Friday, January 05, 2007
Stunting growth - in whose best interest?
The first time I saw a picture of Ashley, I could understand why her parents call her their "pillow angel." Her beautiful smile is engaging; her sparkling eyes, unforgettable. In many ways, she reminded me of my four little girls. But Ashley can't walk or talk. She can't keep her head up, sit by herself, roll or change her sleeping position, or even hold a toy. Basically, she is a baby inside a 9-year-old's body. Doctors say she suffers from something called "static encephalopathy of unknown etiology," which means she had an insult to the brain of unknown origin or cause. She will never get better. And now she's become the focus of an international controversy.
Ashley has the needs of a baby and always will. At 65 pounds, her parents can still carry her around and involve her in family activities, giving her "needed comfort, closeness, security, and love," as they've written in their blog. But what would happen if she got bigger? That's what her parents worried about, and so after long discussions, Ashley's parents, in consultation with her doctors and ethicists at Seattle's Children's Hospital, decided to stunt her growth by giving her estrogen therapy. "As a result, Ashley can continue to delight in being held in our arms and will be moved and taken on trips more frequently," they write. In addition, a surgeon removed her breast buds and uterus so she won't develop breasts or menstruate. "Ashley will be a lot more physically comfortable free of menstrual cramps, free of the discomfort associated with large and fully-developed breasts, and with a small, lighter body that is better suited to constant lying down and is easier to be moved around," her parents wrote, adding that since she looked like a girl, she'd be less of a target for sexual predators.
As you can imagine, this treatment has been very controversial. Art Caplan, an ethicist at the University of Pennsylvania, thinks what Ashley's parents have done is "morally wrong...permanently freezing a person into childhood as a solution is not the right answer." Caplan told me that Ashley has the right to grow up and not to be seen an "oddity" or a "freak." Although many comments on web sites are supportive of Ashley's parents, many have also been quite critical, some even saying the parents are practicing "eugenics." What do you think? What would you do if Ashley were your daughter?
Jump-Start Your Health
This time every year, many people suggest that we do a show on making and keeping resolutions. I wondered how to make such a familiar topic interesting for our viewers. But in talking with my co-workers I discovered that we shared many concerns - dealing with the stress of coming back to work, getting back to healthy eating after splurging over the holidays and getting organized.
This isn't cutting-edge medical news, but it's what many of us need -- a little help getting our lives back on track. So whether you've resolved to make changes or you're just trying to get back to normal, I hope this weekend's show will help you jump-start your new year. Our guest, Dr. Howard Shapiro, has some great advice on that front: "It is a journey, it is a process" but he says, as long as you stay focused on your target, you will succeed.
Do you have a health goal this week, month or year? If so, how are you planning to stay focused?
House Call airs weekend mornings at 8:30 ET.
Thursday, January 04, 2007
Veterans Fight Fat
As you probably know, I am on a kick about obesity in this country. One of the reasons I entered television journalism was that I thought it was too easy to sit on the sideline and complain. It was too easy to resign myself to watching a nation that used to be one of the most fit, robust and vibrant in the world gradually become one of the most obese. I wanted to do more than simply talk: I wanted to try and educate as many people as I could. Truth be told, I am optimistic that we can reverse this trend.
So, here's another good opportunity to raise awareness, and possibly your ire, about something related to obesity. Get this: If you are a U.S. military vet, you've got a better chance of being diabetic than just about any other part of the population. The reason is that most veterans are overweight. In fact, almost 75 percent of male veterans are considered overweight or obese. That percentage is higher than among the general public. In fact, when I searched a little harder, I discovered that it is higher than overweight and obese rates in Native Americans (73.9 percent), Hispanics (72.7 percent) and whites (72.5 percent). It appears, according to a study of nearly 2 million patients who were treated at 136 Veteran Affairs medical centers, our U.S. veterans are the most overweight and obese of any group in the country. Our veterans.
I was surprised by that. I always imagined that a rigorous military training and associated boot camps would create lifelong habits that would fend off obesity and the countless chronic diseases associated with it. It appears that is not the case. It is true that the VA hospitals are trying to do their part. Any overweight veteran who visits a VA doctor gets referred to MOVE. It is a program to get veterans to start eating healthier, become more physically active and start focusing on those behaviors that led them to obesity in the first place.
It is hard to say whether it will be enough. As much money as we spend on body armor, gas masks and firepower, the biggest enemy of all may have been the fatty food we have served our military men and women and the sedentary lifestyle they live once they retire. So, if we are optimistic we can reverse this trend. What would you recommend to better care for our veterans? And, whose responsibility is it?
Wednesday, January 03, 2007
Botox: Poison or Panacea
"Can you steal some for me?" asked my 81-year-old grandmother when she heard I was reporting on Botox. It's a hot commodity even to my old-fashioned granny who has never driven a car nor touched a computer in her life. "It's like magic," she said.
Apparently, she's not alone in her lust and awe. Using the substance for facial lines is this country's most popular cosmetic procedure, according to the latest numbers from the American Society of Plastic Surgeons. In just five years, the number of aesthetic procedures has quintupled.
As more people use Botox as the ultimate wrinkle remover, doctors are realizing that its benefits delve far deeper than the skin.
Here's a brief science lesson: Botox is a brand name for botulinum toxin type a. It's produced by the bacterium Clostridium botulinum. In its purest form, botulinum is one of the deadliest poisons known to humans. It can cause death by paralysis.
In 1989, long before physicians injected Botox into faces, the FDA approved it for patients with debilitating neurological diseases such as dystonia. In these conditions, faulty connections between brain and muscle cause parts of the body to spasm. Muscles are locked into uncomfortable, often excruciating, positions.
Amazingly, Botox liberated many of these patients by temporarily cutting the connection between overactive neurons and muscle, allowing the body to relax a bit. On a basic level, that is what's happening with Botox for wrinkles -- the muscle is loosening its grip on facial skin.
This ability to block the muscle trigger led researchers to use Botox for a whole host of other conditions. It's FDA-approved for excessive sweating due to overactive sweat glands. It is used off-label to treat multiple sclerosis, spinal cord injury, anal fissures, tension headaches and migraines.
In our report airing today and tomorrow, Dr. Gupta will show you Botox's benefits to stroke patients. Up to four in 10 stroke survivors suffer from spastic disability. You may recognize it as stiffness on one side of the body, often seen in a club-like hand or foot. These people lose their independence--the ability to wash themselves, to eat, and even walk.
We'll show you how Botox has been used for years in these stroke patients in combination with physical therapy. It allows some to regain mobility and muscle function.
It's not a cure-all. It does have minor side effects, and more studies need to be done on long-term use. But it's huge news for people like my uncle who just suffered from a stroke. It can give them motivation to get better and their families hope.
So, what did my granny say after I finished my spiel about the possible wonders of Botox? "See. I told you...it's magic. Now, try to steal two bottles. One for me. One for your uncle."
Now, what do you think? Whether it's for cosmetic or other purposes, it's still a poison. Would you want to use Botox?
Botox is a trademark of Allergan.
Tuesday, January 02, 2007
Testing for Down syndrome - Do you want to know?
If you've recently visited the doctor's office, you may have walked out more confused than before you entered. It is true that with the number of detailed tests offered, you may get answers to questions you didn't even know you had. Often times, you are suddenly required to make decisions, big decisions, without a lot of time to think. Nowhere is that more true than when it comes to prenatal screening. And, now new guidelines issued by the American College of Obstetricians and Gynecologists will lead to even more tests, and possibly more questions.
The new recommendation is that all women, regardless of age, be offered screening for Down syndrome. As you may know, Down syndrome is a common birth defect, caused by three copies of the 21 chromosome, instead of the usual two. These children may be mentally delayed in addition to having heart defects. It is well known that older women are more likely to have a child with this defect. For example, a 25-year-old woman has roughly a 1/1,250 chance as compared with a 40-year-old woman, who has a 1/100 chance. The conventional wisdom was that a woman over 35 should be offered an amniocentesis - placement of a needle into the amniotic sac and removal of amniotic fluid for testing. Unfortunately, that test carries a slight risk of miscarriage. Nowadays, non-invasive screening is available that involves testing the woman's blood and performing an ultrasound. In the first trimester of pregnancy, it can tell with more than 90 percent accuracy whether a child has Down syndrome. There is no additional risk of miscarriage, and the costs are fairly reasonable.
The question, though, for many young parents is, "Do we really want to know?" A certain percentage of parents may choose to terminate the pregnancy. Others may choose to immediately establish tax-free health savings accounts to help pay for the health costs of the child. Others may choose to have the child delivered in a hospital that specializes in high risk pregnancies. Many parents are just curious. But, is it worthwhile to know? Do you agree with the new recommendations put forth? Do you think this will reinvigorate the abortion debate?
Sunday, December 31, 2006
Happy New Year
Have you made your new year's resolutions yet? Tell us what they are!
Make sure to check out the Paging Dr. Gupta podcast this Wednesday to get some tips on making good resolutions and sticking to them.
Happy new year from all of us at CNN Medical News to you and yours!
ABOUT THE BLOGGet a behind-the-scenes look at the latest stories from CNN's chief medical correspondent, Dr. Sanjay Gupta, and the CNN Medical Unit producers. They'll share news and views on health and medical trends -- info that will help you take better care of yourself and the people you love.
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