WSJ: Everything You Need To Know About New Cholesterol Guidelines

It’s so very disconcerting when deeply entrenched health wisdom is suddenly flipped on its head. But that’s the way it often goes in this arena.

The Comedian/flickr

The Comedian/flickr

So, with such widespread confusion over the new guidelines on cholesterol and statins, cholesterol-lowering drugs, I was relieved to see that veteran health reporter (and my former colleague) Ron Winslow at The Wall Street Journal offered a just-the-facts-ma’am Q & A on exactly what you need to know about the new guidelines. It’s got everything from LDLs to the new risk calculator — which was down when I checked this morning. (What’s going on with all the bugs in our critcal health care sites??)

Here’s a snippet from Winslow:

The new tack recommended by the American Heart Association and the American College of Cardiology is to prescribe moderate to high doses of cholesterol-lowering drugs called statins to patients who fall into one of four risk groups regardless of their LDL status. Here is a look at the implications:

Q. Why get rid of the LDL targets?

A. The targets lack strong scientific evidence. The expert panel that developed the guidelines concluded that by focusing on an individual patient’s overall risk rather than a relatively arbitrary set of LDL targets, the strategy to prevent heart attacks and strokes will be more effective and more personally tailored to the needs and preferences of each patient.

Q. What should patients do in response?

A. Patients already on cholesterol-lowering medication should ask their doctors at their next appointment whether they are on the most appropriate therapy to reduce their heart-attack and stroke risk, says Neil Stone, a cardiologist at Northwestern University who headed the panel that wrote the cholesterol guideline.

For people not on cholesterol drugs, a new risk calculator is available online. If you have a 7.5% chance of having a heart attack over the next 10 years, you are a candidate for treatment with a statin no matter your LDL level under the new guidelines.

Q. I have no heart problems and my LDL was 90 in a recent cholesterol test. Is it possible I should be on a statin anyway? Continue reading

Marty Walsh’s Childhood Cancer: Curable Here, Not So Easy In Africa

By Elizabeth Mehren
Guest Contributor

Just about everyone in town knows by now that Marty Walsh is the son of Irish immigrants, a former labor organizer, a recovering alcoholic and a man who is happily unmarried to “the love of my life.” But it’s possible that few outside a rather eccentric quartet of Boston University researchers took note of one particular item in the biography of Boston’s new mayor.

Walsh is a survivor of Burkitt’s Lymphoma, a virulent variety of pediatric cancer that is rare in North America. Walsh is living proof that this fierce form of non-Hodgkin’s Lymphoma — known to be the fastest-growing human tumor — responds well to early diagnosis and chemotherapy.

But in sub-Saharan Africa, where Burkitt’s is the most widespread type of childhood cancer, the outcome is often less rosy. Burkitt’s Lymphoma represents half the number of childhood tumors treated at regional hospitals in Kenya and Uganda. Experts say the disease — first identified in 1958 — is on the rise. Diagnosis is challenging. Treatment is costly. In Africa, treatment often is difficult to obtain because so few facilities are equipped to address Burkitt’s Lymphoma.

Like most Americans, I was unaware of the fatal grip Burkitt’s Lyphoma holds on much of Africa. Then last May, I traveled to western Kenya as part of the aforementioned quirky quartet of four professors. We had joined forces to look at the intersection of public health and journalism, particularly at times of crisis and disaster.

Our goal, with funding from the Bill and Melinda Gates Foundation, was to set up a global student news network dedicated to telling the stories of foreign aid from the point of view of the recipients. And so we brought eight B.U. students together with 10 students from two Kenyan universities in Nyanza Province, Kenya’s westernmost province, and set about uncovering narratives about health, education, employment and other areas. To demonstrate our cross-cultural intentions, we named our project Pamoja Together. Pamoja is the Kiswahili word for “together,” so what we were saying was “Together, Together.”

I learned about Burkitt’s Lymphoma as we conducted research in advance of the trip, to a region that lies close to the Ugandan border, high on the banks of Lake Victoria. One of the stories that one of our Kenyan students, C.J. Ouma, reported on concerned a hospital — one of the few in Kenya that treats this difficult disease.

Chronic malaria abounds in equatorial Africa. For children, this condition can be linked to the development of Burkitt’s Lymphoma. The African strain of Burkitt’s also is closely associated with the Epstein-Barre virus, the main cause of infectious mononucleosis. Burkitt’s is especially prevalent in Kenya’s malaria-prone lake regions.

The disease often starts with swelling in the neck, groin, face or under-arm areas. In Africa, lumps on the skin can result from many causes, including insects, parasites, allergic reactions and random rashes. But Burkitt’s distinguishes itself further because these can grow rapidly, sometimes doubling in 18 hours.

Pamella Adhiambo Otieno, mother of a 2-year-old Burkitt’s Lymphoma patient, Christine Achieng, said, “The symptoms started at six months, and we assumed it was a simple growth.” Continue reading

Mass. Hospitals Weigh Medical Marijuana Liability Risk

As Massachusetts lays the groundwork for medical marijuana, new clashes between the state law and a continuing federal ban on marijuana use are emerging. Hospitals, hospice care organizations and nursing homes are weighing the balance of serving their patients and protecting billions of dollars in federal funding.

(“Caveman Chuck” Coker/flickr)

(“Caveman Chuck” Coker/flickr)

Here’s the dilemma: Towards the end of long forms that authorize federal payments to hospitals, an executive has to certify that yes, the hospital is in compliance with federal law. But that statement would not be true if patients at the hospital are using marijuana for medical purposes and a doctor at that hospital is helping them.

“It’s really challenging for the practitioners,” says Larry Vernaglia, an attorney at Foley & Lardner who wrote a memo laying out the issues for the Massachusetts Hospital Association. If doctors say to themselves “‘even though we have this new pathway under state law, we’re not going to help our patients for fear of our liability,’ I think that’s a terrible position to be in,” Vernaglia says.

And hospitals face significant possible risks. Tim Gens, executive vice president at the Massachusetts Hospital Association, says violating federal law could get hospitals in trouble with the IRS over their nonprofit status. Grants through the National Institutes of Health and the Department of Defense fund most of the research at Boston hospitals. And there’s the billions of dollars in payments hospitals receive through Medicare and Medicaid. Continue reading

Why To Exercise Today (If Pregnant): Boost Your Baby’s Brain

Babies' brain activity was measured while they slept. (Photo courtesy universite de Montreal)

Babies’ brain activity was measured while they slept. (Photo courtesy of Universite de Montreal)

In the old days, pregnant women were often told to avoid exercise (except for those who worked the fields until they went into labor in a furrow, that is.) More recent advice encourages pregnant women to keep working out, though without overdoing it.

Now, new research just released at the Society for Neuroscience annual conference suggests that a mother-to-be’s workout could be good not just for her health but for her baby’s brain: Her exercise may translate into faster brain development for her child.

From the press release:

As little as 20 minutes of moderate exercise three times per week during pregnancy enhances the newborn child’s brain development, according to researchers at the University of Montreal and its affiliated CHU Saint-Justine children’s hospital. This head-start could have an impact on the child’s entire life.

“While animal studies have shown similar results, this is the first randomized controlled trial in humans to objectively measure the impact of exercise during pregnancy directly on the newborn’s brain,” University of Montreal’s Prof. Dave Ellemberg explains in the press release. “Most of all we are optimistic that this will encourage women to change their health habits, given that the simple act of exercising during pregnancy could make a difference for their child’s future.” Continue reading

Memories Of A Veteran’s Son: Living With Undiagnosed PTSD

Victor E. Beresin, DDS, was discharged as a Major from the Army, having been promoted to Captain, and won the Bronze Star for his work on the battleship in the Pacific. (Courtesy Gene Beresin)

Victor E. Beresin, DDS, was discharged as a major from the Army, having been promoted to captain, and won the Bronze Star for his work as a medic on a battleship in the Pacific. (Courtesy Gene Beresin)

By Dr. Gene Beresin
Guest Contributor

Waking my dad early in the morning was terrifying. I learned not to do it – not an easy thing for a very young kid.

When I crept into my parents’ bedroom across the hall, I found that if I jumped into bed from my mom’s side, it all went just fine. But if I even tapped my dad and woke him from a sound sleep, he jumped a mile high, looking absolutely terrified, screaming, “What is it! What’s happening? What’s going on?”

It was damn scary. I learned quickly to go to the right side of the antique maple bed, never to the left.

And if I woke Dad from a nap in his study (he would often crash on the tiny bed there, working endlessly on lectures, slides and writing his books) he would jump and scream just as loudly. I stayed away and let my mom do it.

There were also the bouts for a week or two of shaking, sweating, and turning beet red, up night after night – events I recall once or twice during my childhood. Mom said not to worry; he was just having some kind of reaction to an illness he got in the war. “Malaria,” she said. “It will pass.”

Don’t worry? My dad was convulsing. He looked like he was going to die.

No one ever told us about PTSD. The term was not even a term back then. It was the 1950’s, and later the 60’s. My generation only knew that our dads had fought in “the war,” and that now they were home.

In fact, my dad loved to watch World War II movies. We watched them together ritually, just as we watched football games. I knew he hated the Nazis, and I was glued to the screen. As I got older, I started asking questions. Continue reading

Is It Time To Rethink Co-Sleeping?

sundaykofax/flickr

sundaykofax/flickr

By Sarah Kerrigan
Guest Contributor

Pediatricians and public health officials have long warned that “co-sleeping,” or sharing a bed with an infant, is unsafe.

But let’s face it: almost everybody does it. So perhaps the time has come for the public health message to focus less on advising against it and more on advising how to do it more safely.

Because despite all the finger-waggling, co-sleeping is, and will continue to be, extremely common.

For instance, a recent survey, “Listening to Mothers III,” found that about 41 percent of new mothers report that they always or often share a bed with their babies in order to be closer. A 2007 study in Los Angeles County found bed-sharing rates in the range of 70-80 percent across races. And it’s likely that bed-sharing rates are grossly underestimated.

In so many ways, sharing a bed with your infant makes sense. “There is no way I would have had the energy to get out of bed 3-5 times per night to go feed [my baby] in another room,” says Lee, a Boston mother who asked that her last name not be used due to what she says is bias against bed-sharers.

There’s no denying that there can be risks involved in sleeping in the same bed as your infant.

In the United States in 2010, 15 percent of all infant deaths were designated as Sudden Unexplained Infant Death, which includes SIDS, and some of these babies were likely in unsafe bed-sharing situations. “We feel a certain responsibility to work to prevent these deaths,” said Carlene Pavlos of the Massachusetts Department of Public Health.

But just as using a message of abstinence in place of sex education has been shown to be ineffective, so too might a one-sided message that only tells parents, “Don’t share a bed with your baby.” Without offering a positive message of how to make bed-sharing safer, and even its potential benefits, public health organizations may be neglecting a key element to saving babies’ lives. Another Boston-area co-sleeping mother, Lindsey, said: “The fear around (co-sleeping) prevents people from talking about it. I know in my case, I was doing it in an unsafe way for a while because I was afraid to ask for advice.”
Continue reading

Extreme Mothering: When A Child Has A Relentless Disease

Kate and her children Jake and Brook, who has the fatal genetic disorder Tay-Sachs disease. (Mary White Photography)

Kate and her children Jake and Brook, who has the fatal genetic disorder Tay-Sachs disease. (Mary White Photography)

By Dr. Annie Brewster
Guest Contributor

In 2010, Kate, a single mom from Derry, New Hampshire, gave birth to Brook, a healthy baby girl.

Brook seemed to be developing normally and reaching all of her milestones — learning how to sit up and roll over, grasping at toys — until she was 6 months of age, at which point she started to regress. She lost skills she had already learned, and gradually Kate noticed other things. Brook didn’t respond to her name, she would fixate on her hands and just stare and stare; she started dropping toys, unable to hold onto one in each hand at the same time. Eventually, after a long medical work up, Brook was diagnosed with Tay-Sachs disease in 2012, and Kate was told that her daughter would most likely not live past her third birthday.

Today, Brook, is two-and-a-half years old and requires constant care. She is blind. She cannot swallow and is fed through a feeding tube. She is having constant seizures. And she continues to deteriorate. Brook’s older brother Jake, born to a different father and now 9 years old does not suffer from the disorder, but may be a carrier. This will remain unknown until genetic testing is done when he is a little older.

(Listen to the audio on the right to hear Kate’s story of living with and caring for her terminally ill daughter.)

Tay-Sachs is a fatal genetic disorder. A child is born with Tay-Sachs when he or she inherits two damaged copies of the HEXA gene on chromosome 15 (one from each parent), which results in a deficiency of the Hexosaminidase A enzyme and the subsequent build up of a damaging fatty substance in brain cells. The result is a relentless, progressive loss of physical and mental functioning and eventually, death. A person with one damaged gene and one normal gene will become a carrier with no clinical symptoms of the disease. If two carriers have children together, there is a 25% chance of giving birth to an affected child with each pregnancy.

Tay-Sachs, a rare disease with an incidence of approximately 1 in 320,000 in the general population, occurs with increased frequency in certain populations, including Ashkenazi Jews, French Canadians, and Cajuns (from Louisiana). In these groups, approximately 1 in 30 individuals is a carrier, and 1 in 3,500 children will be born with the disease.

Kate, who is of French Canadian descent, underwent no genetic testing and had no idea she was a carrier before Brook’s diagnosis. She knew nothing about Tay Sachs, and was unaware that French Canadians are at increased risk.

How does a mother manage life when her child is dying? She mothers. Kate spends most of every day in her living room with Brook, an oxygen machine hissing in the background, surrounded by pill bottles, suctioning her daughter’s secretions, moistening her lips, and giving her medication to temper her seizures. Kate’s primary goal is to keep Brook as comfortable as possible in her last days, and she works very hard to achieve this. “So many people for so long would say, ‘You’re so amazing, I don’t know how you do this; This is incredible, how do you manage this,'” Kate says. “I would look at them and think, ‘This is my daughter, how can I not do this?'” And every day she tries to spend as much time as possible with her older son, Jake, and to support him through the impending loss of his sister the best she can.

This project was completed in collaboration with Blyth Lord, founder of the Courageous Parents Network, a non-profit whose mission it is to empower parents caring for children with life-limiting illness, and Bill Parker, founder of Hindsight Media.

Dr. Annie Brewster, author and audio producer, is a Boston internist and founder of Health Story Collaborative, a non-profit organization dedicated to harnessing the healing power of stories. You can hear and read more of her stories here, here and here, as part of our Listening To Patients series.

Breaking News: FDA Takes First Steps To Ban Trans-Fat

Up until now, the FDA has deemed trans fat to be “GRAS” — Generally Regarded As Safe. Well, those days may be numbered. Medpage Today reports that the federal food and drug agency is moving to “eliminate partially hydrogenated oils — the main dietary source of artificial trans fat — in processed foods.”

Why? According to the FDA website:

Trans fat has been linked to an increased risk of coronary heart disease, in which plaque builds up inside the arteries and may cause a heart attack.

(FDA)

(FDA)

The Centers for Disease Control and Prevention estimates that a further reduction of trans fat in the food supply can prevent an additional 7,000 deaths from heart disease each year and up to 20,000 heart attacks each year.

In its inimitable bureaucrat-ese, the FDA website explains what today’s action means:

If FDA determines that PHOs are not GRAS, it could, in effect, mean the end of artificial, industrially-produced trans fat in foods, says Dennis M. Keefe, Ph.D., director of FDA’s Office of Food Additive Safety. FDA is soliciting comments on how such an action would impact small businesses and how to ensure a smooth transition if a final determination is issued.

And here’s more from the Medpage Today story:

On the basis of a review of scientific evidence and findings from expert panels, the agency made a preliminary determination that the oils “are not generally recognized as safe for use in food” and should be eliminated, FDA Commissioner Margaret Hamburg, MD, said on a conference call with reporters.

The decision “is very welcome and strongly supported by massive scientific evidence that trans fat has many adverse effects on health,” Walter Willett, MD, DrPH, of the Harvard School of Public Health, said in an email to MedPage Today. “Trans fat has no place on the table, and this step will help make the diets of Americans safer.” Continue reading

Doctor’s Orders: Get Outdoors

“So Melody, as we finish our check-up today, I have one more thing to tell you about,” Dr. Karen Sadler said as she pulled her stool closer to the examination table where 8-year-old Melody Salhudin sat, legs dangling over the edge.

You know, you come here when you’re sick and need medicine, but you know you also come to the pediatrician so we can help you stay healthy. And part of staying healthy is being active,” Dr. Salder explained as she reached for a glossy brochure and a special prescription pad. On it, she wrote a prescription for Melody to get outside and exercise.

Melody Salhudin hits the swings during a break from her walk (Martha Bebinger/WBUR)

Melody Salhudin hits the swings during a break from her walk (Martha Bebinger/WBUR)

It’s part of a program called Outdoors RX  — a partnership between the Appalachian Mountain Club and Massachusetts General Hospital. It’s funded by three foundations for one year, with a budget of $200,000. The two venerable organizations are testing the idea of having doctors write prescriptions for outdoor exercise in two communities with high rates of childhood obesity, Waltham and Framingham.

Melody, a quick study, got the point. “To help people stay strong and healthy and to make sure they get up and get their body like grooving and moving,” Melody said, giggling and twisting her hips.

The Appalachian Mountain Club isn’t known for Melody’s style of moving and grooving.

“Originally we thought of hiking or biking,” and other more traditional AMC activities, said Pam Hess, who runs Outdoors RX. But Hess soon realized that many kids in these communities are not used to, or even comfortable, spending time outdoors. Continue reading

Report: N.M. Traffic Stop Turns Into Forced Enemas, Colonoscopy

(Wikimedia Commons)

(Wikimedia Commons)


It’s the stuff of nightmares.

The New Mexico TV station KOB-TV Channel 4 reports that a man who was pulled over for failing to make a full stop at a stop sign was brought to a hospital and forcibly subjected to repeated anal probes, three enemas and ultimately a colonoscopy.

A drug-sniffing dog indicated a possible odor of drugs on the car seat, and a police officer thought the man, David Eckert, was “clenching his buttocks” when he got out of the car, and wanted his anal cavity searched for drugs, KOB-TV reports. At a nearby emergency room, a doctor refused to do the search, calling it unethical; Eckert was brought to another hospital, where doctors apparently raised no such objections.

From the KOB-4 report, which you can read in full here:

1. Eckert’s abdominal area was x-rayed; no narcotics were found.

2. Doctors then performed an exam of Eckert’s anus with their fingers; no narcotics were found.

3. Doctors performed a second exam of Eckert’s anus with their fingers; no narcotics were found.

4. Doctors penetrated Eckert’s anus to insert an enema.  Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool.  No narcotics were found.

5. Doctors penetrated Eckert’s anus to insert an enema a second time. Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool. No narcotics were found.

6. Doctors penetrated Eckert’s anus to insert an enema a third time. Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool. No narcotics were found.

7. Doctors then x-rayed Eckert again; no narcotics were found.

8. Doctors prepared Eckert for surgery, sedated him, and then performed a colonoscopy where a scope with a camera was inserted into Eckert’s anus, rectum, colon, and large intestines.  No narcotics were found. Continue reading