exercise

Specialist: My Prime Take-Home Points From ‘Dot Earth’ Reporter’s Stroke

This week, longtime New York Times reporter and popular “Dot Earth” blogger Andrew Revkin vividly describes his 2011 stroke in the first-person piece “My Lucky Stroke.” He includes these “prime take-home points”: “Take your body seriously. Time (wasted) is brain (lost). Question authority, but not too much. Old habits die hard.”

Dr. Lee Schwamm, chief of Massachusetts General Hospital’s stroke service and medical director of Mass General TeleHealth, would suggest that readers take away some rather different stroke lessons from Andy Revkin’s story. He shares them here.

By Dr. Lee H. Schwamm
Guest contributor

I congratulate the journalist and blogger Andy Revkin for courageously sharing the story of his stroke and his subsequent recovery. I also thank him for taking the time to share his personal experience for the benefit of his readers, and for the opportunity it presents to highlight some key learning points for patients, as we dissect his journey through the health-care system.

Mr. Revkin was relatively young and healthy, out for a run with his son, when he experienced stroke symptoms. All too often, when we think of stroke, we envision an older patient clutching their chest and being unable to move or speak. This stereotype is dangerous, both for patients and health-care providers, because it lowers our sensitivity to stroke-like symptoms in patients of any age.

Mr. Revkin and his son were concerned enough about his symptoms that he went home, but they didn’t appreciate the immediate seriousness of his condition and he took a shower, hoping his symptoms would resolve. Watch the video clip above showing a young news reporter having stroke-like symptoms, and ask yourself, would you have called 911 if you’d been present? You should have.

Without treatment to restore the blocked blood flow to the brain, 2 million nerve cells are dying every minute of continued stroke.

Then Mr. Revkin did what generations of doctors have advised us to do for a heart attack; namely, take some aspirin and call your doctor’s office. Unfortunately, when it comes to stroke, there are two types: those caused by blocked arteries (ischemic) and those caused by rupture of blood vessels (hemorrhagic). It’s not possible to tell just from symptoms if a stroke is ischemic or hemorrhagic; only a CAT scan or MRI can distinguish them.

Obviously, you don’t want to take an aspirin if you’re having bleeding in your brain, as it will make the bleeding worse. But it’s also not a great idea to take aspirin if it’s an ischemic stroke, especially not six aspirin, as Mr. Revkin did, because there are powerful clot-busting drugs that can be given to reverse the disability caused by ischemic stroke. These drugs — the main one is known as tPA — are only effective if they are given within the first 4.5 hours after the start of symptoms, and aspirin might increase the risk that the drugs could convert an ischemic stroke into a giant hemorrhage that could be fatal.

It’s also really important to realize, as Mr. Revkin mentions, that “time is brain.” Continue reading →

FILED UNDER: Medicine/Science, Personal Health, Massachusetts General Hospital, neurology, stroke

May 15, 2013 | 9:18 AM | Carey Goldberg

How Vermont Passed Assisted Suicide (And Can We Go There To Die?)

The Vermont State House in Montpelier (Wikimedia Commons/jonathanking)

Remember the physician-assisted-suicide referendum that came ever so close to passing last year in Massachusetts, failing in a 51-to-49 percent squeaker?

Well, where Massachusetts feared to tread, neighboring Vermont has now trodden, and the state is about to become the fourth to legalize physician-assisted suicide for terminally ill people, after Oregon, Washington and Montana. It is the first to do so through its lawmakers rather than a popular referendum or court.

The “end-of-life choices” bill rode a wild political roller-coaster before it was finally passed this Monday evening, and it’s now on its way to a supportive Gov. Peter Shumlin and expected to be signed soon.

Vermont Public Radio’s John Dillon has covered the bill all along the way, and I asked him for his insights into the political dynamics behind the action. But first, a brief note for us flatlanders: What will our neighbor to the north’s decision mean for us? Will we be able to drive with our doctors up to Brattleboro or Burlington if we’re fatally ill and want help taking control of our final days?

I sent a query to Patient Choices Vermont, the group that spearheaded the state’s “end-of-life choices” bill, and heard back from Jessica Oski of Sirotkin & Necrason, a government relations firm that has represented Patient Choices Vermont for a decade. She writes:

1. To be qualified to use the assistance of the Vermont Patient Choice at End of Life Bill, a person must be “18 years of age or older, a resident of Vermont, and under the care of a physician.” There is no specific guidance under the law as to who qualifies as a Vermont resident.

2. In order for a physician to benefit from the immunity under the law the physician must be “licensed to practice medicine under 26 V.S.A chapter 23 or 33.” In other words, licensed in Vermont.

Now for the politics. The tale I heard from VPR’s John Dillon suggests three possible lessons for the backers of physician-assisted suicide in Massachusetts: Stick with it. Compromise quickly when the right moment strikes. And you may fare better in a legislature than in a popular referendum.

The Vermont House had considered a “death with dignity” bill in 2007, John said, but it didn’t pass. Last year, a similar measure failed to pass in the state Senate. This year was different. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, Politics, assisted suicide

May 14, 2013 | 2:30 PM | Martha Bebinger

Northeastern U. Goes Smoke-Free — Inside And Out

WBUR’s Martha Bebinger reports that starting this fall, Northeastern University will join a growing number of college campuses that are smoke-free, both inside and out.

Northeastern Dean of Health Sciences Terry Fulmer says going smoke-free will save student’s lives.

“If you smoke when you’re younger, you’re more likely to be addicted for life,” Fulmer said. “So now is our opportunity to help them not get in a habit that will potentially be fatal.”

Northeastern will use peer pressure and a campus education campaign — as opposed to penalties — to enforce the new policy. There’s a free smoking cessation program for students and most faculty and staff can enroll through their insurance plan. Dean Fulmer says she does expect the ban on smoking to affect admissions.

(A partial list of Mass. colleges with some type of smoking ban. Source: The Association of Independent Colleges and Universities of Massachusetts)

Here’s more on new smoke-free policy from Northeastern:

The decision to go smoke-free dovetails with Northeastern’s focus on solving global challenges in health. According to the Centers for Disease Control and Prevention, some 443,000 people die each year from smoking or exposure to second-hand smoke. What’s more, tobacco use is the single most preventable cause of disease, disability, and death in the United States. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, Northeastern, public health, smoking

May 14, 2013 | 9:23 AM |

‘Skinny Jeans’ World: How Do We Protect Daughters From Eating Disorders?

By Katy Aisenberg, Ph.D.
Guest Contributor

“Sometimes it is necessary to reteach a thing its loveliness” – Galway Kinnell

After years and tears spent treating girls with eating disorders, I found myself pregnant — in my 40s — with a daughter.

Penelope is now 10, and suddenly, everything I’d preached and chiseled and chipped and interpreted in my office is getting put to the test. How was I going to try to prevent my own child from having an eating disorder? How would I prevail against a culture of young girls in short shorts, strappy tops and frankly lewd fashion, where my 4th grader must choose between “boyfriend jeans” and “skinny jeans”? As I had told my patients: “Many girls entertain diets — not everyone gets an eating disorder.”

Still, I reviewed the early dangers for developing such a disorder — flipping through my own brain for knowledge.

1. Genetics
We had some family history of mood disorders but nothing that seemed so severe it couldn’t be tempered by attentive parenting.

2. Home obsession with foods

I made absolutely sure that nothing in my house was low-fat, low-calorie and insisted that dessert was part of the meal if you ate your ‘growing foods” a useful phrase I learned from her pre-school teacher.

(Valeri-DBF/flickr)

3. Range of affect (or, enough feelings)

Yup, no problem there. My house was never one where feelings were suppressed. In fact, I might have spent too much time inquiring what my child thought or felt. I was politely interrupted. “Mom,” she said, “I’m watching the cars outside” or “Making a friendship bracelet” or “Telling myself a story.”

4. Too much affect

Yes, I wanted to tone this down. She neded to learn resilience — that horrible feelings, the dementors of loneliness, sadness and intense anger can be survived. She needed to endure them and learn to soothe herself. I reminded myself of this as I clenched my nails into my hand while she hurled about in her crib.

5. Too much talk about appearance
I failed on this. I could not even try to stop my outpouring of sheer joy at her natural beauty. I was, as C.S. Lewis said, “surprised by joy” in this department. I craved her attention like a jilted suitor. But it amuses both of us — and possibly helped her — that I would joke about my “separation issues.” I believe I gave her the freedom to express those same feelings and a good many more.

6. A sense of purpose

We are currently working on this. The most effective cure for the most recalcitrant eating disorders is — surprisingly — community service. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, children's health, eating disorders, fat, media, psychology

May 14, 2013 | 8:31 AM | Rachel Zimmerman

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 13, 2013 | 11:34 AM | Carey Goldberg

What Mass. Hospitals Charge Vs. What They Get Paid

View map in a larger map

Some people play fantasy football, some knit. We here at CommonHealth sometimes like to play with health care data — most recently, a trove of Medicare numbers released last week on how much hospitals officially charge for common procedures and how much Medicare actually pays for them.

WBUR’s Alex Kingsbury first took a look at the wide range in Massachusetts hospitals’ charges for a single category, treatment of chronic lung disease, here. His map illustrated a strikingly broad range from $8,918 to $52,729. Now, in the map above, he rejiggers his Google Fusion Table to explore a broader question I put to him: How do the hospitals shake out in terms of the percentage of their official charges that they get from Medicare?

And here’s a fun little factoid that emerges from the map: That range goes from procedures for which the Medicare payment amounts to less than 18 percent of the charges billed to well over 100 percent of the charges billed. I’d thought this recalculation of the data might yield some interesting insights — Who most overcharges? Or who might feel most shafted by government payments? — but it runs such a crazy gamut that perhaps it serves mainly as yet another indicator of just how distorted and Byzantine and broken the American health care market is. (Didn’t need any further proof of that? Fine. Just enjoy playing with the map.)

Last week’s release of the Medicare data brought a media splash — particularly among data-visualization fans like the Washington Post — but also a backlash.

Health care economist Uwe Reinhardt pointed out that the official hospital charges are famously irrelevant to the reimbursement that health insurers actually pay, to the point that he called last week’s fuss about the Medicare data laughable. He wrote in The New York Times:

Even funnier are the protestations by hospital executives that hardly anyone ever pays these fictional prices, which prompted me to offer the following technical definition: “ ‘Charges’ are the prices that a totally inebriated foreign billionaire would pay a U.S. hospital if his wife were not around to control the bloke.”

Former Beth Israel Deaconess Medical Center chief Paul Levy also blasted the Medicare data as “useless noise”: Continue reading →

FILED UNDER: Insurance, Money, medicare

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 10, 2013 | 6:34 AM | Martha Bebinger

Small Biz Insurance Rates Hold Steady In Mass, For Now

The latest small business health insurance rates may be the calm before the storm.

Premiums for small firms are set to increase from a base of 2.5%, on average, in July. That’s slightly less than the average increase of 2.7% this quarter. Employers willing to live with limits on where they and employees receive care could see premiums drop (take a look below at Neighborhood Health Plan and Celitcare). And notice that no one filed (or was approved for) rate increases above 3.6%, the current magic number for health care cost caps in Massachusetts.

July 1 insurance rates for small businesses in MA

But things may look quite different as of January 1st. Very small businesses could see modest increases or perhaps lower rates. But insurers are warning that firms with 20-50 workers could see premiums jump 30% when parts of the federal health care law kick in next year.

“We all thought that Mass. was going to be held harmless under the ACA, but that looks like that’s not going to be the case, at least not for small businesses,” says Jon Hurst, President of the Retailers Association of Massachusetts. “We’re going to be looking at a lot of small businesses getting extreme, double digit increases come next year.” Continue reading →

FILED UNDER: Insurance, Money, cost, small business

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 →