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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

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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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?

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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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Deal Would Take Controversial Hospital Pricing Question Off Ballot

It was to be a game of high stakes politics with hundreds of millions of health care dollars on the line. But on Wednesday the players negotiated a truce — with help from unified leaders on Beacon Hill — to prevent a November ballot question on hospital prices.

“It is my hope that this plan will avert a costly and divisive ballot initiative and lend assistance to our community hospitals,” said House Speaker Robert DeLeo in a statement.

The ballot initiative that brought DeLeo, Senate President Stan Rosenberg and Gov. Charlie Baker together aimed to close the gap between high and low cost hospitals. It proposed cutting $463 million in payments to the state’s more expensive hospitals and redistributing that money to struggling community hospitals and to consumers through lower premiums.

The Massachusetts Hospital Association opposed the plan. MHA President Lynn Nicholas is relieved to hear voters won’t be asked to adjust price differences between her members.

“The most important aspect of this resolution is not doing complicated public policy through a blunt instrument at the ballot box,” Nicholas said.

The ballot question was proposed by a health care workers union, 1199SEIU. Estimates showed the state’s largest private employer, Partners Healthcare, would have lost more than $400 million a year.

The influential union and the top employer have been in and out of offices on Beacon Hill for weeks, negotiating roughly a half dozen different plans that would have legislators instead of voters settle the hospital price gap problem.

“The most important aspect of this resolution is not doing complicated public policy through a blunt instrument at the ballot box.”

– Lynn Nicholas

The consensus deal announced Wednesday includes some more money for community hospitals — at least $20 to $25 million a year, divided between several dozen hospitals. Some hospitals would benefit and some would lose if an additional hospital assessment of $250 million is approved and distributed through Medicaid payments. The union says it is pleased. Continue reading

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The Promise And Price Of New Addiction Treatment Implant

Amid a raging opioid epidemic, there’s a plea for more treatment options. The Food and Drug Administration expects to have a decision on one by May 27.

It’s an implant. Four rods, each about the size of a match stick, inserted in the upper arm. This new device, called Probuphine, delivers a continuous dose of an existing drug, buprenorphine, but with better results, says implant maker Braeburn Pharmaceuticals.

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 implant is placed inside the skin of a person’s upper arm. (Courtesy Braeburn Pharmaceuticals)

In clinical trials, 88 percent of patients with the implants abstained from opioids, as compared to 72 percent of those taking buprenorphine as a daily pill. (Buprenorphine is commonly referred to by its brand name, Suboxone.)

“I felt completely normal all the time,” said Dave, a paramedic in a small town outside Boston who was on the implant during a clinical trial. He does not want his last name made public so that coworkers won’t find out he is addicted to opioid pain pills.

Dave, 47, has been in recovery for four years with the help of buprenorphine. Dave said he prefers the implant to the pills for several reasons. With the pills he would sometimes feel the drug wear off. He worried about his 2-year-old granddaughter getting into the bottle. And sometimes Dave would just forget to take his medication, which he’s supposed to do in the morning, 15 minutes before he has anything to eat or drink.

“With the implant you didn’t have to worry about that, you just, it was just there and you felt good all the time,” Dave said.

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Boston Medical Center Launches First Comprehensive Transgender Medical Center In Northeast

Dr. Joshua Safer speaks at a press briefing at Boston Medical Center as Kate Walsh, president and CEO of BMC, Dr. Gerard Doherty, chief of surgery, and Dr. Jaromir Slama, chief of plastic surgery, look on. (Jesse Costa/WBUR)

Dr. Joshua Safer speaks at a press briefing at Boston Medical Center as Kate Walsh, president and CEO of BMC, Dr. Gerard Doherty, chief of surgery, and Dr. Jaromir Slama, chief of plastic surgery, look on. (Jesse Costa/WBUR)

Boston Medical Center CEO Kate Walsh was in a meeting a few years ago when something about gender identity and health came up. She turned to Dr. Joshua Safer, who was treating many of the hospital’s transgender patients.

“I said, ‘So you really believe patients are born in the wrong bodies?’ ” Walsh recalls, looking at Safer across a conference room table as she tells the story. “You said, ‘Yes,’ and that’s how we started on this journey to help people live the lives they were meant to live.”

The journey lead to the creation of the Center for Transgender Medicine and Surgery at BMC, the first such comprehensive service in the Northeast. It brings together services the hospital has been building out for several years: primary care, hormone therapy and mental health support, as well as chest and facial reconstruction procedures. Later this summer, as part of the comprehensive center, the hospital will begin genital surgery for men transitioning to women.

“This is very exciting for me to see us stepping up to do this,” said Safer, who will direct the center. “If you look across North America, there are only a handful of surgeons doing this sort of thing.”

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7 Things To Know About The Nation’s First Penis Transplant

Surgical team members Dr. Dicken Ko, left, and Dr. Curtis Cetrulo address the media during a news conference at Massachusetts General Hospital, Monday. (Elise Amendola/AP)

Surgical team members Dr. Dicken Ko, left, and Dr. Curtis Cetrulo address the media during a news conference at Massachusetts General Hospital, Monday. (Elise Amendola/AP)

From The New York Times to cable TV to here at CommonHealth, the country’s first penis transplant made major headlines Monday.

The patient, 64-year-old Thomas Manning, had part of his penis surgically removed four years ago after doctors found he had penile cancer. The news marked a step forward in transplant medicine, but as a resident physician and future primary care doctor, I wondered whether such an elaborate and expensive “proof-of-concept” operation would mean anything for my future patients.

The facts behind the big story:

What did the operation aim to accomplish?

The goals of this operation, according to Dr. Dicken Ko, who co-led the surgical team, were threefold: to reconstruct natural-appearing genitalia, to allow the patient to urinate normally and, hopefully, to help him regain sexual functioning.

They have achieved the first goal, and they are hopeful that Manning will be able to urinate normally in a few weeks. Finally, they did extensive reconstruction of the nerves as well, and are hopeful that he will have normal sexual function in the future.

How was this patient chosen?

For Manning, the motivation to volunteer for this experimental procedure was straightforward. “Because they cut off my penis. Very simple. Very, very simple,” he said in a phone interview. Manning volunteered for the operation and underwent extensive psychological evaluation, according to his team.

The type of injury he had was also an important factor: Because part of his penis had been surgically removed — rather than injured in an explosion — the rest of the vessels and nerves were preserved, which facilitated the operation. This was important, Dr. Ko said, because they wanted to pick a patient who was very likely to have a successful outcome to be the first to receive the transplant.

How difficult was this operation?

The main technical difficulties of the operation had to do with the vascular reconstruction involved, which is when doctors sew together the small blood vessels of the patient to the donor’s vessels.

Before the operation, they had only a vague idea if the vessels were big enough to connect. They also performed a vein graft, which is akin to a heart bypass and allows greater blood flow. That vein graft was the primary difference between the technical aspects of this operation and the first successful transplant, performed earlier this year in South Africa.

Who else could benefit from this surgery?

For now, the surgeons on this team are focusing on cancer and trauma patients, especially veterans returning with combat wounds from Iraq and Afghanistan.

The technical challenges for soldiers injured by explosions are likely to be more daunting, as the injuries are generally more extensive and their own vessels and nerves are less well-preserved. Nonetheless, the surgeons emphasized how motivated they were to work with veterans.

In a statement, Manning himself said he hoped the operation could soon be performed on “service members who put their lives on the line and suffer serious damage as a result.”

When asked about the potential for use with transgender patients, Dr. Curtis Cetrulo, a plastic surgeon and the second team leader, said it could be possible in the future. The approach, however, would have to be completely different and would require “a whole new effort” to be successful, he said. Continue reading

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