brigham and women;s hospital

RECENT POSTS

The Latest Brigham Face Transplant: Vermont Woman Burnt By Lye

Photos from Brigham & Women's Hospital of its latest face transplant recipient, Carmen Blandin Tarleton. (Courtesy BWH)

Photos from Brigham and Women’s Hospital of its latest face transplant recipient, Carmen Blandin Tarleton. (Courtesy BWH)

Brigham and Women’s Hospital has just publicly presented the latest recipient of one of its world-leading face transplants: a Vermont woman whose estranged husband burned her horribly with lye. And the Boston Globe offers a harrowing medical backstory to today’s presentation here: the patient’s desperate decision to proceed with a dangerous drug even though it could have killed her. From the Brigham:

Carmen Blandin Tarleton is a 44-year-old registered nurse and mother of two from Thetford, Vermont. On June 10, 2007, Carmen was brutally attacked by her estranged husband, beaten and doused with industrial strength lye burning over 80 percent of her body.

Carmen was air lifted to Brigham and Women’s Hospital where she was put into a medically-induced coma. She underwent 38 surgeries over a three month period. Over the next five years, Carmen had 17 additional surgeries including some to restore her sight. Despite this, she was left severely disfigured and legally blind. On December 5, 2011, after a rigorous screening process she was approved for a face transplant and the New England Organ Bank began searching for a donor.

In February 2013, a donor was identified and Carmen received a full face transplant at Brigham and Women’s Hospital. Continue reading

Every Minute Of Exercise Could Lengthen Your Life Seven Minutes

stopwatch

At a recent dinner party, a geeky friend of mine was cheerily justifying the piles of money he spends on a personal trainer. He’s feeling so great that it’s worth every cent, he exulted, “And the best part is the return on the time! Every minute you spend working out comes back to you, because you’ll live that much longer!”

“Really?” I wondered. I knew vaguely that being active lengthens life expectancy, but was the return on time spent really 1 to 1?

Certainly, I hoped it was. It’s a daily struggle to make the time to exercise, and the current federal health guidelines call for at least 150 minutes a week of moderate exercise — a lot of time that somehow manages to seem like even more, magnified by the “should” it adds to so many days. There are hundreds of other reasons to exercise, and the one that works best for me is wanting to feel at my best on that very day. But it would be very comforting, I thought, if I knew that all of that time would come back to me.

Not only do you get the time back, it comes back to you multiplied — possibly by as much as seven or eight or nine.

Let me cut to the happy conclusion: It seems that it does. And then some. If you play with the data of a recent major paper on exercise and longevity, you can calculate that not only do you get the time back; it comes back to you multiplied — possibly by as much as seven or eight or nine.

To quote Tom Anthony, a regular CommonHealth reader with a Harvard physics degree who kindly helped me with the math, “I wish I could get these paybacks in the stock market.”

This is all a bit of a public health parlor game, of course, resting on averages and approximations. You, personally, could work out ten hours a week and still die flukishly young. But the math looked so striking that I asked for a reality check from Dr. I-Min Lee of Brigham and Women’s Hospital, a Harvard professor and senior author of that recent paper, “Leisure Time Physical Activity of Moderate to Vigorous Intensity And Mortality: A Large Pooled Cohort Analysis.”

Yes, she confirmed, she had not calculated out the question before, but according to her data, a middle-aged person who gets the recommended 150 minutes per week of moderate exercise — defined as the level of brisk walking — can expect a 1-to-7 return: seven extra minutes of life gained for each minute spent exercising.

Some background: Continue reading

When Doctors Don’t Listen (And Hangover Leads To Spinal Tap)

Dr. Leana Wen consults with co-author Dr. Joshua Kosowsky (Associated Press)

Dr. Leana Wen consults with co-author Dr. Joshua Kosowsky (Associated Press)

Consider these cautionary tales:

• The college student who came to the emergency room for an intense hangover, only to be told she would need a spinal tap to rule out possible brain hemorrhage. (True story. Spinal tap as in puncturing the back to draw fluid. For a hangover. She slipped away instead.)

• The drowsy obese woman hospitalized for days for a possible clot when all she really had was sleep apnea.

•The strapping middle-aged man whose chest felt sore after a day of moving heavy furniture, condemned to a battery of tests for possible heart attack.

These are the kinds of alarming cases that populate a provocative new book to be published next week: “When Doctors Don’t Listen: How To Avoid Misdiagnoses And Unnecessary Tests,”

Dr. Leana Wen (courtesy Darren Pellegrino)

Dr. Leana Wen (courtesy Darren Pellegrino)

Dr. Joshua Kosowsky

Dr. Joshua Kosowsky

Dr. Leana Wen, a senior resident in emergency medicine at Brigham and Women’s Hospital and Massachusetts General Hospital, co-authored the book with Dr. Joshua Kosowsky, clinical director of the Brigham and Women’s emergency department — a new-minted doctor joining forces with a senior colleague, both seeking to warn patients about prevalent flaws in medical thinking that could cause them harm — and how to counteract them.

Our conversation, lightly edited, is below, and beneath it, an abridged excerpt recounting the tale of the hung-over college student in more detail.

Here’s how I think I’d distill the message of your book: Patients, beware of “cookbook medicine” and of getting stuck on a “diagnostic pathway,” of doctors who get hung up on trying to “rule out” a “worst-case scenario,” and so bombard you with yes-and-no questions that you cannot tell your story, the story that may actually point to your diagnosis.’

But how would you distill it, and translate those phrases I just used? 

I like what you said. The way I think about it, too, is that our health care system, and our individual parterships with our doctors, have become so out of control, and patients have the ability to — and have to empower themselves to — take control of their health care. And they should start by understanding what the doctor’s thought process is, understanding the ‘cookbook medicine’ that many doctors practice, and what they can do to focus care on their individual symptoms and story.

How would you explain what you mean by cookbook medicine?

Doctors are under a lot of pressure to be faster and faster and see patients in shorter and shorter periods of time. And so instead of listening for 10 minutes without interruption, they begin to ask yes/no questions —

Yes, I was amazed by the statistic in the book that the patient on average only gets 12 seconds to start telling the doctor what’s wrong before they get interrupted —

Another study recently showed that it’s more like eight seconds. And so that’s how cookbook medicine comes about. Anyone can relate to being asked, ‘Do you have chest pain? Do you have shortness of breath? Do you have headache?’ That’s not individualized care, that’s putting you in a pre-set mold and trying to say that whatever applies for everyone else, also applies to you.

For example? Continue reading

Study: Multivitamins Slightly Reduce Cancer Risk In Older Men

(US Navy via Wikimedia Commons)

Please don’t groan. Yes, this is one more of those confusing studies that seem to flip-flop the previous confusing studies. But let’s just file it away as a valuable data point in an evolving picture, and rejoice that at least, as these studies get bigger and better, the findings should become stronger.

Last we heard — last fall, actually — a study of more than 38,000 older women in Iowa brought disturbing news to the millions who take daily vitamins. It found, as NPR reported: “Use of many common supplements — iron, in particular — appeared to increase the risk of dying, and only calcium supplements appeared to reduce mortality risk. The increased risk amounted to a few percentage points in most instances.”

Now comes a somewhat countervailing study: The Journal of the American Medical Association reports that in 15,000 older men, multivitamins do confer apparent benefit, reducing the total risk of cancer by 8 percent. I spoke with the study’s co-author, Dr. Howard Sesso, an associate professor of medicine at Brigham and Women’s Hospital. He acknowledged my flip-flip complaint, but noted that this latest study does take the research up a notch:

Previous multivitamin studies have been “observational studies,” he said. “These are free-living populations, and they take multivitamins or they don’t,” and the researchers would try to control for the pre-existing differences between vitamin takers and non-takers.

This new research, he said, is different in that among the 15,000 men in the Physicians’ Health Study, it randomly assigned men to take vitamins or a placebo, for an average of 11 years. So it’s longer-term than previous studies, and it is “the first long-term randomized trial that tested whether daily multivitamin use prevents cancer.”

In a few weeks, he noted, the researchers will also present data on vitamins’ effects on heart and blood-vessel health. And in a months, on eye disease and cognitive function. Continue reading

How Your Kidneys Could Signal Trouble Ahead For Your Brain

New research finds links between the humble kidney and our brains. Shown here is the kidney of an embryonic mouse, genetically altered to glow green.

The last time Dr. Julie Lin went for her annual check-up, she asked for tests of her kidney function that her primary care doctor would not otherwise have ordered.

It was not just that Dr. Lin is a Brigham and Women’s Hospital nephrologist — a kidney specialist — and often sees patients who, by the time their disease has been detected and they have been referred to her, are verging on total kidney failure.

It was that she had found in her own research — which is just out in a leading nephrology journal — that tests of your kidney function can apparently yield surprisingly telltale insights into the health of your brain, and possibly other organs as well.

The research looked at more than 1700 women over age 70 in the long-running Nurses’ Health Study, following them for up to six years. It found that in women whose urine tests indicated the very beginnings of kidney dysfunction, their cognitive abilities — higher-order brain functions like memory and verbal fluency — declined two to seven times faster than normal.

More than half a million Americans are in ‘end-stage’ kidney disease, and among them, 88,000 die each year.


The cognitive experts working on the study were “really struck by how strong an association there was, how much faster a decline this very small amount of protein in the urine is signaling,” Dr. Lin said.

The study mainly raises the possibility of an easy, non-invasive urine screening test that could provide a useful window into brain health. But it also has potential implications for a medical-emotional conundrum: Over 20 million Americans are afflicted by chronic kidney disease; more than half a million are in its ominous “end stage,” and among them, 88,000 die each year. So why, oh why, don’t you care more about your kidneys?

Continue reading

First-Ever Clinical Trial For Personal Genome Sequencing To Enhance Medical Care

Using the human genome for better patient health

Brigham and Women’s Hospital announced today it’s been awarded $9.6 million for a new project to study how mapping patients’ entire DNA can be incorporated into actual medical practice. Here’s the press release:

The proposed project, led by a multi-disciplinary team of more than 40 scientists, will first design an informatics pipeline to interpret several million genetic variants from each patient, and generate clinical reports that will be meaningful to practicing physicians. After that, 200 patients and their physicians will be enrolled in a clinical trial where they will receive either standard care with whole genome sequencing or standard care without whole genome sequencing. Researchers will study two types of volunteers – healthy middle-aged patients followed by primary care physicians and patients with newly diagnosed hereditary cardiomyopathy. The MedSeq Project will begin enrollment in 2012.

“This study will build on the expertise and accomplishments of this remarkable scientific team to create and test novel methods for interpreting whole genome sequencing information and actually using that information in clinical medicine,” said Robert C. Green, MD, MPH, a physician-scientist in the Division of Genetics at BWH and overall director of the study. Continue reading

Help For Paranoia: A Primer On Bacterial Meningitis

Autopsy slide of bacterial meningitis


Bacterial meningitis is extremely rare, and also extremely crazymaking: Many of its symptoms overlap with the sorts of seasonal viruses that sweep through the population in chilly weather, turning the nasty hassle of a bug into a source of mortal fear.

In the wake of the awful news that a Boston Latin Academy 7th-grader died of probable bacterial meningitis on Monday evening, many of us may be reinterpreting every headache and fever. So I’m deeply grateful to Sacha Pfeiffer and Lynn Jolicoeur of WBUR’s All Things Considered for this helpful primer on bacterial meningitis. They quote Dr. Paul Sax of Brigham and Women’s Hospital on the symptoms of possible bacterial meningitis:

“A person who has a very severe headache, very high fevers, a person who says it’s the worst headache of my life. A person who says that they have a very stiff neck in association with that fever and headache. Also, if there’s been any change in sort of the level of cognition of a child or an adult, someone who’s sort of not thinking right while those things are going on, those would also be very much warning signs. And also in particular, fever and headache and a rash would be particularly alarming.”

And his advice for parents: Continue reading

Beyond Jello And Toast: Hospital Chefs Face Off In Contest

Yuck. (A 2007 photo from a Canadian hospital)

What will they compete on, who makes the reddest Jello? The toughest toast? Who best mixes apple juice concentrate with water?

That was my admittedly snarky reaction when I got word that later this month, 13 of the Boston area’s top hospital chefs would be competing in a culinary contest that organizers believe is unique in the nation.

Even the press release for the event had to acknowledge an image problem for hospital food:

When asked what to say to those who think hospital food is “gross,” Chef James Boyd, Executive Chef at Children’s Hospital Boston, said “They haven’t been to a hospital lately! From old school ‘hospital food’ as they call it, it’s changed so much. There are more healthy items out there and we’re doing more sauté items to order now.”

Boyd and his team are one of 13 hospital and healthcare teams battling it out in the “Best Chef of the Healthcare Industry” competition to help celebrate the Massachusetts Health Council annual award gala on October 27th at the Boston Seaport Hotel.

It may surprise many people to learn that hospital chefs are trained at some of the best culinary institutes around the world. The competition is an opportunity for them to change the perception that many people have about hospital food and to shine a spotlight on the healthy ingredients they use to create palate-pleasing menus for their patients.

I can’t recall a single palate-pleasing thing from my time in the hospital several years ago — readers, has anyone had a delicious hospital meal lately? — but I do buy the premise that hospital chefs can help lead the way on healthier cooking. They often have little choice about, say, keeping sodium or sugar low.

‘It’s very counterintuitive for hospital and health care food to be featured as something special and wonderful.’

And improved hospital food fits perfectly into the trend that Rachel noted recently here in her post on single-bed hospital rooms, that patients are being rebranded as consumers.

So, for example, Chef Manar Alsebai, the production manager of patient food at Brigham and Women’s Hospital, says that his kitchens offer food room-service style: Patients have a menu and can order whatever they want from it between 7 in the morning and 8 at night. The food should arrive within 45 minutes. “I’m not saying it’s perfect,” he said. “It’s a challenge sometimes, because of the elevator and other challenges, but I still think it’s good compared to what used to be done.”

Chef Brian Ray, food and nutrition operations manager at The Lahey Clinic, compared a patient’s tray today to what it would have been like ten years ago. Continue reading

Q&A: State Of The Science On Early Alzheimer’s Disease

Even as I write this, I can feel the biological hallmarks of Alzheimer’s Disease building in my brain: the beta-amyloid plaques gumming it up, and the tau protein tangles snaking through the neurons. But a bit of paranoia is a small price to pay for the critical new understanding that scientists have gained about Alzheimer’s Disease in recent years: that the brain pathology begins long before the forgetfulness shows up. Early brain pathology means early detection is possible, and early detection means the potential for blocking the disease before it turns into the terrible dementia that affects millions.

Today is a landmark day for Alzheimer’s research: The first major new set of guidelines since 1984 on defining and diagnosing the disease has just been issued. The Alzheimer’s Association has posted them here, and both The New York Times and The Boston Globe do a nice job of summing them up. I spoke this morning with Dr. Reisa Sperling of Brigham & Women’s Hospital, lead author of today’s paper on the earliest, “pre-clinical” stage of Alzheimer’s Disease.

Dr. Reisa Sperling of Brigham & Women's


This is the first time in 27 years that the guidelines on Alzheimer’s have been re-issued. What are the biggest changes?

The biggest changes are that we’ve reconceptualized Alzheimer’s Disease as a continuum. The first criteria published in 1984 only dealt with Alzheimer’s Disease as a stage of dementia, which we now recognize to be at rather late stages of the disease process. The new criteria incorporate an earlier symptomatic stage called mild cognitive impairment due to Alzheimer’s Disease. And the earliest stage, which we have called pre-clinical Alzheimer’s Disease, is a new concept of the disease beginning in the brain prior to the clinical symptoms.

How would you sum up the state of the science on early detection of Alzheimer’s?

The pre-clinical stage is primarily detected through bio-markers. There have been tremendous advances over the past decade in being able to detect evidence of Alzheimer’s Disease in the brain during life. These include PET scans for amyloid, cerebrospinal fluid tests, and both functional and structural MRI scans.

Is there any one particular holy grail in terms of research on early detection of Alzheimer’s?

I don’t actually think it will be one thing. I think that we know from the autopsy data that there are actually several processes in the brain involved, and I suspect that we will need a combination of biomarkers to detect these processes. But the holy grail would be finding the combination of biomarkers in people who are still cognitively normal that accurately predicts who will progress to Alzheimer’s Disease dementia.

In terms of the existing ways for detecting Alzheimer’s Disease early, I gather none of them are ready for prime-time in the clinic? Continue reading

Good News About Hot Flashes At Menopause: Study Finds Link To Lower Heart Risk

Thus far, there’s been nothing much good to say about hot flashes. They can be the bane of a menopausal woman’s life, the sudden flushes and sweats, often striking in public or ruining a night’s sleep.

But today, a study of more than 60,000 women, led by researchers at Brigham and Women’s Hospital and Northwestern, offers heartening news for those who experience hot flashes and other symptoms early in “the change.” The Brigham reports:

New research suggests that women who suffer from hot flashes and night sweats may be at lower risk for cardiovascular disease, stroke and death. The research titled “Vasomotor symptoms and cardiovascular events in postmenopausal women,” is published in the online edition of the journal Menopause.

“Our study provides reassurance that the classic symptoms of early menopause, experienced by the majority of women at mid-life, are not a marker of an increased risk of heart attack or stroke in the future,” said JoAnn Manson, MD, coauthor and Chief of Preventive Medicine at Brigham and Women’s Hospital.

There’s less-good news for women who don’t start experiencing hot flashes and other symptoms until several years after the onset of menopause. In the study, their health risks appeared higher. Here’s the Brigham’s rundown: Continue reading