publish a story about it.

I asked Dr. Daniel B. Jones, director of the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center and a Harvard professor of Surgery, for his perspective. He began by emphasizing that all patients are entitled to privacy about their health care, including a governor. He went on:

That said, it is not uncommon for patients, when they have weight loss surgery, to say, ‘I don’t want anyone to know about this.’ We try to get patients over that hump as part of the pre-operative evaluation.

As physicians, we really want patients to identify: Who’s your support group? Who’s your champion? If your spouse doesn’t know what you’re doing, they’ll bring junk food into the house; if family members don’t know, they may think you’re not eating enough. So we really want some core people to know what’s going on. That said, most people do have a core group but don’t want other people to know.

Dr. Daniel B. Jones (BIDMC)

We don’t know the reason but we think there’s still sort of a stigma to having weight-loss surgery. So even though we’re doing 150,000 weight-loss operations a year [in the United States], there’s the idea that if you have a weight-loss operation you’re somehow ‘taking the easy way out.’ You’re kind of ‘cheating.’ You’re just not tough enough to do the diet and exercise required for weight loss. You’re somehow ‘weak,’ right?

We even see this with gastric bypass patients who, six months after surgery, when they’ve lost 100 pounds and they’re healthier and more mobile, they still ask themselves, ‘Should I have done this without an operation?’

So this is sort of normal. In fact, I had a nurse — this was a real clandestine operation. She came in with a separate name, only a bare-minimum number of people got to know who it was. It was done in complete secrecy, but three to four months later, after her lap band was working, the whole hospital knew she’d had it. So what happens is, you reach a point of ‘Everyone can know.’

I quote people a 40-percent chance that the band over their lifetime will need to be repaired, revised or removed.

The other part of it is a concern that you might fail. And the pressure’s kind of high. So once you’re winning, everyone likes to share success. Not everyone knows whether they’re going to achieve it. You have to remember, everyone who’s had a weight loss operation has, by definition, already been on multiple diets — that’s a requirement for any operation in an accredited bariatric program. It’s very common for people to have lost 15 or 50 or 100 pounds, and for one reason or another they’ve gained back even more. It has to do with our physiology. It’s not about willpower.

The body has a set point and whether you like it nor not, your body hovers there. So if you diet in the traditional sense and knock the weight down, your body thinks you’re somehow starving it. And the first chance it gets, it fires off chemicals that not only push you back to where you started, it sets your new set point higher. We call this yo-yo-ing.

Whether it’s the band or the sleeve or the bypass, [weight-loss operations] do things that make it possible for people to get the weight off and keep it off. Continue reading →

FILED UNDER: Medicine/Science, bariatric surgery, weight loss

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 →

FILED UNDER: Insurance, Money, Personal Health, costs of care

May 6, 2013 | 8:48 AM | Rachel Zimmerman

Suck On This: Pacifier-Licking Parents Have Less Allergic Kids, Study Finds

Admit it, you’ve done this: your kid drops her pacifier on the floor and, too exhausted to schlep to the kitchen sink to rinse it, you just give it a good lick and hand the binky back.

Well, it turns out this not-so-pretty cleaning method you turn to when no one else is looking may, in fact, be one helluva gift for your child’s immune system.

(Joe Suspense/Flickr)

Researchers in Sweden report that “children whose parents sucked on their pacifiers to clean them had one-third the risk of developing eczema (the most common early manifestation of allergy), at 18 months of age, compared to children whose parents did not use this cleaning practice.”

It gets better. Infants who were born vaginally and were lucky enough to have a parent suck clean his or her pacifier got an added boost, the study found: “The prevalence of eczema was approximately 2.5 times lower at 18 months of age in vaginally delivered children whose parents sucked their pacifiers than in caesarean section-delivered children whose parents did not have this habit (20% vs. 54%),” the study says.

The takeaway from the study, published online today in the journal Pediatrics, is this: It looks like early exposure to parents’ saliva may help stimulate a baby’s immune system, Continue reading →

FILED UNDER: Medicine/Science, Personal Health, allergies, asthma, eczema, immune system, pediatrics

May 6, 2013 | 6:41 AM | Martha Bebinger

Take Two Aspirin And Download This App (At Your Own Risk)

Don’t be surprised if one day soon your doctor ends an appointment saying, “Here’s a prescription for a drug that will help, and download this app.”

Medical apps are turning our phones and tablets into exercise aides, blood pressure monitors and devices that transmit an EKG. But the proliferation of apps is way ahead of tests to determine which ones work.

Christine Porter is hooked on the My Fitness Pal app.

Christine Porter posts food, drink and exercise infofmation to her health app every day and says she’s almost always honest. (Martha Bebinger/WBUR)

In October, after deciding to lose 50 pounds, Porter started recording everything she eats or drinks and any type of exercise she does.

“It’s telling me I have about 1,200 calories remaining for the day,” Porter said. She took a long walk at lunch and built up some calorie credits so she wouldn’t have to skimp so much at dinner.

Porter heard about the app from her health coach at the Ambulatory Practice of the Future, a primary care clinic for Massachusetts General Hospital employees.

“I usually give patients a choice of several apps that might help them,” said health coach Ryan Sherman. “Some patients won’t even look at them and then others might say, ‘Oh, yeah, this could work for me.’ ”

Increasingly, Sherman says, patients are coming in, pulling out their phones and asking, “Hey, have you seen this one?” The options are both exciting and hard to manage.

“There’s a new one every day so it’s trying to keep up with that,” Sherman said. “And if there’s not one place to look that can be hard.”

Which is one reason doctors at this Mass General clinic are suggesting — but not prescribing — apps. It’s hard to know which of the roughly 40,000 choices work.

Experts who are trying to figure out which apps are safe and effective generally separate them into two categories: those that actually turn your phone into a medical device and everything else. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, health information technology, mhealth, patient empowerment

May 3, 2013 | 5:30 AM |

Caring For Kevin: An Autistic Man, An Exceptional Doctor, A Life Renewed

Kevin Fitzgerald, after surgery, his vision restored (George Hicks/WBUR)

Kevin Fitzgerald, after the second of two eye surgeries, with his vision restored (George Hicks/WBUR)

By Rachel Zimmerman

Kevin Fitzgerald is parked in a wheelchair near a set of elevators at Boston Medical Center, tense with fear.

He’s a big guy, nearly six feet and about 280 pounds. But because of his severe autism, Kevin can’t verbalize his thoughts. He can only moan.

Dressed in her scrubs, Dr. Susannah Rowe, Kevin’s eye surgeon, sits on the floor next to him. While waiting for a heavy dose of anti-anxiety meds to calm her patient, Rowe practices what she calls “verbal anesthesia.” “It’s OK to be afraid,” she tells Kevin. “Want to hold my hand?”

Institutionalized since childhood, Kevin, now 56, has been losing his sight for the past two years to the point that doctors said he can see little more than shadows. He’s here at BMC awaiting cataract surgery, a fairly simple procedure that generally takes about 30 minutes in the operating room. But for Kevin, who has long feared doctors and has a history of aggressive, unpredictable behavior — like hitting himself or inadvertently hurting others or running away when he’s in distress — the procedure isn’t simple at all.

Surgeon Susannah Rowe, anesthesiologist Oleg Gusakov, M.D. and nurse anestheticst Dale Putnam, CRNA, prepare Kevin for surgery. (George Hicks/WBUR)

Dr. Susannah Rowe, anesthesiologist Oleg Gusakov and nurse anestheticst Dale Putnam in the pre-op room with Kevin. (George Hicks/ WBUR)

It’s not simple for the doctors, either. They’re practicing a special art: medical care for the disabled and mentally ill. It often breaks the rules of traditional care, loses money for their practices and can even put them at physical risk if a frightened patient spins out of control.

But there’s a huge need for such specialized care. As many as 50 percent of people with intellectual disability (defined as an individual with an IQ of 70 or less and difficulty functioning in daily life, among other criteria) have vision problems, according to state experts. And a far higher proportion of these disabled patients have severe vision problems compared to the general population.

With delayed or limited access to treatment, these men and women can begin to lose their already-tenuous connection with the physical world; and their behavior, driven by fear and the inability to understand why things are growing darker, can deteriorate further toward what looks like aggression. Rowe, the surgeon, says anyone with a disability or severe mental illness whose mood, anxiety or behavior gets worse should immediately have their vision checked.

Join doctors in the operating room for Kevin’s surgery. Warning: It gets graphic.

Kevin’s situation may seem exceptional but he’s not alone. According to the state Department of Developmental Services, there are about 32,000 adults and children with intellectual disability (what used to be called mental retardation) eligible for services in Massachusetts. About 9,000 of these adults live in group homes.

But not everyone with an intellectual or developmental disability is getting the care they need, experts say. Consider:

A recent Massachusetts study found that people with autism still face significant barriers in accessing medical care, and it’s worse for patients like Kevin, who can’t fully communicate.
A 2009 survey of eye specialists from around the state found that while most providers believe patients with intellectual disabilities require 30-60 minutes longer for a medical appointment, the vast majority of the specialists didn’t allot that extra time.
According to a 2004 Public Health Reports article: “Research indicates that most individuals with developmental disabilities do not receive the services that their health conditions require…[and] individuals with mental retardation face more barriers to health care than the general population.

Research has also demonstrated that many primary care providers are unprepared or otherwise reluctant to provide routine or emergency medical and dental care to people with developmental disabilities.”

Andrew Lenhardt, a primary care doctor in Hamilton, Mass., who treats many disabled patients, including Kevin, says: “The level of dignity and respect and basic medical care that’s given to people with disabilities is often meager…These people can’t advocate for themselves, they’re an easy target to be treated inadequately or poorly.”

Continue reading →

FILED UNDER: Insurance, Medicine/Science, Money, Personal Health, autism, boston medical center, cataracts, cost of care, developmental disability, eye surgery, intellectual disability, special report

May 3, 2013 | 4:02 AM | Posted by Carey Goldberg

Saving Nalini: Leading Psychologist Seeks Bone Marrow Donor To Survive

Nalini Ambady, whose survival depends on finding a bone marrow donor in the coming weeks, with her daughters. (Courtesy)

Psychology professor Nalini Ambady, formerly of Harvard and Tufts and now at Stanford, has leukemia and just weeks to live unless she finds a bone-marrow donor who matches her, most likely one of South Asian descent. Her family and friends in academia and beyond are mounting an extraordinary public effort to save her, including attempts to use the findings of her field — social psychology — to motivate potential donors. (See, for example, this Psychology Today post: Point. Click. Save This Woman’s Life.) Here, Dr. Liz Gaufberg, of Harvard Medical School and Cambridge Health Alliance, shares her own plea with the public to help.

By Liz Gaufberg, MD
Guest contributor

This April vacation, my husband and our teenaged daughters decided we needed a true break. We booked a beach resort and made a pact to unplug. No cell phone. No texting. No Facebook. No Internet. No TV. We’d read books, eat meals together and talk about what matters to us. We made only one exception to the no-technology rule: Nalini.

My dear friend Nalini is in a race against time with leukemia – searching, hoping, waiting for a bone marrow donor to save her life. I am in the habit of speaking with Nalini almost every day. Everyone agreed I would be allowed to go to the hotel lobby to email her and visit her CaringBridge Site. If Nalini took a turn for the worse, I would leave our vacation early.

Day one of vacation went just as planned. Over dinner we chided each other about sunscreen and talked about the books we had cracked. Our 13 year old adored The Sisterhood of the Traveling Pants. I read Nathan Englander’s book of short stories “What We Talk about When We Talk about Anne Frank.” The title story turns on a game that a contemporary suburban American Jewish couple plays. The game is a thought experiment they call “Who Will Hide Me?”

Professor Nalini Ambady last summer (courtesy)

They run through a list of non-Jewish friends and acquaintances and imagine — in the event of another Holocaust — what each individual would do. Is this someone who would risk his or her own life and family to save us? Would they turn us in? After initial teen protests that the game was “morbid” and complaints about a Mom who never talks about “normal stuff,” we played a few rounds at the table. What about that nice neighbor who digs our car out in the winter, would he? The bagger at Stop and Shop, would she? What would we do if someone needed us?

The game came to an abrupt end when we overhead a woman at the next table talking about our home city of Boston. Had we heard correctly? Yes. Two bombs had exploded at the Marathon. Back in our room, we quickly plugged in the TV. After bomb number one exploded, it looked at first like chaos, with people running in all directions. But as we watched, we realized…some people were actually running toward the explosion while others were running away. What would I do? Would I run in and try to help or would I clutch my children and run away? So much for our brief self-imposed ban on technology; it was the only way to find out how we might support and help, even from afar.

Our dinner table talk about saving the lives of strangers turned to saving Nalini. Nalini Ambady, a professor of Psychology at Stanford, needs to find a bone marrow donor in the next few weeks in order to survive. A match for Nalini will most likely come from someone from Nalini’s birthplace — Kerala, in Southern India. Unfortunately, the percentage of South Asians on the U.S. Bone Marrow Registry is dismally low. A South Asian like Nalini has a 1-in-20,000 chance of finding a match, while for Caucasian recipients the chance is 1 in 8. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, bone marrow donation, leukemia

May 2, 2013 | 4:10 PM | Posted by Carey Goldberg

How An AIDS Specialist Read Recent News Of A ‘Breakthrough’

HIV particles, yellow, infect an immune cell, blue. (NIAID_Flickr)

By Paul E. Sax, MD
Guest contributor

There it is, right in your daily paper, on your tablet or computer screen, or wherever you get your news today — a headline about a great medical breakthrough everyone’s been waiting for:

Scientists On Brink Of HIV Cure

Researchers believe that there will be a breakthrough in finding a cure for HIV ‘within months’

Yes, I read this exact headline recently. Here’s the full article, published in the English newspaper the Daily Telegraph. It details how some Danish researchers have figured out a way for “the HIV virus to be stripped from human DNA and destroyed permanently by the immune system.”

Dr. Paul Sax (Courtesy BWH)

Furthermore, they are “expecting results that will show that finding a mass-distributable and affordable cure to HIV is possible.”

By all means, go ahead and read the full piece; you’ve got 20 free reads on the Telegraph website. As a treat, there’s a colorful stock photo too, showing red blood cells floating through some blood vessels, along with a few HIV virions glowing bright green — it’s very Fantastic Voyage-esque, minus Raquel Welch in her scuba gear.

But return here for a moment, please. I’m going to recommend three simple steps to getting the most from this — and other medical breakthroughs — in the mainstream media.

Step 1: Be a skeptic. As exciting as curing HIV would be, and no matter how much you’d like this to happen, just think for a moment about the plausibility of this story. Are scientists really on the “brink” of curing HIV? If so, why is this only appearing in the U.K. Telegraph? Trust me, this brink-of-cure has not yet appeared in peer-reviewed medical journals or at scientific meetings.

And wouldn’t you expect this kind of advance, if real, to show up everywhere in media land? Fire up that Google machine, and see what you can find about it elsewhere — lo, it’s the great following herd, all stampeding after that same U.K. Telegraph story. And importantly, here’s a New York Times piece on the very same general subject — HIV cure — and they don’t even mention these Danish researchers. Sure, the Times misses some stories, but it’s got some pretty impressive Health and Science sections — could they miss this, researchers on the brink of curing HIV, no less? I think not. So perhaps Mr. U.K. Telegraph Science Reporter is exaggerating a bit, for the sake of his story, of course.

Step 2: Don’t be a complete snob — give the story a chance. Continue reading →