Author Archives: Charles Lieberman

On Mental Health

mental illness

More than one American in 20 has some form of major psychiatric illness, most often schizophrenia. Four times that number, one in five, has some sort of mental health issue. Despite the commonness of mental health problems, these problems continue to be stigmatized. This stigma is one of the most dangerous aspects of mental illness, and one of the largest obstacles to seeking treatment. Much of the difficulty mental illness causes the patient lies not in the illness itself but in lack of treatment and lack of support from friends, family, and co-workers, and an inability for patients to get the help they need, which in turn is due to the stigma preventing the patient from telling anyone or even, in many cases, getting a proper diagnosis.

In fact, only 40 percent of mentally ill people even start treatment, and many of them drop out. The stigma of mental illness is self-perpetuating. People with mental illness hide their conditions from those around them. The popular image of mental illness comes from fiction and from those who are too sick to hide it, and harmful, damaging, and pernicious stereotypes take root. People raised in the stereotypes, and surrounded by people who are raised in the stereotypes, are unable to tell people about their problems, or even recognize them as mental illness, and so it continues.

The stigma of mental illness also means sufferers face discrimination. It may be harder for people who are mentally ill to find jobs or housing, and in some cases they may even face physical violence. Women who are mentally ill are at heightened risk of sexual assault, in part because of the expectation that they will be dismissed as delusional if they report it, and all people with mental illnesses are under threat of violence from people who will be believed if they say it was defensive.

Fortunately, more and more people, including several celebrities, are coming forward about mental illness. By coming forward, they are changing the public face of psychiatric difficulty and helping break the stigma. There are some indicators that thee efforts are having the desired effect. Last year, a study conducted in England found attitudes toward the mentally ill improving, and greater sympathy and understanding of mental illness, with less fear and distrust.

Regrowing Spinal Tissue

Proper handling and cleaning of surgical instruments during surgery helps to prevent infections.

Spinal cord injuries are generally regarded as impossible to recover from. The spinal cord is responsible for connecting the brain to most of the body, providing the pathways through which the brain sends signals to the muscles in the arms, legs, and other areas, and receives information from these areas—touch sensations, when a person feels something on the skin. When the spinal cord is injured, these communications are disrupted, and the brain can not communicate as effectively—or at all—with these areas. There are 12,000 new cases of spinal cord injury every year in the United States, generally from automobile accidents, falls, violence, and sports injuries, and most result in permanent paralysis and sensory problems.

Now researchers have found a way to help recovery, and have successfully saved at least one patient’s spine. The researchers used olfactory stem cells to regenerate damaged tissue. The cells were taken from the scent receptors in the nose, an area in which cells are regularly damaged and regularly repaired by the body. Because of this, the tissue could be removed from the olfactory bulb and would be regenerated as part of the ordinary repair process; it also meant that thee cells, which are designed to regenerate and which, being stem cells, are not locked into any specific function, could grow new spinal cord tissue when used there. Though none of the patients in which this was tried made a complete recovery, all three experimental subjects showed a significant degree of recovery and gained back at least some of the lost function.

The most successful procedure was done in a Bulgarian man named Darek Fidyka, who’d had his spinal cord entirely severed in a knife attack, and became completely paralyzed from the chest down. As a result of his injuries, he’d been unable to move or feel anything below his rib cage. Fidyka was the most severely injured of the three patients in the study, and according to doctors, he is believed to be the first person ever to recover from such an injury. From total paralysis, he has recovered to the point that he can walk, with the help of a walker, and drive a car.

Pontine Glioma

brain

Childhood cancer is ordinarily treatable. Although it can be scary when one’s child develops cancer, children’s resilience means cancers in children respond very well to treatment. The only exception is brain tumors, which, because it requires such precision to treat anything in the brain, are the riskiest for children. That includes a cancer of the brainstem called a pontine glioma, one of the most dangerous tumors to treat.

The brainstem is the part of the brain that controls essential function. It’s difficult to label any part of the brain the most important—the entire thing is important—but it is the brainstem in which dysfunction has the most inevitably noticeable and broadest, and widest ranging effects. The pons, where pontine glioma develops, is responsible for breathing.

Children who develop pontine glioma will have trouble walking, standing, and speaking, because the tumor affects parts of the brain that communicate with the arms and legs, as well as the speech areas. It also affects the facial muscles, making eye movement and swallowing difficult and causing one side of the face to droop. Children with this type of tumor may also have trouble closing their eyes all the way, and may have double vision. Pontine gliomas often grow rapidly, causing damage as they do.

It is not known what causes these tumors to develop. There is a type of fungal infection of the scalp that is ordinarily treated with radiation, and children who have had this radiation treatment are more prone to developing glioma of the brainstem, but not all cases can be traced to that source. In a recent study, researchers found that the genetic code of the tumor contains gene mutations that had not previously been linked to any form of cancer, and they say this may prove to be a useful diagnostic tool in the future.

Sadly, children diagnosed with pontine glioma are not expected to survive more than nine months. Fortunately, however, new treatments are being developed that could well save lives. Now that mutations linked with pontine glioma have been discovered, scientists are tracing the effects of those mutations, determining how they relate to tumor development, and finding ways to prevent tumors from developing and destroy them when they do.

Advances In Fighting Migraines

migraine

Migraine affects more than 10 percent of people throughout the world, and about 12 percent of people in the United States. It strikes three times as many women as men. Migraine is wildly under-diagnosed, however, because exactly what it is and how it works is not clear. That means that public health experts estimate that more than half of all people with migraine have never received a diagnosis. It also means there is no reliable treatment for migraine headaches. It is also difficult to research treatments because people who experience migraines show no symptoms between times.

That’s why prevention is best. As best as can be understood, migraines appear to be linked to a neurotransmitter—a chemical used by the brain for various functions—called dopamine. The exact nature of the link is not clear, but dopamine in migraines may be activated by triggers which vary from person to person. Among the most common migraine triggers are onions, alcohol, secondhand smoke, and MSG. Some chemical compounds are also common triggers, such as the nitrates used in curing meat or tyramine, which naturally forms in aged foods such as wine or certain cheeses. Stress is another frequent cause of migraines, not necessarily directly, but in the period after the stress has passed hen the body is recovering from its heightened state. That means a migraine sufferer’s best option may be to learn and avoid their specific triggers, though this can require painful trial and error

However, it may not always be possible to avoid triggers. In these cases, there are some treatments that may help alleviate symptoms. While caffeine is a trigger for some patients, in others it can improve matters. Some prescription medications also have benefits. Beta blockers, the antidepressant amitriptylene, and anti-seizure medications seem to prevent migraines from occurring. More unusual approaches have also been tried. One of these is transcranial magnetic stimulation, in which powerful magnets are moved over the skull. Although it’s not clear what effect this has, it has been shown to work for many patients. Another treatment option that helps with migraines is medical marijuana, though again, that can be a trigger for some patients.

Enterovirus Outbreak

enterovirus

Enterovirus 68 as been known for more than 50 years, but a recent outbreak that has hospitalized children across the United States has parents looking for answers. Enteroviruses are a common source of childhood illnesses, primarily causing respiratory or inflammatory disease. Most ordinary infectious diseases children get growing up result from enteroviruses. These diseases are generally fairly mild and quickly run their course, causing nothing worse than temporary discomfort. However, enterovirus 68 is on of the more severe types. Only six outbreaks were reported from 2005 to 2011, but since this past August, there have been nearly 700 cases throughout the country, resulting in five deaths.

The cold is a type of enterovirus and indeed most enteroviruses are spread like colds, through close contact. That means any sort of direct touching, or sharing eating utensils or drinking glasses, or toys. People can also pick up the virus by touching their faces after touching a surface that has the virus on it, such as a chair or table at which a sick person has recently been sitting. The spread can be prevented by washing hands and surfaces, and avoiding shaking hands with, kissing, or hugging people who might be infected. Most people with enterovirus 68 can treat it with the care given a cold—rest for a week, plenty of fluids. It is slightly more of a danger for children with asthma. It is unusual, though not unheard of, for enterovirus 68 to be deadly.

What is unusual about the August outbreak is its size. After fewer than 100 reported cases in the Unites States in half a century, the recent outbreak has seen 30 cases per day at just one hospital, with close to 700 overall over about two months. Some experts say it’s a statistical artifact, with previous cases going unrecognized, while better diagnostic techniques and greater attention by health agencies are making the virus more readily identified without actually being more common. This frequently happens with rare or recently discovered diseases. Some enterovirus 68 patients have had paralysis, but it’s not clear i or how this relates to the virus.

Give A Heart On Valentine’s Day

organdonorribbon

Today, 19 people will die who could have been saved. It isn’t yet known who they are, but they are among the more than 120,000 people awaiting organ transplants in the United States. Some of them are children. A small number are infants under one year old. One person will have die waiting for a transplant for every four patients who get transplants. These people will die because there are ten times as many people waiting for organs as there are willing donors, including living donors for some organs, and not all of those donors can donate to every, or even any, would-be recipient.

Organ transplants are necessary. In fact, because they are so difficult—they require not only an exact match, but anti-rejection drugs that suppress immune response to the transplanted organ isn’t rejected for the remainder of the recipients life—transplants are only performed when the recipient has a good chance with a transplant but essentially no chance without one. These people need donors who agree to allow their kidneys, pancreas, liver, lungs, heart, and intestines to be removed posthumously and given to someone who needs it, if it is useable, or for a part of any of these organs except the heart to be removed from a living donor and transplanted into a patient in need.

People who volunteer to donate organs are given the same treatment as other patients when they themselves are hospitalized. There’s no rush to declare them dead to use their organs. In fact, their organs require more extensive testing, to determine what is useable and how it can best be used. This testing is paid for by the recipients insurance, or by charitable organizations. These are also the sources of funding for living tissue donors; no expenses are born by the donors or their families. Modern donated organ and tissue recovery techniques mean it’s even possible for someone to have an open-casket funeral after donated tissue is removed. No one is too old or too sick to donate tissue; even people with illnesses affecting some organs are generally able to donate the rest. In most states, enlisting as a donor is done though the department of motor vehicles. but any health care facility should have information on how to volunteer.

Love And Health

love

Love is an important part of life. Anthropologists say it has existed across cultures and throughout human history. Some scientists have even proposed a biological component to falling in love. There is some evidence of this—hormones such as oxytocin and PEA that are activated by, among other things, interactions with romantic relationship partners, for example—but love is also a mental state, a set of actions, and a social phenomenon. Additionally, it turns out love, as well as being an important part of life, can have a significant impact on a person’s health.

For one thing, being in a relationship can help lessen stress. Sometimes relationships are a source of stress, but a healthy relationship means a less stressful life overall—though studies have found that unhappily partnered people have higher blood pressure than people in happy relationships or single people. On top of that, being in love can help spur wound healing. Injuries in coupled people healed an average of one full day faster than singles. People’s partners also seem to encourage healthier habits and preventative care, and discourage substance abuse.

There are downsides as well. Love can hamper attention, according to studies. People in love is not a mental illness, at it is sometimes facetiously called, but people in love do seem suffer impaired cognitive abilities. Scientists tested people who had been in relationships for six months or less on the ability to separate out relevant from irrelevant information, a common task to test cognitive ability and attention. The newly partnered people performed worse on this task than others. Previous studies found, however, that in longer relationships, the ability to ignore distractions is essential to the health of the relationship. Thinking about a new partner—male or female, men and women alike—seems to use mental resources that would otherwise be devoted to these tasks.

In the long run, though, being in love is an overall improvement. Even kissing can help make people healthier. Kissing burns calories; not as many as other forms of exercise, but those aren’t as much fun. Kissing helps lower blood pressure, fights calories, and even helps with headaches.

Multiple Births

twins

About one pregnancy in 30 results in multiple births, two or more children born at once. Almost all of these are twins. The frequency falls off dramatically as the numbers of births goes up with triplets rarer than twins, quadruplets rarer than triplets, and five or more births almost unheard of and nearly always as a result of medical intervention of some kind. Higher order live births are rare, more often some or all of the fetuses miscarry or are stillborn. In 2013, only 66 sets of quintuplets or higher were born in the United States, and there were more than 32 times as many twin births as all higher order births combined. In all, there are about 130,000 sets of twins born every year.

Common reasons for multiple births are older mothers—twinning is more common in mothers over 30—and fertility treatments, which often involve multiple ovulation or the creation of multiple embryos as a hedge against a greater risk of losing them. Fertility drugs, which encourage ovulation, often lead to multiple mature ova in one cycle. Twinning runs in families. A woman who is a twin is likely to have twins herself. Twins can be either monozygotic, developing from a single zygote that splits, or dizygotic, in which two ova are fertilized and two entirely separate zygotes develop. Triplets are sometimes monozygotic; triplets usually, and higher order births almost always, are either strictly polyzygotic or a combination of the two.

Multiple births are prone to complication. Because multiples are so hard on the gestational environment, it is quite common—moreso as the order increases—for one or more of the fetuses not to survive. The most births ever recorded is a woman who delivered octuplets after undergoing fertility treatments, but it is very rare for all eight fetuses to survive in such a pregnancy. Although more than 90 percent of single pregnancies are carried to term, more than half of twins and 91 percent of triplets are preterm, another factor affecting survival. Because of this, multiples tend to have low birth weight and are more prone than singletons to cerebral palsy.

Congenital Heart Defects

The heart is an intricate organ made up of many parts, making open heart surgery a common option when something goes wrong.

Congenital heart defects are the most common kind of birth defect among children born in the United States, affecting nearly one percent of all newborns in the country. There are multiple kinds of heart defect, classified according to the location of the problem within the heart as well as what, specifically, is wrong. The types of heart defect include:

Complete atrioventricular canal defect, a failure of the walls separating the chambers to meet and fully close. This means blood entering the lungs mixes with blood that s to circulate to the rest of the body, causing improper oxygen distribution.

Truncus arteriosus, in which the blood vessels leading in from the lungs and out to the body are fused together, when they are supposed to be separate. This condition also interferes with proper circulation of the blood through the body.

Ebstein’s anomaly, in which the heart valve on the left side cannot fully close.

Tetralogy of Fallot, the co-occurrence of four different malformations. These are a hole between the heart’s lower chambers, the aorta right above this hole and connected to both chambers rather than only the left, a blockage in the link between the heart and the lungs, and a thickening of the wall of the right chamber.

Pulmonary valve stenosis, in which the heart valve doesn’t open all the way and blood sometimes flows back out.

Atrial septal defect, a hole in the wall separating the heart’s upper chambers.

Coarctation of the aorta, a narrowing of the artery that carries blood out of the heart. This can can lead to high blood pressure, which is dangerous in infants.

It is often important that heart defects in newborns and infants be treated, usually with surgery. Because these defects are typically diagnosed so young—symptoms are frequently apparent early on, such as the tetralogy of Fallot, which can result in blue skin—and because infants born with heart defects may have other illnesses as well, there might be limits on the types of surgery that can be performed. In some cases, however, it is possible to leave the defect as is, at least temporarily, and it is sometimes possible for children born with heart defects to grow up quite healthy regardless.

Depression And Allergies

pollen

More and more, researchers are starting to see a connection between allergies and depression. There is evidence of relationships in both directions, so allergies exacerbate depression, while depressive symptoms and affect make allergy symptoms worse. One study found that this connection is partly responsible for an uptick in suicides as winter turns into spring. Part of this is a hope that depression is merely seasonal being dashed—people tough it out through the winter but go into a decline when spring doesn’t bring improvement—but now it appears that allergens increasing in the springtime also bears on this phenomenon.

Depression is thought of as a mental illness, but the brain is part of the body, and there’s no bright line, medically speaking, between physical symptoms and mental ones. One place where this is apparent is allergic reactions causing depressive symptoms. Allergens are normally harmless substances, such as pollen, that trigger an immune response in people who are sensitive to them. Part of this immune response is inflammation. Inflammation can lead to a low feeling called dysthymia; this is why people who are sick feel awful. Dysthymia is also a symptom of depression. Some scientists have proposed that a hitherto underestimated cause of depression itself is inflammation due to allergy.

Meanwhile, stress is both a cause and an effect of depression. Depression can be a response, in part, to stress, but t can also increase it. Stress is also intimately bound up with the immune system The stress hormone cortisol temporarily suppresses the immune system, only for it to come back turned up after the stressor has passed. That means that stress, anxiety, and depression actually make allergic reactions worse, particularly on the second day. That means not only does stress directly lead to depression, it also increases depression as a result o the inflammation from an allergy attack.

In children, scientists have also found a genetic link between allergies and depression, as well as behavioral problems. While allergies themselves exacerbate depression, and allergies and depression alike are partly responsible for children misbehaving, there is evidence that genetics is behind a predisposition to allergies, a predisposition to depression, and a tendency to act out.