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Narrating Medicine: The Long Lasting Impact Of Child Abuse

One day when we were in first grade and sitting on a rickety wooden bench under a large oak tree in her backyard, my best friend’s mother called her to come inside.

A few minutes later, I heard wailing like an animal being gutted. Squinting my eyes and looking perplexed, I turned to my friend’s younger sister who was sitting beside me. She whispered, “She’s just getting beat.” Beat? What’s that, I wondered. She explained. Depending on the severity of their perceived wrongdoings, they were administered one of three levels of physical punishment: a stick, a belt or a big slab of wood. Their parents had moved from Ireland to our small suburb in New Jersey.

The Catholic schools the parents had attended as children in Ireland were very strict and the nuns reportedly beat them until their knuckles bled. Here, as parents in New Jersey, they told their daughters to strip naked and mercilessly receive corporal punishment. (I learned this from her sister, and over the years, from my friend.)

This was not a onetime event. These were repeated, deliberate acts. Continue reading

She Wiped Her Nose, Then Prepped My Biopsy. Still, It's Hard To Ask The Nurse To Wash Her Hands

Hand washing before and after touching a patient is mandatory. And before and after walking into a patient’s room or touching medical equipment. (Arlington County/Flickr)

Hand washing before and after touching a patient is mandatory. And before and after walking into a patient’s room or touching medical equipment. (Arlington County/Flickr)

I was lying on my back on a gurney, getting my abdomen washed by the nurse.

She dipped Q-tip-like sticks into the brown antiseptic and then swirled them on my skin where the physician would make his incision. He would penetrate layers of skin and muscle to get into my liver and extract cells. He would send the cells to the laboratory to assess what kind of cancer I had. Eight days earlier, I had learned I had masses in my abdomen and chest. Three days earlier, I had learned the masses were cancer. That day I was on the gurney getting prepped for a liver biopsy, to find out what kind of cancer it was.

While one nurse washed my incision site, another nurse prepared the room. She was adjusting the lights, surgical equipment and my gown. And she rubbed her nose with her hand. Everyone rubs their nose. Humans unconsciously touch their nose or mouth more than 3.6 times per hour.

When we do this, we spread germs into our body from whatever we were touching before and spread germs from our body onto whatever we touch next.

I laid there and wondered if I should say something to her.

In medical school in the early ’90s, I had learned about the risk of normal nose bacteria infecting surgical sites. While on the gurney that day, I remembered a story about a patient with a massive infection in his surgical wound site. The hospital searched for the source of his Staph aureus. They found it in the surgeon’s nose. This story was told to us to remind us of the dangers of what we were seeing on the wards in medical school — which was still full of old-school clinicians who drew blood without gloves and washed their hands only intermittently.

Today things are supposed to be different. Hand washing before and after touching a patient is mandatory. And before and after walking into a patient’s room or touching medical equipment. The compulsory annual online classes for all clinicians include specific directions on how to wash your hands. There are signs on the walls and screen savers on the hospital computers reminding us to wash our hands.

But there I was, flat on my back, wondering if I should say something to the nurse. I was afraid she’d be upset with me if I said something — I was all but naked, lying on my back and pretty much in her hands. The hands that had just wiped her nose. I didn’t say anything. I tried to get my courage up to say something — but couldn’t. A few minutes passed. I decided it was too late to say anything. But I told myself if she did it again, I would say something to her.

And then she did. She rubbed her nose with her hand and then reached for the equipment table with that same hand. The equipment that would be in my liver in a few minutes.

I called her on it. Continue reading

Yes, We’re Mammals, But Is It Wise These Days To Promote Breast-Feeding As ‘Natural’?

Public health officials should think twice about the unintended consequences of calling breast-feeding 'natural,' the authors of a new paper argue. (Michael Sawyer/AP)

Public health officials should think twice about the unintended consequences of calling breast-feeding ‘natural,’ the authors of a new paper argue. (Michael Sawyer/AP)

Hippos do it. So do orangutans. There’s no question that for us mammals, nursing is one of those defining behaviors in nature. The question is whether public health officials, in promoting breast-feeding among human mothers, should deploy the term “natural.”

Two academics pondering these and other linguistically charged questions sparked an online frenzy recently with a paper on the unintended consequences of promoting breast-feeding as a “natural” practice — and relating it to the anti-vaccine movement.

University of Pennsylvania ethicist Anne Barnhill and medical historian Jessica Martucci, writing last month in the journal Pediatrics, suggest that by using the word “natural” in campaigns endorsing breast-feeding, public health officials and medical professionals may be inadvertently fueling other groups that reject public health efforts — like anti-vaxxers. Continue reading

Commentary: I Needed Help With My Autistic Son. Others Need Help Too

The author, Susan Senator, and her son, Nat (Courtesy of Ned Batchelder)

The author, Susan Senator, and her son, Nat (Courtesy of Ned Batchelder)

The winter my son Nat broke our playroom window with his head was an endlessly snowy one. He was home on school break and on sensory overload — rocking too wildly on a rocking chair, too close to the bay window. A nauseating shatter, like the crack of thin ice underfoot.

Miraculously, he was not hurt.

Nat has fairly severe autism, and back then he struggled with all the unstructured time and the oppressive indoors of a New England winter. We all did. The season of days spent inside wears on all families. But if you are also living with a child with a complex developmental disability, who is nearly non-verbal and with sensory issues, it can mean that he will likely need extra help staying safe.

Back then I didn’t realize just how sensitive Nat was to confusion and unorganized days, or how his anxiety roared inside him, jangling his nerves, forcing him to pace, to scream, or to pinch. I understand now that autism wasn’t the enemy — lack of help was. We needed someone trained in autism education, who could work directly with Nat on activities of daily living, self-calming, social skills and how to behave out in the community; someone who could also work with us on how to organize Nat’s time at home to comfort him with a better sense of order. Continue reading

Should Docs Ask Patients About Guns? AG Healey, Mass. Medical Society Take Up Issue

“For God’s sake, you mean, physicians should be precluded from asking about the most lethal consumer product out there: a gun? That’s just wrong," Attorney General Maura Healey, seen here in a file photo, said at a forum Tuesday. (Jesse Costa/WBUR)

“For God’s sake, you mean physicians should be precluded from asking about the most lethal consumer product out there: a gun? That’s just wrong,” Attorney General Maura Healey, seen here in a file photo, said at a forum Tuesday. (Jesse Costa/WBUR)

Every year, the Massachusetts Medical Society picks an important public health topic of the day and tries to figure out how to make a difference.

This year, it’s guns.

Dr. Georges Benjamin, director of the American Public Health Association, warned physicians at a forum here Tuesday afternoon to be ready for pushback.

“‘Cause you will be asked, ‘Why do doctors care about this?’ I’d love for you all to say: ‘It’s mine, because it hurts people or kills people, it’s a physician’s prerogative,’ ” he said.

According to the Centers for Disease Control, about 90 Americans are killed with guns every day.

Attorney General Maura Healey hopes to partner with the medical society to reduce gun deaths.

“Now’s the time for us to seize this and take it back and reframe this issue,” Healey said. “We can begin to treat gun violence as the public health crisis that it is.”

Healey and the medical society plan to craft uniform questions doctors would ask patients about guns. But, the answers may create new problems for doctors. Continue reading

Endometriosis Linked To Heart Disease, And Why Lena Dunham Might Care

Earlier this year, the writer, actor and deliciously self-deprecating starlet Lena Dunham announced that health problems would prevent her from promoting her award-winning HBO series “Girls.”

“As many of you know I have endometriosis,” she wrote on Instagram (with the photo below). “I am currently going through a rough patch with the illness and my body (along with my amazing doctors) let me know, in no uncertain terms, that it’s time to rest.”

More recently, television host and cookbook author Padma Lakshmi cited her battle with endometriosis as “a major reason” her marriage to writer Salman Rushdie failed.  

“Once diagnosed, I was relieved to know that I wasn’t crazy and that there was a reason for all this pain,” Lakshmi writes in the introduction of a new book by her doctor, Tamer Seckin, “The Doctor Will See You Now.” “Endo is not a life-threatening disease, but it does take away your life.”

Now, it turns out, new research suggests endometriosis, which afflicts about 10 percent of all reproductive-age women in the U.S., may be even more damaging than previously thought — indeed potentially life-threatening. 

Doctors at Brigham and Women’s Hospital in Boston report that women with endometriosis — abnormal growth of uterine tissue outside of the uterus that can cause extreme pain and lead to infertility — have a 60 percent increased risk of coronary heart disease.

What’s more, the researchers found, the association between endometriosis and heart disease is strongest in women 40 or younger. Among them, there were 65 cases of heart disease per 100,000 women with endometriosis, compared with 19 cases in women without the condition.

“That’s a threefold increased risk” of having a heart attack, chest pain or requiring treatment for blocked arteries, said senior study author Stacey Missmer, director of Epidemiologic Research in Reproductive Medicine at Brigham and Women’s.

Many patients with endometriosis report that it can take years of suffering with the disorder before finally getting a proper diagnosis and adequate treatment. Even then, they say, their pain and distress is often minimized.

Linda Griffith, a professor at MIT and director of the institute’s Center for Gynepathology Research, said that even with growing awareness about the disorder, endometriosis isn’t always taken seriously. There’s still an attitude that endometriosis is “a women’s problem” she said, and that sufferers should simply “buck up” and deal with their “bad cramps.”

“To me, this study is a clarion call that we can’t just sit idly by,” said Griffith, who has undergone numerous surgeries for her own endometriosis. “This paper is important because the message is that women with this disease go on to have serious health problems, and their increased risk is high. …It should make people stop and think and stimulate more studies.” 

So what’s the connection between endometriosis and heart disease? Continue reading

WBUR Asks: Want To Nominate Someone As Your Fitness Inspiration?

Nintey-year-old retired Marine Col. Jonathan Mendes crosses the finish line at the end of the 2010 New York City Marathon, after 9 hours and 55 minutes. (USMC via Wikimedia Commons)

Nintey-year-old retired Marine Col. Jonathan Mendes crosses the finish line at the end of the 2010 New York City Marathon, after 9 hours and 55 minutes. (USMC via Wikimedia Commons)

Shhhhhh… We haven’t announced it officially yet, but we here at CommonHealth are working on a podcast that aims to apply the power tools of public radio — solid information, great storytelling and sound — to fitness. You know the umpteen Why To Exercise Today posts we’ve put up over the years? Kind of like those, only even better, and in the form of ear candy plus a daily email you’ll be able to sign up for in a few weeks.

As we begin the early stages of production, we’d love your help — and this is a chance to give props to someone you think deserves public recognition for what’s usually private effort. Is there someone you know who’s really your fitness inspiration? Who’s turned their health around, or just fights the good fight every day, as they’re able? Someone you’d like us to consider featuring in one of our podcasts or posts?

Let us know! Click here and fill out the Google form.

We welcome nominations of anyone you deem deserving, but there are a few types of folks we’re particularly looking for right now. People who…

• Seem to have zero free time but somehow manage to exercise anyway.

• Can talk about how exercise affects their weight, or their mood, or their energy levels.

• Can talk about how they overcome their own inertia and resistance.

• Actually enjoy weights and resistance training.

• Find ways to exercise despite their problematic location, or great ways to do it for free.

• Can talk about “falling off the wagon” of exercise and getting themselves back on.

• Have set themselves very gradual exercise goals, or found very simple rules.

• Can talk about how exercise affects their aging.

• Can share how their buddies/the social side help.

Thank you in advance! And please stay tuned — watch for word of “The Magic Pill.” (As in, exercise is the closest thing we have to one.)

Why To Exercise Today: Journal Warns Zapping Your Muscles At Gym Not Safe

Fitness training with electrical stimulation (Bodystreet/Wikimedia Commons)

Fitness training with electrical stimulation (Bodystreet/Wikimedia Commons)

Confession: I didn’t know this was already a thing. I thought it was still purely my fantasy: I lie down on a padded table and tell the electrode technician, “Please give me the equivalent of an hour of CrossFit.” Then I relax as my muscles and nerves are zapped into activity that approximates an actual workout, but sweat-free.

I’m filing that fantasy away with my hopes for a pill that will someday activate my brown fat so brilliantly that the need for actual exercise is utterly obviated. Because a letter just out in the journal BMJ warns that the relatively novel practice of “whole-body electrical stimulation” at the gym can land you in the hospital with rhabdomyolysis, or muscle breakdown.

(Of course, non-electric CrossFit can apparently lead to the dreaded “Uncle Rhabdo” too, if you really overdo it. Also, I should note that the electrical stimulation discussed in the BMJ letter is the kind used during a workout, not instead of one as in my fantasy.)

The letter, titled “It’s time to regulate the use of whole-body electrical stimulation,” opens with the background:

Transcutaneous electrical stimulation (ES) of human nerves and muscles has long been used as a non-pharmacological treatment for pain relief, and for rehabilitation after disuse. Whole body ES has recently emerged as an alternative form of physical exercise for improving fitness and health in healthy people. Despite limited scientific evidence on the safety and effectiveness of this form of exercise, several ES company sponsored fitness centers have recently been opened in different countries worldwide, making this technology easily accessible to the general population.

Now for the no-free-lunch part:

On 4 August 2015, a 20-year-old man presented to our hospital with severe muscle pain shortly after a session of gym based whole body ES exercise supervised by a fitness professional. Rhabdomyolysis was diagnosed, and he was treated with intravenous 0.9% saline for five days.

In Israel, a TV documentary publicized the potential risks of electrical stimulation, reporting that thousands of Israelis have tried it. The BMJ letter notes that several problematic cases have arisen and the Health Ministry issued an official public warning against the practice in January. The warning said bluntly: “The devices must not be used in gyms. Use without medical supervision could cause danger to health.”

The BMJ letter suggests that other health authorities follow suit. I asked its senior author, Dr. Nicola Maffiuletti, head of the Human Performance Lab at the Schulthess Clinic in Zurich, three quick questions by email:

Do you happen to know how common it has become for gyms to offer electrical muscle stimulation, and has it arrived in the United States yet?

Maffiuletti: “‘Whole body EMS’ is increasingly offered worldwide, also in the U.S. (there are three main brands that are distributed in more than 40 countries worldwide, including the U.S.). As an example, more than 500 centers have been opened in Spain in the last five years that offer whole body EMS. (Spain is one of the countries where EMS is more used.)”

What is the science on whether EMS actually works to replicate the effects of exercise? Is there any good research on that? How does the actual science compare with the marketing/advertising claims? Continue reading

Opinion: A Call For Protecting The Health Of Women Who Donate Their Eggs

Human egg and sperm (Spike Walker. Wellcome Images/Flickr)

Human egg and sperm (Spike Walker. Wellcome Images/Flickr)

By Judy Norsigian and Dr. Timothy R.B. Johnson

The egg market is growing.

As couples and individuals continue to rely on assisted reproductive technology to overcome infertility, to make parenthood possible for gay couples and for other reasons, the demand for eggs is increasing swiftly. Between 2000 and 2010, the number of donor eggs used for in vitro fertilization increased about 70 percent per year, from 10,801 to 18,306, according to a report in the Journal of the American Medical Association.

And although there are no exact figures for how many young women engage in egg-retrieval-for-pay, the numbers are at least in the thousands. Many of these women are in their early 20s — often university students in need of cash to cover their tuition fees. But what most of these women, as well as the general public, don’t realize is that there are no good long-term safety data that would enable these young women to make truly informed choices.

Now, a number of women’s health and public interest advocacy organizations — including Our Bodies Ourselves, the Pro-Choice Alliance for Responsible Research and the Center for Genetics and Society — are studying women’s knowledge about egg retrieval and calling for more and better research about its risks.

Here’s an example:

One drug frequently used to suppress ovarian function (before the ovaries are “over-stimulated” to produce multiple eggs that can then be harvested and fertilized) is leuprolide acetate (Lupron). The U.S. Food and Drug Administration has not given approval for this particular use of the drug, and thus its use during egg retrieval protocols is “off label.”

In various surveys of younger women engaging in so-called egg “donation,” it appears that this fact about off-label use is rarely shared. Probably few, if any, of these young women know about the 300-page review of many Lupron studies that Dr. David Redwine submitted to the FDA in 2011. In this report, he documents a plethora of problems, some long term.

How can we encourage the collection of adequate long-term data about the extent and severity of egg retrieval risks? Given the strong anecdotal evidence of problems such as subsequent infertility, a possible link to certain cancers and more prevalent short-term problems with Ovarian Hyperstimulation Syndrome (OHSS) than previously reported in the literature, more well-done studies are needed.

Continue reading