Monthly Archives: October 2013

Judy Collins On Suicide, Mental Illness And The Story Her Voice Is Telling

Singer and songwriter Judy Collins at WBUR. (Robin Lubbock/WBUR)

Singer and songwriter Judy Collins at WBUR. (Robin Lubbock/WBUR)

I thought I loved Judy Collins because her voice was ineffably crystalline, because her songs were the soundtrack of my youth, because her “Who Knows Where The Time Goes?” becomes ever more relevant as I get older.

But now that I’ve heard her converse with Here & Now host Robin Young, I understand something more: that infusing her inimitable voice were the pain and the power that come from a life that has included glory but also rock-bottom despair: alcoholism, depression and the 1992 suicide of her son, Clark.

Not that she has kept any of her travails secret. Now 77, she has written and spoken about them so publicly that this week she received the McLean Award from McLean Hospital for “her work to increase awareness about mental health through her many interviews, compelling memoirs and advocacy efforts.”

“She has courageously and very publicly shared her experience with depression, alcoholism and the struggles she faced following her son’s suicide, thus helping dispel the stigma of psychiatric disorders,” says the award’s text. “She has reached countless people with her message and is a true champion of mental wellness for all.”

Here’s some of her conversation on Here & Now, lightly edited:

RY: What was it like? You became sober, I’m sure still, in some part of your heart, mourning your father, the alcoholic, and then having to watch your son…

JC: The worst, the worst. He committed suicide in relapse. I don’t know how I got over it, really. You don’t get over it. I shouldn’t put it that way. You get through it, however. And people reached out to me — people were so kind. There was a kind of cluster of women — Mariette Hartley and Iris Bolton, Joan Rivers.

“This is not a big terrible dark secret.”

Joan called me one night from Las Vegas, while she was in the dressing room, getting dressed, and she said, “I know” — it was about four days after his death — she said, “I know you want to stop working.” I said, “You bet, I’ve already canceled everything for the next year.” I said, “Bury it. I don’t even want to look at it.” She said, “You can’t do that because you won’t recover unless you keep working.” And she knew that because she’d lost her husband to suicide. Continue reading

Yuck! The Weird Things Kids Swallow Or Stuff Go On Display At Boston Children’s

A variety of items ingested by children, from a sardine can key to a crucifix, are on display at Boston Children's Hospital. (Charles Krupa/AP)

A variety of items ingested by children, from a sardine can key to a crucifix, are on display at Boston Children’s Hospital. (Charles Krupa/AP)

A chicken claw. An FDR pin. A crucifix. A toy sheriff’s star.

Those are some of the weird items that have been removed from kids’ throats, nostrils and ears by doctors at Boston Children’s Hospital and are included in a macabre, yet important, display.

A visitor’s first reaction might be to laugh at the framed collection of dozens of items that dates to 1918 and hangs at the entrance to the hospital’s ear, nose and throat department, but it’s also a reminder to the parents who walk past it every day to remain vigilant. Continue reading

Narrating Medicine: What I Learned About Cancer Survivorship Clinics

In this 2015 file photo, a nurse places a patient's chemotherapy medication on an intravenous stand at a hospital in Philadelphia. (Matt Rourke/AP)

In this 2015 file photo, a nurse places a patient’s chemotherapy medication on an intravenous stand at a hospital in Philadelphia. (Matt Rourke/AP)

When a friend recently finished her grueling year of breast cancer chemotherapy, she received warm congratulations from her health care team and was invited to ring a special bell set up in her doctor’s office. Another friend, cancer-free for a year, is rewarding herself by taking part in a bike ride fundraising for cancer research. Me? Now that I have been on maintenance chemo for two years, I am celebrating by getting a mammogram.

Let me explain. Cancer survivors need continued specialized health care to assess for late side effects from the treatment and the cancer, and specialized preventative care. For example, girls who have received radiation therapy need mammograms at a far younger ages than their peers, and children who have received brain radiation need a yearly hearing assessment.

One way to assess and treat cancer survivors is through Survivorship Clinics. These are places where patients get multidisciplinary appointments and where survivors meet with, for example, specialized health care providers, mental health care providers, nutritionists and physical therapists.

Research presented this week at the American Society of Clinical Oncology describes the value of such clinics. Care of survivors is especially important in children: Over 80 percent of children with cancer survive and need a care plan to guide surveillance for late effects of cancer therapy.

Yet while almost three-quarters of children have a late side effect from their cancer treatment fewer than 20 percent get surveillance for late effects.

In the study presented this week, the authors randomized patients to either attending a Survivorship Clinic or receiving a customized survivorship care plan to use with their primary care provider. The authors found that the participants in the Survivorship Clinic were much more likely to receive recommended testing and more likely to have late effects of treatment identified. In fact, out of about 50 patients in each group, the authors found previously unidentified late effects of cancer — including obesity, high lipids, hypothyroidism, neuropathy, osteopenia, restrictive lung disease, substance abuse and anxiety — 21 times in the Survivorship Clinic group, but only once in the group that that received a written care plan. Continue reading

New England Governors Converge To Address Opioid Epidemic

Seated from left are Vermont Gov. Peter Shumlin, Rhode Island Gov. Gina Raimondo, Connecticut Gov. Dannel P. Malloy, Maine Gov. Paul LePage, Hassan, and Massachusetts Gov. Charlie Baker. The governors met Tuesday in Boston to discuss strategies to deal with the opioid addiction problem in all their states. (Michael Dwyer/AP)

Seated from left are Vermont Gov. Peter Shumlin, Rhode Island Gov. Gina Raimondo, Connecticut Gov. Dannel P. Malloy, Maine Gov. Paul LePage, Hassan, and Massachusetts Gov. Charlie Baker. The governors met Tuesday in Boston to discuss strategies to deal with the opioid addiction problem in all their states. (Michael Dwyer/AP)

Pressing for the same or nearly the same limits on opioid prescriptions is one of the ways New England’s Republican and Democratic governors are working together to address the drug epidemic.

The six regional governors gathered in Boston Tuesday for an opioid panel.

There are some signs that efforts to slow the surge of opioid overdoses are working, but the death toll is grim. Narcan, or naloxone, the drug that reverses the effects of many overdoses, is becoming more widely available — and that’s a good thing, says Gov. Charlie Baker.

“We lost 1,500 people in Massachusetts in 2015, but my own speculation, based on the data I’ve seen, makes me think the number without Narcan would have been north of 5,000,” he said. “And it has a ton of, still, negative momentum.”

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Birth Control’s Next Frontier? Health Center Aims For Quick And Easy IUDs And Implants

Family Health Center of Worcester. (Jesse Costa/WBUR)

Family Health Center of Worcester. (Jesse Costa/WBUR)

Come in to the Family Health Center of Worcester for just about any reason and, if you’re a woman of child-bearing age, you’re all but certain to be asked “the one key question.” In Portuguese, if that’s what you speak, or Albanian or Vietnamese — or English:

“Are you planning to become pregnant in the next year?”

If you’re not, that’s an opening for a conversation about birth control options. Vietnamese medical interpreter Annie Huynh says that after just a few months of those conversations, she’s already seeing a dramatic shift away from the many accidental pregnancies she was seeing a couple of years ago.

“Now, I hardly ever hear [it’s] an accident anymore,” she says. “It’s something either they plan for, or they don’t get pregnant anymore because of the education that I got that I’m able to pass on to them.”

That education includes training on how to talk about birth control, says Jennifer Averill Moffitt, the health center’s perinatal services manager.

“Whereas before, perhaps the counseling was, ‘Here are these 12 methods, choose which one is best for you,’ ” she says. “Now, we’re saying, ‘Here’s the most effective method, and here are some other choices. Choose what’s best for you.’ ”

The most effective method is long-acting birth control. That includes intrauterine devices, or IUDs, and the Nexplanon hormonal implant — a matchstick-sized rod that’s implanted in a woman’s arm and prevents pregnancy for three years. They’re not for everyone, but for typical users, both have failure rates of well under 1 percent, compared to an annual pregnancy rate of 9 percent for women who take the pill. (That’s due mainly to user error: Pills are easy to miss, while the long-acting methods are “set and forget.”)

The long-acting methods are on the rise nationwide — about 12 percent of women on birth control now use them — and they’re getting a lot of the credit for the recent drop in unintended pregnancies to a 30-year low. But the rate is still strikingly high: Forty-five percent of all American pregnancies are unplanned.

“If we had a stent that was 20 times more effective than another stent, it would be an outrage that we weren’t offering them.”

– Mark Edwards, co-founder of Upstream USA

So why aren’t even more women using IUDs and implants, especially now that Obamacare makes them much more likely to be covered?

For one thing, they’re not always easy and quick to get — particularly for low-income women, whose unplanned pregnancy rate can be five times the rate of high-income women.

Enter Upstream USA. It’s a nonprofit that aims to remove the health care system’s remaining barriers to long-acting birth control.

“There are many health centers we work with that are literally not offering IUDs and implants at all. Period. So literally zero percent of women are getting access to these methods,” says Mark Edwards, the Boston-based co-founder of Upstream USA.

“From our point of view, that’s unconscionable,” he adds. “This is a method of contraception which research studies have shown is actually 20 times more effective than the pill in terms of real-world use, and yet health centers are not making these methods available. In any other form of medicine it would just be an outrage. If we had a stent that was 20 times more effective than another stent, it would be an outrage that we weren’t offering them.”

Upstream goes into health clinics like the Family Health Center of Worcester and helps them up their birth-control game. That means training just about the entire staff on birth control counseling, from the medical assistants and interpreters to the schedulers. Continue reading

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Minimum Age For Buying Tobacco In Worcester Raised To 21

The new regulation would go into effect on Sept. 1. (Charles Rex Arbogast/AP)

The new regulation would go into effect on Sept. 1. (Charles Rex Arbogast/AP)

The Worcester Board of Health has unanimously voted to increase the minimum age for purchasing tobacco products in the city from 18 to 21.

The Telegram & Gazette reports that the new regulation, which goes into effect Sept. 1, was among several tobacco proposals the board had been discussing internally.

Local retailers opposing the measure say the new minimum likely won’t have much of a difference on teens who seek out tobacco products.

Chairwoman Abigail Averbach says it has long been a mission of the board to limit Worcester residents’ exposure to nicotine.

Dr. Lester Hartman, co-founder of the Tobacco 21 movement, says the new age restriction creates an important “social distancing” effect where young teens can no longer count on fellow students to buy them tobacco.

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Bad Allergies, Yes. Worst Boston Year Ever? Experts Say No, But Perfect Storm Of Trees, Grass, Mold

"At this moment there's a lot of tree pollen in the air and a lot of grass pollen in the air," says Dr. Mariana Castells, an allergist at Brigham and Women's Hospital. (Courtesy Lukasz Szmigiel/Unsplash)

“At this moment there’s a lot of tree pollen in the air and a lot of grass pollen in the air,” says Dr. Mariana Castells, an allergist at Brigham and Women’s Hospital. (Courtesy Lukasz Szmigiel/Unsplash)

I got a call from the school nurse this week: my daughter had an itchy rash on her arms and neck and red blotchy patches around her mouth.

“My best guess is it’s allergies,” the nurse said, suggesting Benadryl and hydrocortisone cream. “This is a particularly bad season. Kids who never had allergies are coming in. Kids who take Zyrtec or Claritin in the morning are still coming in — their eyes so inflamed and irritated.”

Mention allergies these days and you’re sure to get a story: a colleague left Cape Cod early this weekend, because her allergies got so bad. “The pollen was everywhere,” she said. “It was even on my dishes.”

Micheline Maynard, a senior producer at Here & Now, sent me an email detailing her own allergy hell:

Last week, I had a bout of allergies that had me weeping in the newsroom, and sneezing and coughing. (I was apologizing to my colleagues and saying, “I’m not crying!”) Claritin did nothing, and I took half a Sudafed 12-hour, which helped a little.

I went to Michigan over the weekend, which is basically the same latitude as Boston, and enjoyed a problem-free weekend. I slept with my windows open, I did things out in the garden, and felt completely recovered. No coughing, sneezing, no headache.

Within an hour of getting back to Boston on Monday, my head was completely stuffed up. I was sneezing and coughing, and feeling generally blah… I actually Googled “severe allergies” because I’d never experienced anything like it.

Dr. Elisabeth Poorman, a CommonHealth contributor and third-year medical resident at Cambridge Health Alliance, said she’s experiencing bad allergies this year, “and [I] never have since moving from Atlanta, where pollen is a way of life.”

So is this season truly the most awful for allergy sufferers — the worst one ever — or, as one doctor suggests, do a high percentage of reporters and their friends just happen to have allergies, hence the outcry?

Continue reading

Diagnosing CTE In The Living: Massive Study Of Degenerative Brain Disease To Begin

Robert Stern, director of Clinical Research at BU's Chronic Traumatic Encephalopathy Center, and former New England Patriot safety Tim Fox. (Jesse Costa/WBUR)

Robert Stern, director of Clinical Research at BU’s Chronic Traumatic Encephalopathy Center, and former New England Patriot safety Tim Fox. (Jesse Costa/WBUR)

About 50 medical researchers from around the country converged on Boston Wednesday, as they prepare to launch a massive seven-year study into the brain disease known as chronic traumatic encephalopathy, or CTE, in July.

CTE is a degenerative disease similar to Alzheimer’s. It’s only found in people who’ve played football, boxed or taken part in other contact sports.

The researchers are recruiting 180 former NFL and college football players in order to study their brains. The goal is to develop ways to diagnose CTE in people while they’re alive. The only way to diagnose it right now is by studying the brain after death.

One of the lead researchers is Robert Stern, Ph.D. He’s a Boston University School of Medicine professor of neurology and neurosurgery and director of clinical research at BU’s Chronic Traumatic Encephalopathy Center.

Helping Stern champion the research is Tim Fox, a 62-year-old former NFL safety who played for the Patriots, Chargers and Rams. He thinks he has CTE.

Fox and Stern spoke with WBUR’s All Things Considered host Lisa Mullins about the disease. Stern says while much of the focus has been on concussions, CTE is caused by something that can seem more benign.

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At ‘Pain School,’ Veterans Learn To Manage With Fewer Pills

Robert, a veteran who injured his back several times during a dozen years in the Navy, stopped using opioids to treat his pain and is now a student at the Bedford VA's Pain School. (Jesse Costa/WBUR)

Robert, a veteran who injured his back several times during a dozen years in the Navy, stopped using opioids to treat his pain and is now a student at the Bedford VA’s Pain School. (Jesse Costa/WBUR)

Today’s topic: stress. Psychologist Tu Ngo looks out at a small group of veterans seated around a classroom table. “Why would we be talking about stress when we’re here because of your pain?” she asks seriously, then smiles. “Lil’ pop quiz now.”

A man who’s sitting near the door, in case his PTSD flares up and he needs to leave, is ready with an answer. “Stress may increase your anxiety, the anxiety may increase your feeling of pain,” says Tom Schatz, “the feeling of pain may increase depression, etc. etc.”

“Very good, that’s a great description of the vicious cycle we know happens when you have pain,” says Ngo, who heads the pain program at the Bedford VA Medical Center. “Pain is a stress response, it’s a signal to the brain saying, ‘Hey, there’s something wrong.’ ” Continue reading

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New Addiction Treatment Implant Will Hit The Market Next Month At $4,950

A graphic shows how the implant is placed inside the skin of a person's upper arm. (Courtesy Braeburn Pharmaceuticals)

A graphic shows how the new addiction treatment implant Probuphine is placed inside the skin of a person’s upper arm. (Courtesy Braeburn Pharmaceuticals)

There’s a new tool in the fight against the nation’s raging opioid epidemic.

The FDA on Thursday approved an implantable version of the drug buprenorphine, which staves off opioid cravings. Labels for the new device are rolling off printing devices today, and trainings begin Saturday for doctors who want to learn to insert the four matchstick size rods into patients.

The implant, called Probuphine, is expected to be available by the end of June.

“This is just the starting point for us to continue to fight for the cause of patients with opioid addiction,” said Braeburn Pharmaceuticals CEO Behshad Sheldon.

But one day after the FDA approved this first long-acting delivery method for buprenorphine, debate continues about how effective the implant will be and whether insurers will cover it.

A Game Changer … Or Set Up For Failure? 

The head of the National Institute on Drug Abuse calls the new implant a game-changer because it will help addiction patients stay on their meds while their brain circuits recover from the ravages of drug use. And addiction experts say it will be much harder for patients prescribed the implant to sell their medication on the street, which is a problem for addiction patients prescribed pills.

“I think it’s fantastic news,” said Dr. Sarah Wakeman, medical director of the Substance Use Disorder Initiative at Massachusetts General Hospital. “We need as many tools in the toolbox as possible to deal with the opioid epidemic.”

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