Monday, April 30, 2007
What is in the best interest of the dying?
There are few things sadder than seeing a child with a tube up his nose. When Catarina Gonzales first showed me video she had shot with her camera phone of her little boy, Emilio, my heart broke for them both. Emilio is Catarina's life, and soon, Emilio will die. The 17-month-old suffers from Leigh's disease, a rare genetic disorder that's destroying his central nervous system. Emilio can't hear, see or eat without help.
Emilio is spending his final days in the Pediatric Intensive Care Unit at Austin Children's Hospital in Texas. A ventilator keeps him alive. Doctors say they can't help him. In fact, they believe the ventilator is prolonging Emilio's suffering. The hospital, which is run by the Catholic church, believes the ethical thing to do is to stop life support and let Emilio die. In Texas, that's permissible. Under a law signed by then-Gov. George W. Bush, a hospital can cease life support if it is deemed "medically inappropriate".
But Catarina says it's not her son's time. She is suing the hospital. The two sides have been in and out of court, with the next hearing scheduled for May 8. Catarina contends the hospital is "trying to play God by saying who lives or dies." She says that Emilio isn't in pain and that he responds to her touch. In the meantime, Catarina is by Emilio's side day and night. She spends hours on her cell phone, trying to find another hospital to take her son. But so far, she's had no luck.
In some ways, Emilio's situation is the same one thousands of American families face every day. When death is near, what is in the best interest of the dying? Should doctors have the final say or the family?
Friday, April 27, 2007
Planning for a bird-flu outbreak in real time
"I don't have good news," the director of the Centers for Disease Control and Prevention said gravely, as reporters leaned forward in the CDC briefing room. "Until recently, H5N1 was a bird virus, contained to birds. Now there's strong evidence that in at least some cases, it has adapted and is capable of transmitting from one person to another and then another."
Sounds alarming. But we're not alarmed, because it's only part of a drill, an exercise involving more than 1,000 people, simulating a cross-globe outbreak of deadly bird flu. It started Wednesday morning in the CDC's very real Emergency Operations Center, in its Atlanta, Georgia, headquarters.
At 8:37 a.m., we got the scenario: a dozen people sick in the United States, all with connections to an Indonesian student at Georgetown University. The young man and two others are dead. Other suspected cases are on a plane being held at an airport in Honolulu, Hawaii. There are recommendations to funnel international flights to just 20 U.S. cities for screening, to send an investigative team to Jakarta, to move vaccines and antiviral medications closer to the hot zone.
"It's hard to define the worst-case scenario," CDC Director Julie Gerberding told "reporters" (in reality, CDC staffers), as well as real reporters observing the mock press briefing. The 25 percent fatality rate in this week's scenario "is beyond our planning imagination," she said.
It's easy to make light of role-playing scenarios, to say they don't approximate the real thing. But a drill like this helps inspire that imagination. It can turn up fixable problems - it took more than an hour to get everyone logged into computer stations in the Emergency Ops Center - but mostly, it gets everyone thinking about the questions they'll be asking in a real crisis.
How worried are you about bird flu? Let us know.
Fit Buddies update
As Dr. Sanjay Gupta's 2007 Fit Nation Tour heads to New Orleans, Louisiana, for weekend events, the CNN Fit Buddies are working to improve their eating and workout habits. Here's an update from the second week of the weight-loss challenge. Read about their successes and pitfalls every Friday here on the Paging Dr. Gupta blog. (More Info)
Is this how far I've fallen? So out of shape that tossing a basketball is a chore. Well, not exactly, but close enough. (The next shot hit the rim.)
This moment inspired me to really focus on the weight training. I always thought lifting weights right now would do more harm than good. Not the case. You just have to do it the right way.
And I'm already seeing the positive effects. At the end of the week, I went back to the basketball court and made three three-pointers in a row. The touch is coming back!
Having to keep track of every item that goes in your mouth is a powerful tool. It certainly made me a lot more aware of my choices. One night I struggled with myself over eating a fudgesicle. I quickly e-mailed my buddies. The response was to "back away from the freezer!" Ed reminded me of the wasted calories and the fact that I would be giving them up for a temporary high. It worked! I was proud of myself and thankful for the support.
The food diary also got me into the habit of checking the calories, proteins, fats, sugars and carbs in each of my meals. I can't believe how many are hidden in seemingly innocent foods. Robert woke me up to the fact that each glass of wine has the same sugar count as a donut! So biggest lesson of the week: Wine=donut. Bad!
I'm not much for gooey, mushy foods, but my girlfriend convinced me to try her oatmeal concoction - oats, milk, fresh fruit and honey. It looked more like brick mortar with strawberries, but I gave it a shot...
Was it good? No, but I ate it because it's good for me. Do I like working out? No, but I do it because it's good for me.
I never quite understood that whole "no pain, no gain" saying. I always said "no pain, no pain - it's that simple."
My arms hurt, my legs hurt, I ate oatmeal and even salmon (the one fish I don't like) - but it's working. I don't know if I've lost weight yet, but I can feel my body changing for the better.
I'm learning that to really make a change in my health, my appearance and my lifestyle, there is going to be a little pain along the way, but it'll be worth it in the long run.
First, being part of a team. It was great to see firsthand how the CNN Fit Nation team puts on a production, as they did in Atlanta, Georgia, last weekend. From the visual aids - a plastic yellow lump of a pound of fake fat and a mirror that shows people what they would look like 10 pounds lighter - to one of the best visual and speaking aids - CNN's own Dr. Sanjay Gupta, the event was a great awareness-builder.
Second, getting information you can actually use. I was a fan of the CNN show "House Call," long before joining the Fit Nation team, because the show takes complicated topics and gives me the resources to do my favorite thing, TAKE ACTION! So if you are following along, logging your nutritional habits and making "modest" changes like portion control, or simply making better food choices, it is indeed easier if SOMEONE ELSE is looking at it1 You may want to pick someone you will actually listen to, and who has solid nutritional habits of his or her own.
Exercise is the other bookend to positive results, but as we have seen through the new food pyramid, walking a few times a week for even as little as 10 or 15 minutes can improve your health. (I suggest 30 minutes at a "brisk" walking pace.)
Lastly, go with your strength. Ed is an ACTION guy, I think his goal is to out-work everyone else. Stacia is the "alpha" and she has me doing my homework, because whether it is the latest nutritional software, or shaking up her workouts, her attitude is "bring it!" And Matt has the Apollo 13 attitude - failure is not an option. Although he may not excel in any one area of his workout or nutrition, his program is balanced, and one I feel he can continue in one form or another for the rest of his life.
I don't know your motivation (your health, the way you look or feel), and I don't know why you have not been able to reach your fitness goals (time or money restrictions, or lack of motivation). What I DO KNOW is if you will join the Fit Nation TEAM, and start taking ACTION... we WILL over the next several weeks, inspire you and give you information on nutrition and exercise you can use NOW, TODAY, and as the old saying goes... what do you have to lose, but the weight!
Thursday, April 26, 2007
Ready for the end of the period?
When I realized I was having terrible mood swings at the same time every month, I started to take action to protect the people most important to me.
Me: Hey hon, so I'm pretty hormonal this week. Just a friendly warning...
Hubby: *Blink.* So, I've got to work late tonight. And tomorrow night. And the night after.
Me: [unintelligible because of my uncontrollable sobbing]
I can't fault the poor guy for wanting to avoid me. He's got the patience of Job but even he'd get run down after a few takes of me flipping out about the simplest things. "What do you mean your phone isn't charged? I really needed to talk to you! What if I was seriously injured and needed to reach you from the ambulance?" You know, the everyday stuff.
So in 2003 when the makers of Seasonale started to market their birth control pill as a chance to cut down to just four menstrual periods a year, I seriously sat up and listened. How great would it be to side-step the inevitable back pains, bloating, and bad attitude that much longer? It would probably make for a happier married life, I thought. But it seemed, I don't know... unnatural. And too new. So I sat back and waited for some scary study to come out saying that missing your period is actually bad for your health.
Instead, I just learned that the FDA is now about a month away from approving Lybrel, a contraceptive that allows you to get evade your period for even longer than three months. Like, forever. Or at least as long as you want.
So this whole period-skipping must not be so bad for us then, right? I mean, studies so far show that there are no added risks to your health if you do it. My doctor told me that I could do the same thing with regular birth control pills, just keep taking the white ones, and that some women do it for various health reasons. But other docs will point out that there are still no long-term studies out there to prove that the health risks won't surface later on down the line.
I know I'm not alone in still wondering whether this is a good idea. Wyeth, Lybrel's makers, said that almost two-thirds of women they surveyed said they were interested in giving up their periods, the New York Times reported.
But what about that comforting monthly sign that you're not pregnant when you don't want to be? And that feeling you first had when you started to menstruate back in junior high - that feeling of hey, I'm a "real" woman now, complete with menses and bra straps? Is having a period a biological phenomenon that we should just accept and respect as the way God made us? Or do you think if we have the technology to make our lives a little easier and less painful, then we should take advantage of it?
Wednesday, April 25, 2007
WIC on the chopping block
Not too long ago, one of our producers suggested a story on the most utilized food program in the United States. The news: The Women, Infants and Children program was finally getting vouchers for fresh fruit and vegetables. It may not sound too enticing at first - it didn't to me -- but then I considered that we're battling an overweight and obesity epidemic in our children. So the government is just now offering low-income mothers and children assistance in purchasing fruit and vegetables? I asked the producer to check her facts.
WIC has been providing nutrition services for low-income women and children for over 30 years. For most of that time, malnutrition was a key problem - so the vouchers focused on milk, bread, cereal - foods that can sustain you. Now, the concern is overweight and obesity in children, so the Department of Agriculture decided to add vouchers for produce - a healthy diet addition -- that can be redeemed at local grocery stores.
This was great - a success story on battling overweight and obesity. But then the producer came back to me with more information. It turns out WIC is on the chopping block, facing a $145 million cut in President Bush's 2008 budget.
If this happens, some fear that the produce voucher proposal will disappear. For now, Congress is debating, one hopes keeping in mind what those dollar signs on the page mean in real life.
For more, watch American Morning on Thursday, 6-9 a.m. ET, and tune in to House Call with Dr. Sanjay Gupta weekend mornings at 8:30 a.m. ET?
Tuesday, April 24, 2007
Out of Touch After Surgery
I'm back at work after an unexpected surgery. Waiting for my body to heal wasn't easy. But what made my surgery all the more difficult was the surprising lack of access I had to my doctor afterwards. Complications had me in the emergency room twice. I talked to ER doctors more than my own. I felt neglected.
Feeling neglected doesn't mean you're being neglected. But feelings are powerful nevertheless. When I got back to work I called Regina Sara Ryan. She's the author of "After Surgery, Illness, or Trauma." Ryan had some great advice on how to handle a doctor you think is out of touch. "It's a tricky path to walk," she says. "We are afraid of damaging this relationship." Still, she says the relationship we foster with our doctor is one of the most important bonds we have with someone. So... how to make things work:
1) Speak up. Don't let your physical weakness silence your concerns. Ryan says too many of us try to take on the burden of our recovery alone -- a saint-like approach that internalizes our worries and makes us passive healers. Sometimes our doctors intimidate us by their stature, their expertise. Try not to be overpowered by that fear, and if you still find yourself struggling ask a friend or relative to speak to your doctor on your behalf.
2) Keep a list. You're less likely to monopolize time and more likely to get the answers you need if you have a list of questions ready to ask your doctor. "A list gives the idea that you are not being casual," Ryan says. Remember, you're dealing with a physician you think is inattentive. A list of questions makes it harder to dismiss them.
3) Don't make your doctor the enemy. Your approach should be to salvage trust. Not an easy task when you're angry or in pain but try, regardless. Speak to your doctor about working together, even getting along. But be realistic. "Don't expect a best friend or the ultimate healer," Ryan says. What you want is a committed partnership.
4) Don't be blindly obedient to your doctor either. Express displeasure when your care seems below standard or your treatment disagrees with you. If your doctor isn't responding, Ryan says most hospitals have patient-advocacy programs that you can turn to for a new ally.
5) Last resort, make the switch. "A gruff manner is one thing," Ryan says. "But if your doctor isn't listening to you, if you have a real sense that something is wrong then it might be time to look for a new doctor." Red flags that should make you question: 1, a sense of incompetence, and 2, a lack of clear, available information.
Easing back into my routine feels so good, especially after the pain of surgery.
Have you ever felt neglected by a doctor? What did you do to get more attentive care?
Monday, April 23, 2007
Thumbing your way to arthritis
"Supercalifragilisticexpialidocios! Even though the sound of it is something quite atrocious. If you say it loud enough you'll always sound precocious."
Even though my fingers ached just thinking about it, I did try texting the phrase on my alphanumeric keypad. I gave up after two minutes. I would have easily lost to Morgan who thumbed her way to victory and $25,000. (Full Story)
As Morgan rejoices in her keypad domination, I realize I'm beginning to pay a higher price for all those years of clicking away - first on Atari, then Nintendo, Sega, remote controls, and most recently my best friend, the Blackberry.
It's unofficially called Blackberry thumb. It's an ache and pain, sometimes throbbing in your thumbs. Officially, the diagnosis is tendonitis or inflammation of the tendons. The thumb, with one fewer joint than the rest of the fingers, is more sensitive to stress than the four other jointed fingers. Just as carpal tunnel syndrome sidelined keyboard users and forced some of them into braces, thousands of Blackberry and PDA users are showing up in orthopedists' offices around the country.
So why is it that Morgan isn't feeling the pressure, and my weary digits are feeling the pinch? Young people are at lower risk because their joints are still filled with fluid. Dr. Keith Raskin of New York University says that the elderly or people with a history of arthritis or tendonitis are at higher risk for Blackberry thumb.
Although I'm far from qualifying as elderly, I asked for a few tips on avoiding the ailment. Raskin suggests typing with the wrists in a neutral position with the thumbs resting freely without stress. He also says there is good news: "If patients reduce the workload, the symptoms will resolve."
So between videogames, texting and "Blackberrying," is this next generation facing a lifetime of Blackberry thumb? Do you text as a regular way to communicate? Why text over calling? Have you had any texting-related ailments? Is it changing the way we interact--for better or worse?
Friday, April 20, 2007
Introducing the Fit Buddies!
As Dr. Sanjay Gupta takes his 2007 Fit Nation Tour on the road, you can follow the progress of three CNN employees who are taking on the challenge of losing weight. Do you struggle with your weight? Does your hectic lifestyle contribute to your difficulties? Then you share something with our Fit Buddies. (More info)
A busy reporter, a medical producer traveling with the Fit Nation Tour, and the director of coverage in CNN's global newsroom in Atlanta work long hours, travel a great deal and rarely have time to get to the gym. Fitness trainer Robert Dothard has agreed to take a challenge of his own - get the Fit Buddies fit! Read about their successes and pitfalls weekly here on the "Paging Dr. Gupta" blog. (Watch Video)
The plan was simple. We would do my first fitness assessment, have dinner and then work out.
Four hours later, violent storms and tornadoes started rolling through Dallas.
Robert was ready for dinner, and of course, I was 30 minutes late.
This is my life. Breaking news usually dismantles the best laid plans. But I love what I do, and I want to be successful and healthy chasing news and telling stories. I'm traveling this week too, but I've managed to work out every day!
Notable this week:
Best Meal: Grilled tilapia on a bed of rice with green beans and broccoli. Oh, and a great dinner roll.
Worst Meal: Holding two crying babies, eating a slice of cheese pizza, some sesame sticks and a protein bar.
Biggest struggle: Finding a consistent time of day to work out.
Best workout: First workout lifting weights with Robert. I haven't done that in years and it felt great to get those muscles burning again.
It's been a great week. I got my husband on the fitness train too. He agreed to exercise with me. I really need the support.
Though my mind has been cheering me on this week, my body has been screaming back at me - a guttural scream. I've been using many long-dormant muscles. I can really feel the burn. I have found myself walking to the farthest restroom at work to get those extra steps in. I have taken the stairs A LOT more than normal. It has really become a mind game. May the best woman win!
Notable this week:
Best Meal: Sashimi - minus the rice
Worst Meal: Enchiladas and margaritas on Saturday night
Biggest Struggle: Staying away from "office" food!
Best workout: Tuesday - because I felt so guilty about missing Monday night's session due to breaking news at Virginia Tech
I will say, had I taken this breaking news trip a few weeks ago, I would have eaten more than my fair share of the pizza we ordered, and I would have ordered a big steak at the saloon. What really bothered me was that I had to miss all my workouts!
By far, the thing that’s helped me the most is being accountable for what I eat. I was ashamed to write in my food diary that I had eaten pizza Tuesday night, but the fact is, I ate it... so I wrote it down.
The good news is, I'm back on track. If you fall off the wagon, that's no an excuse to throw in the towel! Get back on the wagon!
Notable this week:
Best Meal: Grilled salmon, brown rice and broccoli
Worst Meal: Pizza during breaking news
Biggest Struggle: Getting to my workouts!
Best Workout: Running ¾ mile! I haven't run since high school!
Matt already had a challenge this week: being sent to the tragic Virginia Tech shootings. He has continued to report his food log to me, and he has managed some exercise on the road, but now that he is back in Atlanta, he can expect a "butt kicking" workout.
Stacia is simply amazing to me. She keeps more plates spinning than anyone I have worked with in a long time. I don't care if I have to sleep on the floor of their home, or follow Stacia around the CNN Center, we are going to reach her goals!
Not even the fact that we are training long distance is going to stop Ed from reaching what I feel will be the most drastic and noticeable changes of all three participants. And guess what: It is something we all can do. TAKE ACTION!
For years I have told people starting a fitness program to follow AAA: assess, accept, and act!
I will say, Ed has taken more action than Matt and Stacia, so that's my way to let everyone know it's GAME ON!
I know there are many people who have the same challenges we will face and overcome, and if we can help you, then I know we're truly on our way to building a Fit Nation!
Wednesday, April 18, 2007
Life or death in 30 seconds
Yesterday, I met Matt Green and Matt Lewis, president and vice president of Virginia Tech Rescue Squad - volunteer, student EMTs as I once was.
They both put on their game faces as we approached with the camera.
"You guys saw things that were just awful," Dr. Sanjay Gupta told them. 'What was going through your minds?"
"This is what we train for," they told us. 'We just focused on one patient at a time."
Certainly a very humble account of what happened.
In my calls to area EMS squads in Blacksburg, they all told me the same thing - the campus rescue squad deserved all the credit. They took charge immediately and did an incredible job.
Approaching a scene as dangerous and gruesome as this, an EMT must first do two things: Stay out of harms way, and establish incident command with police and firefighters.
The next and most difficult task: triage. An EMT's best friend in this situation is protocol.
"If you can get up and walk out, do that now," you scream to the injured. Those who can walk out get tagged "green." They probably have bumps and bruises, maybe even broken bones, but they will be fine. They walk out to awaiting medical staff.
That's the easy part. Triaging the rest of the injured victims requires a life-or-death decision every 30 seconds.
The first question you ask yourself with each patient: Are they breathing? No? Can you fix that easily by repositioning the head? If not, you tag that patient "black" - a grim reminder of what you're dealing with.
The truth is, your best shot at saving the most people is to let those who truly don't have a chance of surviving die, and devote your resources to those who can be saved. Sounds reasonable on paper, but a very difficult decision to make in real life - especially in 30 seconds.
The next group: red. These are the most critical patients. After a few quick stabilizing measures, the "reds" go right to awaiting ambulances and helicopters. With luck, a life saved.
Next come the "yellows." These patients are not as serious as the reds, but if they don't get care soon, they may be headed for the red zone.
At Virginia Tech, rescuers triaged dozens of victims in only a few minutes - no easy task for the most seasoned medic, and certainly not for these students.
These are very difficult times for the Virginia Tech community, but these rescuers can rest assured that they did everything they could.
Protocols, years of training and gut-wrenchinging decisions helped save lives Monday. But the decisions of that day are likely to stay with Matt Green, Matt Lewis and their fellow rescuers for the rest of their lives.
Tuesday, April 17, 2007
Questions from Blacksburg
It just hit me. After nearly 24 hours of confusion, chaos and charging hard to get here and report, the gravity of what happened at Virginia Tech is starting to sink in. Journalists are not supposed to show their emotions, but in this case, how can you not? 32 innocent lives, snuffed out in fit of rage. Sisters, sons, sweathearts. Gone. What a waste.
I've done stories with ER docs about what happens in times of crisis. It's not chaos as is often portrayed on TV. It's actually more like an intricate dance. Everyone knows his or her part. Folks we've talked to say the emergency response here was top notch. I am sure the families and friends of the survivors are grateful to know that.
I was in Oregon in 1998 when Kip Kinkel, then 15, killed his parents and then opened fire at his school. At the time I couldn't help but wonder, why do people commit such horrible crimes? Are some people "evil," or are such crimes the result of mental illness? Is there another explanation? Or no explanation? I'd like to know what you think.
The scene in Blacksburg
"The injuries were just amazing. This man was brutal. There was not a shooting victim that didn't have less than three bullet wounds in them," said Dr. Joseph Cacioppo. He was one of the many off-duty doctors and nurses who called in to help at Montgomery Regional Hospital in Blacksburg, Virginia, after Monday's campus rampage.
Three bullet wounds in each person he saw.
33 dead including the gunman.
17 wounded remain hospitalized.
Two hours between shootings.
25,000 Virginia Tech students.
Four major and one minor surgeries performed on Monday. None overnight.
It's hard not to focus on numbers. It's what journalists default to when big news breaks. A little more than 24 hours ago, the first reports said that one person was wounded and one person was dead. There was an audible gasp at the news conference when the number of dead increased to 20. By the time the final toll - 33 - was announced, we were already on our way to Virginia.
I'm part of a large CNN team in place in and around Blacksburg. Legions of correspondents, crews and producers from every network have descended. Satellite trucks dot the campus. Our mission here, as medical journalists, is to get beyond the numbers and to tell the stories of people at the heart of this tragedy. We want to hear about the heroic doctors and nurses who saved lives yesterday -- the life-and-death decisions. We seek to understand what the community will learn from this unparalleled trauma. We're working hard to bring you answers.
CNN Chief Medical Correspondent Dr. Sanjay Gupta will be joining me this afternoon. What do you want to learn from our reporting? What details are you waiting to hear? Were you just as staggered by the numbers as we were?
Monday, April 16, 2007
Cancer and the Presidency
Cancer is playing a surprisingly big role in the 2008 presidential election. Rudy Giuliani underwent radiation therapy for prostate cancer in 2000. John McCain has been treated for malignant melanoma, an aggressive form of skin cancer, several times. Of course, there is Elizabeth Edwards, wife of John Edwards, who has had a recurrence of breast cancer. Possible candidate Fred Thompson recently revealed details of his slow-growing lymphoma, now in remission.
The first presidential candidate to publicly acknowledge having cancer was Paul Tsongas. In his 1992 White House bid, he and his doctors told the public that he had been cancer free since his treatment for aggressive lymphoma in 1986. After Tsongas lost the Democratic nomination, he admitted that he and his doctors had lied about a recurrence of cancer in 1987. Tsongas died from complications of cancer treatment in 1997 on the next-to-last day of what could have been his first term.
Given how forthcoming today's candidates have been, it's hard to believe that past presidents have gone to extreme lengths to conceal their cancer treatment. In the summer of 1893, President Grover Cleveland had secret surgery to remove cancer in his jaw. The tumor was larger than a golf ball. It was just a few months after winning his second term as president. That procedure was concealed from the public for almost a quarter of a century.
More recently in 1967, President Lyndon Johnson had a secret operation to remove skin cancer form his ankle. His condition and treatment were kept under wraps for 10 years.
President Ronald Reagan was the first commander in chief to admit to having had cancer. He broke the presidential seal of secrecy in 1985. First, he had surgery to remove polyps that turned out to be colon cancer, and then just months later, he had skin cancer removed from his nose.
Cancer was once considered not only a political liability, but a death sentence. Today it's a very different disease.
"Thirty years ago if you were told you had cancer, your odds were about 50-50 that you were going to survive five years. Now the odds are closer to about two out of three people living to five years," says Dr. Len Lichtenfeld of the American Cancer Society.
Cancer prevalence rates have gone up, but so have survival rates. While there is definitely room for greater progress, new therapies and better screening have made cancer a more manageable disease.
"As a doctor, I'm aware of the fact that many folks who get to be the age that presidents would be, have other illnesses as well," adds Dr. Lichtenfeld. "They have hypertension, problems with cholesterol, heart disease, diabetes. Is cancer really all that different?"
Does it matter to you whether or not a presidential candidate has cancer? Does the public have a right to know if a sitting president has cancer? Do you think there are major differences between being a cancer survivor and having a history of chronic conditions such as high blood pressure, cholesterol or heart disease? Do you think cancer survivors have any limits to their ability?
Friday, April 13, 2007
Chasing life has changed mine
By David Martin
CNN Medical News
Talking to leading researchers on aging and reading up on their work for Dr. Sanjay Gupta's Special Investigations Unit special Chasing Life (Saturday and Sunday at 8 p.m. and 11 p.m. ET) has altered the way I eat, exercise and think about life in general.
You could say I've become an active participant in my health. With any luck, I'm healthier now and will gain a few extra healthy years at the end of my life as a result.
I understand as I never did before how the small decisions I make every day can affect how many vital years I have.
My lifestyles before and after "Chasing Life" are very different.
Before: I didn't think much about my diet.
After: I try to eat seven fruits and vegetables a day, preferably brightly colored ones rich in anti-oxidants. Fruits and vegetables are so much more effective than supplements or anything else we can eat at maintaining good health into old age.
Before: I ran a lot but didn't think much about lifting weights.
After: I try to mix it up a lot more. We lose a lot of muscle mass and bone density as we get older. Weightlifting helps on both fronts. Added strength later in life lowers the chance of a catastrophic fall in old age.
Before: I considered reading and writing as the way to brain health in my golden years.
After: I'm aware how the brain and body are connected. My diet, whether I exercise and how much stress I'm under all potentially affect how well my mind will function as I age.
Before: I didn't think much about the link between my outlook on life and my health.
After: I'm acutely aware how optimism, laughter and relaxation can all result in physiological changes that promote good health.
Before: I avoided tofu if at all possible.
After: I've tried to work tofu into my diet as a high-protein, low-fat, extremely healthy food. It's not so bad. Really.
Now, if I can only get the habit of flossing. That's been shown to add a year of life, on average.
Please let us know the ways you're chasing life.
Thursday, April 12, 2007
Considering conception in a kit?
CNN Medical News
My friend Scottye is pregnant. In fact, she's having twins. But her road to pregnancy was rocky, and she and her husband spent thousands of dollars on fertility treatments. Scottye's situation isn't unique, particularly as women often wait longer to have babies. That's why a new product caught my eye when it recently received FDA approval.
It's been humorously referred to as "Baby in a Box," but its real name is the Conceivex Conception Kit. It's the only FDA- approved home conception kit. The kit costs $299.95 and is available with a doctor's prescription from the company's Web site www.conceptionkit.com. The kit includes eight ovulation predictors, a conception cap - a flexible cup-like receptacle that is placed over the cervix, a non-latex "semen collector" (actually a condom), a pregnancy test kit, a conception wheel to help plan when the baby will be born, a journal, and an instruction manual.
The maker says these items can be used together for as long as three months "to enhance the couple's chance of becoming pregnant." The most important part of the kit, according to the instructions, is the conception cap, which brings the sperm into direct contact with the cervix, increasing the sperm's chances of reaching the uterus and implanting in an egg. The manufacturer is careful to point out that the kit is NOT appropriate for more complex infertility issues including hormonal problems, endometriosis, low sperm count, blocked fallopian tube, and a host of other common conditions.
We showed the kit to several doctors, and the resounding reaction was that they didn't see any harm in trying to use the kit, but that women might have trouble placing a full conception cap onto the cervix without spilling the contents. One doctor pointed out that many women's cervixes are angled differently from the picture in the diagram, and he also pointed out that it might be difficult to remove the cap after the recommended six to eight hours.
This kit wouldn't have helped Scottye and her husband, who fit into the "complex" category. But it might be useful for a couple who need lessons in predicting ovulation, or in an instance where the man isn't fertile and they choose to find their own donor rather than use expensive fertility procedures, or perhaps in the case of a lesbian couple who have a donor in mind.
Would you try the Conceivex kit if you were having trouble conceiving?
Wednesday, April 11, 2007
Expanding the base for Autism research
By Miriam Falco
Managing Editor, CNN Medical News
April is Autism Awareness Month, and in many respects, awareness of the neurological disorders that fall under the "autism spectrum disorders" umbrella has grown. The latest CDC statistics suggest that 1 child in 150 has an autism disorder - autistic disorder; Asperger's disorder; childhood disintegrative disorder (CDD); Rett's disorder; or PDD-Not Otherwise Specified (PDD-NOS). That's about 1.5 million people in the United States right now. The Autism Society predicts that number will rise to 4 million in the next 10 years.
Parents of children with autism face many frustrations, including finding the proper treatments, getting access to the therapies their children need and paying for the care, because many insurance plans don't cover autism. Just this month Harvard researcher Michael Ganz published a study that says the lifetime cost of autism is $3 million. He suggests that doctors and health-care professionals urge parents to seek financial counseling, so they are able to plan ahead.
There's no test or cure for autism. But researchers around the country are looking for answers to the question: What causes autism? They're finding more clues each day. But so more needs to be learned. And who better to learn from than families with children with autism? A new project launched by the Kennedy Krieger Institute in Baltimore, Maryland, hopes to accelerate the process of unraveling the mysteries of autism by bringing researchers and families together. It has created the "Interactive Autism Network," or IAN - the first nationwide online autism registry. Parents are encouraged to register at http://www.ianproject.org/, because they know things about their child that doctors, therapists and researchers are unaware of. Linking their knowledge to the scientists searching for better treatments and a possible cure is essential. According to Dr. Paul Law, the project director who also is the father of a child with autism, a lot of families want to participate in research, but either they don't know about what's already under way or it's inconvenient for them to go where the research is being done. The IAN project hopes to bridge that gap by providing an online tool.
Does your child, or someone you love, have autism? Would you participate in the Interactive Autism Network?
Tuesday, April 10, 2007
More clarification on supplements
By Caleb Hellerman
Judging from viewer e-mails, our report on anti-aging supplements struck a nerve. Most who wrote were upset and argued that research does support supplements after all, suggested that CNN is in the pocket of the pharmaceutical industry, or both.
Dr. Frank Pinto, the supplement enthusiast we featured, wrote to say that he was disappointed. "Like many other issues in medicine, further study is warranted. Another reason for taking supplements is to ensure adequate amounts of essential vitamins, minerals, and trace elements that cannot be adequately obtained from the diet."
That's certainly true. In fact, Dr. Jeffrey Blumberg, of the Human Nutrition Research Center on Aging at Tufts University, says just 3 percent of Americans follow government dietary guidelines.
Our original headline should have been more specific. Our current headline better reflects the story's focus on anti-aging supplements. As you pointed out, there are well-supported examples of supplements' effectiveness that have nothing to do with aging. Here are two: Folic acid taken by pregnant women has been shown to sharply decrease birth defects, and the National Institutes of Health recommends additional selenium for many people with severe gastrointestinal illness.
It's also true that the book on anti-aging supplements isn't closed. Not just Andrew Weil but our e-mailers pointed out studies showing heart benefits from Omega-3 fish oil supplements (our own Dr. Sanjay Gupta takes one daily) and a potentially lower cancer risk from Vitamin D.
But mainstream science moves slowly. Neither the American Cancer Society nor the National Institute on Aging recommends supplements for the general population, and the American Heart Association "does not recommend using vitamin, mineral or herbal supplements to treat or prevent heart disease and stroke," according to its Web site.
This won't be the last word on supplements at CNN - I guarantee it.
Chasing Life: Stem Cells and Aging
By John Bonifield
CNN Medical News
I peered through the window of an airlock into what might be one of the most controversial rooms in America. At the Geron Company in California, stackable incubators store human embryonic stem cells that are swimming in nutrients - the kind of cells that critics say are grown only by destroying life. The room isn't large, but it doesn't take a large room to grow something as small as a cell. And it's the vast number of cells this room is designed to grow that makes it unique. "What we have here is the world's first and probably the world's only GMP, fully-scaled production plant to manufacture embryonic stem cells," Tom Okarma, Geron's CEO, said on a tour of the company he runs.
How these cells will be used in the future is one of the most contested issues in medicine. In the United States, Geron is positioning itself to be among the first to test stem cell therapies in human clinical trials. It intends to ask permission from the Food and Drug Administration to test a spinal cord injury treatment by the end of this year. In paralyzed rats, it's improved mobility.
We went to the Geron Company for our reporting on Chasing Life , Dr. Gupta's new hourlong program for CNN's Special Investigations Unit that examines the keys to healthy aging. Our investigation also took us to a clinic in Russia where a doctor injects less controversial adult stem cells into patients to keep them young, he says - a claim no research supports. The potential of human embryonic stem cells is that they can transform into more specific human cells, but they can be obtained only by destroying an embryo; Geron uses embryos that were destined for destruction or being frozen forever and would never be implanted to develop into a child. Ethicists swings both ways. In investigating advances into how we age, I wanted to know how these cells might be used. Geron's Okarma said stem cells aren't the fountain of youth, but they will be the pills of tomorrow.
"The whole object here is not to change the lifespan - the biological limit of life. Stem cells are not going to do that," Okarma said. "What we hope stem cells will do is increase the health span - the fraction of our time on earth that is spent in good health."
Dr. Sanjay Gupta investigates stem cells in his new book "Chasing Life," available in stores now, and on CNN on Saturday and Sunday at 8 and 11 p.m. ET.
It was strange listening to Okarma describe how we generally die. We have one or perhaps two organ systems that because of disease or injury begin to malfunction first. They tend to be critical systems. The brain. The heart. The lungs. The liver. The kidneys. It's an inexorable decline that he says stem cells may one day prevent to keep us functioning up until the end of life.
How do you think stem cells will impact how we age? What would life be like at 80 or 90 without the need for caregivers? If we could create cells that would restore the function of critical organs as they are impacted by disease, how would it free us from the burden of premature death? Is it worth the destruction of an embryo?
Monday, April 09, 2007
A doctor's take on the plagues
Yesterday was Easter Sunday. In between conversations about the Resurrection and the sugar highs induced by chocolate bunnies and multi-colored marshmallow Peeps, I managed to make my way to the movies. I went to see, "The Reaping." I guess I hadn't had enough religion in church, so I had to turn to Hollywood for a little bit more. Apparently, I wasn't the only one. The movie placed No. 5 at the box office this weekend.
It's about a minister-turned-scientist, played by Hilary Swank, who investigates divine mysteries. She's called to a small fictional town in Louisiana that appears to be revisiting the 10 biblical plagues of the book of Exodus.
I've always found the plagues fascinating. The gory story is more than 4,000 years old. God, angry at Pharaoh and the Egyptians for keeping the Hebrews as slaves, unleashed 10 plagues: rivers of blood, frogs, lice, flies, murrain or disease affecting only the cattle, boils, hail, locusts, three days of darkness and death of the firstborn.
Over the years, archaeologists and doctors alike have tried to gain insight on the mystery. Dr. John Marr, an epidemiologist at the Medical College of Virginia, and many other scientists have come up with a "domino theory of natural causes" to explain the plagues. Some estimate that about a month passed between each one of the plagues.
First plague - bloody rivers: possibly caused by red algae sucking out all the oxygen in the water, producing noxious toxins and killing the fish. In addition to the dead fish, the algae itself turns the water color red.
Second plague - frogs: The death of the fish allowed for the unhindered breeding of tadpoles. But once the algae levels rose high enough to affect the amphibians, they were driven out of the water and forced to live on land. They could not survive out of the water for long and died.
Third plague - gnats;
Fourth plague - flies: Without any frogs or toads to eat them, the population of gnats and flies flourished amongst their dead bodies.
Fifth plague - disease;
Sixth Plague - boils: "May have been outbreaks of anthrax in cattle and humans, respectively," according to a 1999 CDC article in "Emerging Infectious Diseases."
Seventh plague - hail: "Hail isn't that uncommon, even in Egypt." says Dr. Marr.
Eighth plague - locusts: Arrived in time to eat up the crops destroyed by the hail storm.
Ninth plague - three days of darkness: Sandstorms are very common in Egypt.
Tenth plague - death of the firstborn: Deadly airborne mycotoxins grow rapidly in top layers of poorly stored grain. Starving Egyptians, out of fish and beef, dig out after a sandstorm and rush to the granaries for food. The first to enter would be blasted with mycotoxins and the first to eat, usually the eldest family members, ate the top, most contaminated portions of the grain.
To be clear, the biblical story of the plagues is not about how it happened physically or whether it happened it all. It has carried messages of overcoming oppression for generations. Even with scientific evaluation, it remains a mystery.
"The order of the plagues had to be in that order. The crescendo of terror culminated in the Pharaoh letting Moses' people go. Statistically, that in and of itself, is a miracle," concludes Dr. Marr.
What do you think about the 10 biblical plagues of Exodus? Do you think a scientific basis for the plagues bears any importance? How does this analysis affect your view of the plagues? Do you think there are modern-day plagues?
Friday, April 06, 2007
Remembering a miracle
My husband's best friend, Hans, was supposed to be in our wedding. But three weeks before the ceremony, Hans learned he had testicular cancer. He was 38. The prognosis wasn't good. The cancer had spread to his lungs, part of his stomach and his liver. We visited Hans a few days before we left on our honeymoon. He looked awful, and we were not optimistic that he would be alive when we returned. In a cold and dingy hospital room, we bowed our heads and prayed for our friend. The doctor who was treating Hans came into the room too, and the three of us held hands and prayed together.
By the time we got back from our honeymoon he was sitting up in bed. Six weeks later he would walk out of that hospital, minus part of his lung, and he would live way beyond the number of years the doctors had given him. I believe it was a miracle. Now, I have another friend who is a Harvard-educated scientist who will tell you that no miracle took place. He's an atheist and believes that everything that happens can be explained scientifically. He would say that God didn't save Hans, but rather, the doctors did. In many ways I can't argue. Hans was treated with a cutting-edge vaccine designed to fight testicular cancer, much like Lance Armstrong's treatment. But there was something in that room the night we prayed that makes me believe it was more than just a vaccine that kept Hans alive. I believe prayer, hope and faith had an awful lot to do with his healing.
Plenty of studies have been done on the effects of prayer. A good many have found that those with faith tend to be healthier. But other studies have found no such effect. Researchers at Duke University, in one of the largest studies ever conducted on prayer and healing, found no difference in the recovery of heart patients who had prayer, compared with those who didn't And regardless of religion - Buddhist, Muslim, Jewish or Christian - their outcome was about the same.
Around this time of Easter, I often think of our friend Hans. I will always remember him as a man who taught me an awful lot about prayer and healing. I feel when fighting an illness, you have to believe something or someone will help you through it. For Hans I think it was his strong will to live, and his beliefs. For my friend from Harvard, who has fought clinical depression most of his life, it's the medicine he takes every day. But I will never forget that day in that hospital, when three people joined to ask for help from a higher power. I believe prayer works.
What do you think...do you think prayer helps heal the sick?
Thursday, April 05, 2007
Imprisoned for illness
Here's an interesting dilemma: A young man in Arizona has recently been placed in solitary confinement. He has been there for eight months and there is a good chance he will be there for the rest of his life. It is a punishment usually reserved for the very worst criminals. But Robert Daniels has not been charged with any crime. However, some say what he did was criminally negligent.
Robert has what is known as XDR TB - extremely drug resistant tuberculosis. Both the first line and second line of treatments simply don't work for him. The organism causing his infection has become too smart, easily dodging attacks from antibiotics. Add to that another problem: XDR TB is very, very contagious and Robert Daniels ignored doctor's warnings to wear a mask. And, that is where his crime may lie. Not wearing a mask, walking into public places and possibly putting many others at risk. You see, TB is spread through the air when someone who has the disease sneezes, coughs or even talks.
XDR TB is extremely rare - there have been only around 50 cases in the last 15 years here in the United States. It is more common in Africa and Asia and often accompanies HIV and other immune-compromised states.
So, how should Robert Daniels be treated? Should he be locked away for the rest of his probably-shortened life for not wearing a mask? Or, is there some sort of compromise? Also, this is just one man, but what does this say about how our country could deal with an outbreak with millions of people contracting a contagious disease such as SARS or smallpox?
Wednesday, April 04, 2007
Yet another finding on hormones
Hormone replacement therapy is back in the news, again. As we were discussing this around the CNN offices, I was surprised at just how many women weighed in. Many were so frightened about the risks including heart disease and breast cancer that they swore off hormone replacement altogether. Other women say they will continue to take their hormones regardless of the risks. Yes, they tell me, their symptoms of hot flashes and night sweats are that bad.
Well, today there was a new wrinkle in the whole debate. It is likely some good news. Turns out that after looking at all the studies on women and HRT, something very interesting emerged. For women between the ages of 50 and 60 - usually the beginning of menopause - there seems to be no increased risk of heart disease after all. The risk certainly goes up at age 60 and even higher at 70. (Full Story)
Remember, HRT seemed like a good idea when it was first introduced. As a woman's hormone levels go down over time, you could simply replace that with a pill. As a result, the hope was that you could fend off the ravages of time. Problem was, it didn't work. In fact, for many women the opposite was true. The rates of heart disease and cancer actually went up.
In some ways, the new finding doesn't surprise me. The current guidelines are, only if you have debilitating symptoms of menopause, take the lowest HRT dose possible for the shortest amount of time. Still, we are all different and our needs change over time. The women who are in that critical perimenopausal time frame have a new decision to make. In light of today's new information, should they take hormones to address the symptoms of menopause? Would you, if you were in that position?
Tuesday, April 03, 2007
Making sense of mammograms
Doctors don't always agree on everything. Sometimes, one doctor might tell you to get a certain test and another will say don't bother. At times, you will find a doctor who will want to whisk you off to the operating room, while another will say "go home and rest." There are certain things, though, that patients count on being consistent. One of those things is a schedule as to when to get screened for cancer. For a long time, women heard they should get a mammogram every one to two years, beginning at age 40. Not so fast now says the American College of Physicians. (Full Story)
Based on looking at lots of different studies, they have concluded that the benefits of mammography in women aged 40 - 49 might be outweighed in some cases by certain risks. The risks include a concern about radiation exposure, findings on mammograms that might lead to unnecessary biopsies, worry and anxiety. The flip side is of course that you could find cancer early, which is so critical. By the way, all organizations seem to agree that women 50 and older should get a mammogram.
So, this really is a rub in the world of medicine. What might make sense for the public generally might not necessarily be a good idea for anyone in particular. Sometimes the public health recommendation is at odds with individual recommendations, as is the case here. Many doctors will continue to tell their individual patients to go ahead and get the test, even as recommendations reflect less benefit in women aged 40 - 49.
Keep in mind that many people will take solace in the fact they are not at "high risk." While factors such as family history, breast density and genetic mutations may qualify women as high risk, the majority of women found to have breast cancer never had any of these risk factors. In essence, they become the first person in a family history to have the disease. That was the case in my family, and I am delighted she did get the test. So, what do you do? Will this make you more or less likely to either get a mammogram or recommend it to a loved one?
Monday, April 02, 2007
Can you prove faith?
"Do you really believe in all the tenets of the church?" I asked earnestly. "I mean all of it - heaven, hell, purgatory and the Pope being closer to God?" I pressed in my adolescent voice.
"Chris, I am a nun," replied Sister Clevie. "It comes with the territory," joked my ninth-grade religion teacher.
I laughed, but I couldn't drop it. "I think you're a great nun, but can you really believe in everything the church teaches?"
Religion has always been a big part of my life. I spent years in Catholic school, countless hours in churches - both Roman Catholic and Protestant. Now, I'm even engaged to be married to an ordained minister. All my life, I've been surrounded by the faithful, but I'd be lying if I said my faith never wavered. After all, I am a medical journalist. Much of my life is centered on the measurable: clinical studies, solid data and scientific fact. But like many of you reading this, I've longed for a better understanding of God and the reasons that people believe. Ironically, I've been searching for ways to prove faith.
That's why I was so fascinated by the emerging field of neurotheology. Dr. Andrew Newberg and his team at the University of Pennsylvania have been scanning the brains of believers: Franciscan nuns, Tibetan Buddhists and Pentecostal Christians speaking in tongues. Dr. Sanjay Gupta will report on the interesting and unique findings on "Anderson Cooper 360" in a two-part special starting Wednesday at 10 p.m. ET. The science may offer better insight into the idea of whether human beings are hardwired to believe in God.
To be sure, the idea of scientifically tracking belief in God has many critics. Scott Atran, University of Michigan anthropologist and author of "In Gods We Trust: The Evolutionary Landscape of Religion," is skeptical. He says it's "fundamentally misguided" to look at brain scans for any true meaning of why people believe. Others say the search for knowledge is important, but proof is beyond the point. The Rev. Stephanie Weiner of Union Congregational Church in Montclair, New Jersey, says, "I believe in science. I believe in the medical arts, but when it comes right down to what we're doing with people, it's what do you do after the science runs out or after the medicine can't do anything else."
What do you think about proving faith scientifically? Some people say that God must have created our brains to be able to interpret the almighty. Other people say that religion is nothing more than a byproduct of evolution. Do you think our brains are hardwired for faith? Do you think there is anything to learn from studying the brains of the devout? Do you think spirituality is a direct result of adaptive evolution?
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