Category Archives: Other Health Conditions

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.

Advances In Fighting Migraines


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 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.

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


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.

Go Red For Women

Have you considered how exam room layout can affect patient care?

Heart disease kills more women than breast cancer. In fact, it kills more women than every form of cancer combined—one in four American women can expect to die of heart disease, making it the number one cause of death for women in the United States. Not only do more women die of heart disease than die of cancer, more women die of heart disease than men do, in part because people, doctors and patients alike, don’t realize that women don’t show heart disease the way men do. An estimated 42 million women have undiagnosed heart disease, and one reason it is undiagnosed is that health care professionals are looking for male symptoms women don’t have.

On top of that, the symptoms of heart disease in women are more subtle than in men, making them harder to spot as well as harder to recognize. When a woman has heart disease, it affects the main arteries, but is more likely to be in the smaller blood vessels in the chest as well than when a man does. She may experience neck or shoulder ache, abdominal pain, shortness of breath, throat pain, nausea, lightheadedness, dizziness and fatigue, or sweating.

The the symptoms are different, the risk factors for heart disease are largely the same in men and women, though not always to the same degree. Diabetes and stress, for example, are more strongly linked to heart disease in women. Smoking is one of the biggest controllable risk factors for heart disease in anyone, because it narrows the blood vessels, but this is particularly the case with the smaller ones that are more affected in women. The danger of smoking is also exacerbated by hormonal birth control; the hormones make the effects of smoking worse. On top of that, hormonal birth control is itself a risk factor, as are the hormonal changes wrought by menopause, both concerns unique to women.

To raise awareness of the special concerns women have for heart health, today is the American Heart Association’s Go Red For Women Day. Today is the day to start to take steps to lower your risk of heart disease death. That means quitting smoking. It means making the effort to get enough exercise, about 30 to 60 minutes most days. It means a heart-healthy diet with lots of fruits and vegetables and low in saturated fats. It means maintaining a healthy weight. It means talking to your doctor about an aspirin regimen that can help prevent arterial plaque from building up. It’s never too early, and you’re never too young, to start protecting your heart.

Measles Returns

L0032962 Back of female with measles

Decades ago, measles was a common childhood disease, and complications were also common. Around one-third of people who contract measles—and it was nearly ubiquitous at one time—get some other medical condition a a direct result. The most common of these is otitis media, or a middle ear infection, which may result in hearing loss. Other complications include pneumonia, bronchitis, and encephalitis; in many cases measles can even be fatal. Measles can also cause corneal ulceration and scarring, which could lead to diminished eyesight.

These complications are largely in the past, however, thanks to measles vaccination, which became available in 1963 in the United States and was almost universal after 1977. The measles vaccine provides immunity to 95 percent of children older than one year who receive a single dose, and most of the remaining five percent develop immunity after a second dose.

During the heyday of the disease, "measles parties" to allow infected children in a community to spread the disease to their uninfected neighbors—especially the girls, because women who get the disease as adults, particularly during pregnancy, are prone to miscarriage or to having children with birth defects—were common. Measles vaccination is the same basic principle, stimulating an immune response so the disease doesn’t affect adults, but in a more certain and concentrated way with less suffering involved.

Unfortunately, measles has recently had a resurgence. In the late 1990s, false controversy began to be sown over the safety and efficacy of vaccines, and the 610 cases reported last year were the first large harvest. As parents are delaying vaccinating their children against measles—such as by rejecting the measles-mumps-rubella combined vaccine in favor of getting the three immunizations separately and spaced out—or refusing entirely, communities across the United States are seeing a growing number of measles cases, despite the disease having been declared eradicated in the Americas in 2002. In 2014, there were more than 200 cases of measles reported in the country for the first time in 17 years.

Not all parents who don’t vaccinate fear the bogeyman of alleged safety issues; some interpret religious requirements as forbidding it, and some have genuine medical reasons they can’t. However, when almost all children are vaccinated, herd immunity protects those who are not. Herd immunity means if someone is infect, even a highly contagious disease such as measles has no place to go.

Goodpasture Syndrome


Goodpasture syndrome is a rare autoimmune disease first discovered in 1919. It affects less than one in 500,000 people—according to some estimates, as few as one in two million people. The condition occurs when the immune system attacks the the glomeruli, or lining, of the lungs and kidneys. In the kidneys, the glomerular cells are part of the apparatus responsible for the first stage in filtering the blood, which is the function of the kidneys. When this cell layer is mistaken for an infectious agent, the immune system can cause significant damage.

In particular, this disease can result in patients coughing up blood. They will also experience shortness of breath and chest pain. Once the condition moves to the kidneys—or when it starts there—symptoms include swelling of the limbs, a puffy face, high blood pressure, or blood or protein in the urine, due to the disease harming kidney function. Goodpasture syndrome generally starts in the lungs first, and moves to the kidneys afterward. However, in 10 percent of cases it stays in the lungs, and about three times as often, it never affects the lungs at all.

It is not entirely clear what causes Goodpasture disorder. It is likely that some people are particularly susceptible to the illness, because there is a long list of possible triggers, things that damage the blood vessels in the lungs and draw the attention of the immune system, some of them quite common, but the disease remains rare.

These triggers include cigarette smoke, high oxygen levels, sepsis, cocaine, infections such as flu, metal dust, hydrocarbons, and organic solvents. There appears to be a genetic component, and certain gene mutations are themselves triggers. Recently, scientists found that the element bromine plays an important role in protecting the kidneys from the immune system.

It is important for Goodpasture syndrome to be treated quickly, because it can progress rapidly, and soon become fatal if let alone. Treatment generally means suppressing the immune system long enough for it to become acclimate again to the kidneys. Another treatment is blood purification, in which unwanted antibodies—to the body’s own organs—are removed. However, even once the disease is cured, the damage it has done remains.

Heart Health


The heart is the body’s motor, and when it stalls out, it can cause problems. The heart doesn’t deteriorate as its person gets older, but when heart disease strikes, it can interfere with the functioning. Heart disease is deadly, and it gets more likely with age. However, just because it is more likely doesn’t mean it’s inevitable. It is estimated that 80 percent of cardiac-related deaths could have been prevented. That would mean saving close to 650,000 people. It’s easy to keep the heart healthy with a few simple lifestyle changes.

Avoiding stress is one of the most important things a person can do to prevent heart disease, and it has a fairly large return on investment, yielding a lot of improvement for simple actions. Destressing can mean slowing down, getting enough sleep, organizing one’s life—through straightening up the home, the office, and the e-mail inbox as well as staying on top of scheduling by making to-do lists and maintaining a calendar. Taking a relaxed attitude and keeping life in perspective also helps. And some destress techniques are also good for the heart in and of themselves, such as quitting smoking, eating a healthy diet, and staying active.

In fact, even simply walking can help the heart—as little as parking at the far end of the lot, or getting off the bus of subway one stop earlier than usual, will make a difference. Just 30 minutes of walking a day provides benefits. More intense workouts are even better for people who can do them. Twenty-five minutes of intense aerobic exercise a day, three days a week is a great way to build a healthy heart.

A heart-healthy diet is also important, but it doesn’t have to be bland or boring. Good menu options for heart health include oatmeal which can be dressed with fruit such as bananas; avocados, including in guacamole; soy; olive oil; and berries. These foods help lower cholesterol, cut fat, and provide protein. Potatoes, tomatoes, red wine, and green tea are all good for the heart, containing substances that actually fight heart disease , such as lycopene in tomatoes and flavonols in red wine. Flavonols are also found in dark chocolate, another indulgence that helps the heart.