Forget the turkey, save yourself this Thanksgiving

Clinton wrote this …

Let’s dispense with the tired clichés and get right to it. Some people just don’t enjoy the holidays. Or, they don’t enjoy the people they have to share the holidays with.

Sometimes the issues boil over at the dinner table, when food becomes the trigger for all kinds of highly charged emotions.

Cynthia Bulik, director of the UNC Eating Disorders Program, knows this. She shared stories with Tara Parker Pope in the NYTimes. From the story:

Dr. Bulik told the story of a patient whose mother scolded her for not eating her homemade cookies. “You don’t like my cookies?” she asked. As a result, the daughter relented and took a cookie. But when she then reached for a second, her mother scolded her again. “Do you really think you need another one?” she asked her.

Sound familiar?

Jonathan Abramowitz,a psychologist in UNC’s College of A&S and department of psych, offers these very timely tips (watch them here):

Remember, the holidays are temporary. If you have to survive by counting down the hours, or telling yourself with each fake smile “it’ll be over soon,” – do it.

Know what triggers your anger or sadness or anxiety, when they happen and how they make you feel; when you see them coming slow your thoughts so you don’t go from 0 to 100 in 5 seconds flat.

Put things in proper perspective. Does the gravy – or the sister-in-law, or your hair – have to be perfect? Nope.

Don’t obsess or try to control what others do or say, but you can change the way you think about something.

Limit demands and ultimatums; replace “should,” “must” and “have to” with “I wish,” “maybe” and “my preference …”

“When someone becomes stressed they’re experiencing an age-old, very normal reaction to the perception of some sort of threat,” Abramowitz says.

Go into an experience thinking that you’re driving your own bus, and enjoy the ride as best you can. You don’t have to expect to have a great time, but you can expect to come out on the other side intact.

Allergic to eggs, the flu shot or flu meds? Maybe, maybe not.

Clinton wrote this …

First it was H1N1 virus itself, then the vaccine became the shot heard ‘round the

CDC

world. Everywhere. All the time. Practically. Is the virus real? Is it as bad as people say? The government should to more, faster! The government should stay out of health care!

The most recent news has been about the drugs that affect the virus – the bug recently mutated into a resistant strain in a very limited population of people who were ill before they had the flu. On Monday, GSK stopped a clinical trial in Canada of an anti-flu drug because too many people in the study had anaphylactic shock.

Which brings me to Maya Jerath, one of our allergy and immunology experts in the Thurston Arthritis Research Center.

Here’s what she told ABC News yesterday about the drug allergy cases, trying to assure people not to worry.

On Monday the doc told me that she’s seen a lot more people come into her clinic concerned that they’re allergic to eggs, and they couldn’t get the flu shot.

Most people, the doc says, got a goose egg on the egg allergy test. She says they likely were never allergic to eggs at all (they may have carried the diagnosis over from childhood), had hives unrelated to food allergies, or they were allergic to eggs, but the reaction was such that the flu shot was still advised – by an allergist.

In fact, not to get too far from the flu, but she said 20% of adults think they have a food allergy, only 2% – 3% actually do. The others have a food intolerance. The difference is that an allergic reaction can be deadly; an intolerance is intolerable for many hours, but it’s not life threatening. (We’re not talking about environmental allergies – allergic rhinitis.)

This is a big deal to people who restrict their diets thinking they have no choice. People who are truly allergic have to be constantly vigilant for the trigger. Some limit their diets to just a few foods – one patient thought she could only eat organic chicken and a couple of starches. Parents can do this to the extreme, unwittingly pushing their kids into a failure to thrive.

Bottom line: If you think you might be allergic to eggs, or meds or cats, see an allergist.

There’s no sense in scrambling your life if you don’t have to. And get a flu shot.

Burn survivors share stories, provide healing

Clinton wrote this …

Last Saturday afternoon four people told their stories about being burned as children — two in house fires, one in a plane crash and another, as a 13-year-old, who attempted suicide — to a gathering of more than 200 at the 17th annual Celebration of Life, a reunion for burn survivors and their families, fire fighters and the staff of the NC Jaycee Burn Center.

“The sharing is not only healing for (the one sharing the story), it provides healing for others,” burn survivor Pam Elliott told News 14 at the event. “It’s just, it’s healing for your soul.”

The survivor who set herself ablaze, who is now a counselor, met a chaplain at the reunion and remembered his voice. He had been sent to her bedside to pray when death seemed imminent. “She wanted to tell the chaplain that she wasn’t going to die, that she didn’t want to die, but she couldn’t. She was intubated,” says Anita Fields, director of the burn center’s After Care programs.

That story spoke not only to other survivors, but to the burn center staff, who sometimes question if what they do is really making a difference. The work constantly intense, and the pace of patient progress can take months.

“Burns are a hard thing to do,” Anita says. She’s been at it for 23 years. “It’s probably reunions and events like this that have kept me doing burns for so long.” The reunion, she says, is a celebration of hard work paying off.

The story of one survivor, Robert Leffer of Sanford, NC, has become popular in the local media. After his truck crashed last January, he fled the cab, on fire. Passersby stopped and put out the flames, then helped him call his wife. “I love you and the boy (their toddler son) so much,” he told her. Then he fell asleep and awoke three months later, in the burn unit.

Leffer was discharged two weeks ago to the SECU Family House, a home near the hospital where patients and their families can live while being close to continuing hospital care. Read more about his story in our Family House Diaries series.

Many survivors’ stories are dramatic — the circumstances that caused the burns and their recoveries. But, Bruce Cairns, burn center director, says, “it’s important to know that burn patients are among us. They’re just like everyone else, they just happen to have a burn injury they’re adjusting to.”

From spinal cord injury to national champion

Tom wrote this …

OK, here’s a warning for you, folks:  I’m about to go all bicycle geeky on you.

Today the UNC Health Care Rehabilitation Center sponsored a spinal cord injury expo in the lobby of North Carolina Children’s Hospital, here at UNC Hospitals. One point of this event is to demonstrate that people who suffer spinal cord injuries can still lead active lives.

To that end, there were people at the event who demonstrated wheel chair ballroom dancing. In addition, guest speakers included Erika Bogan, Miss Wheelchair America 2010, and Todd Richardson, 2007 U.S. national champion in the Handcycling B category.

Todd Richardson with his handcycle.

Since I am a cycling geek myself, I was quite taken with Todd’s story. He’s 45; I’m 44. He lives in a nearby town and rides his handcycle, which you can see in this  somewhat blurry picture from my iPhone, on some of the same roads that I ride.

Todd told me he used to race motorcycles. But that came to an end when he crashed while riding with a friend in 1987, broke his back and lost the use of his legs. Since then he has taken up handcycling, and he’s quite good at it.

In addition to his national title, he won the 2009 Clocktower Classic in Rome, Ga. and raced in the 2007 UCI Para-Cycling World Championships in France.

Now that he’s lived roughly half of his life without the use of his legs, Todd told me, he feels an obligation to share his story with others who are first coming to grips with life after spinal cord injury, to help give them hope.

And, if I may say so myself, he’s got one sweet-looking bike!

To screen, or not to screen? If so, when?

Tom wrote this …

One of the most hotly debated and enduring conflicts in medicine is the war of words between experts who urge people to be screened early and often for cancer, and other experts who say the evidence just isn’t there to justify current screening recommendations, and that screening may even cause more harm than good.

The latest battle in this war erupted this week, when the influential U.S. Preventive Services Task Force issued new guidelines saying there was no need for most women to start getting mammograms at age 40. Instead, they could wait until age 50 to start, and then should get one only every other year, instead of every year. In addition, the panel said there is no reason for doctors to continue teaching women to perform self breast exams at home.

The reaction to this announcement was fast, furious and, I have to say, entirely predictable. For those who truly believe in the value of yearly mammograms starting at age 40, their opinion was not shaken, while those who questioned that protocol felt vindicated.

And here at UNC, we have people on both sides of the issue.

The majority view was represented by Dr. Etta Pisano, who has devoted her career to improving breast cancer detection methods after her mother died from the disease when Etta was a teenager.

“This makes no sense to me,” she told The News & Observer. “I am tired of the debate over this. There is plenty of evidence that mammography reduces breast cancer mortality.”

She explained her thoughts in more detail in this video.

For the contrarian view, we have Drs. Nortin Hadler and Russ Harris.

In his 2008 book, “Worried Sick: A Prescription for Health in an Overtreated America,” Hadler wrote, “Mammography is a technique with compromised reliability, limited sensitivity, and troubling specificity. It is a technique that is far more likely to lead to the extirpation of lesions that are best ignored than to the extirpation of lesions that are lethal, and it will miss many of the latter.”

Way back in 2002, Harris co-wrote an editorial in the Journal of the National Cancer Institute titled, “Routinely Teaching Breast Self-Examination is Dead: What Does This Mean?” This editorial was written in response to a clinical trial conducted in China, which found no statistically significant difference in breast cancer deaths in women taught to perform self breast-exams compared to those who were not.

I doubt very much that this week’s skirmish will be the last. Stay tuned …

Viagra for women? New drug increases female libido

Tom wrote this …

Once I started telling people that I was writing a news story about a drug for treating low libido in women, the jokes began. (You can add your own joke here, if you like.)

But for thousands of women who suffer from what is formally called hypoactive sexual desire disorder or HSDD, it’s no joke.  Some report feeling great distress as a result of HSDD.  Their relationships with their spouses or significant others suffer, and can even fail, because of HSDD.

John M. Thorp Jr., M.D.

In fact, HSDD is the most common sexual problem reported by women, just as erectile dysfunction is the most common sexual problem among men, says UNC’s Dr. John Thorp, who was the principal investigator for North America in four separate clinical trials of the drug, called flibanserin.

This drug, like Viagra, was originally intended for treating depression but didn’t work well for that purpose. And, also like Viagra, researchers testing flibanserin discovered, more or less by accident, that it had unintended effects that proved beneficial in the sexual context.

The original Viagra (for men).

Now an analysis of the data from three of the four flibanserin trials shows that the drug does indeed help women increase their sexual desire, to have a greater number of satisfying sexual events, and to reduce the amount of distress they felt because of low libido. These results were presented on Monday, Nov. 16, at a big medical meeting in France.

For now, flibanserin is an investigational drug, available in the U.S. only to women taking part in clinical trials. Approval from the U.S. FDA, and a catchy name for the drug, could be years away (although there are unconfirmed reports that the drug’s maker, Boehringer Ingelheim Pharmaceuticals, plans to call it “Girosa.”)

What color should the women's car be?

Only then will we know for sure whether women will sing the praises of flibanserin. Or Girosa. Or whatever they end up calling it.

And maybe this drug, too, will have its own race car.

Media coverage so far today has included the CBS Early Show, Good Morning America, which aired an interview with Dr. Thorp, HealthDay and MedPage Today, to name just a few.

Science, not science fiction: Two flu drugs studied at UNC

When Scott Pelley of “60 Minutes” asked HHS Secretary Katheleen Sebelius about political punditry critical of the public health response to novel H1N1, she pointedly said, “I tend to like to get my health advice from doctors and scientists.”

She’ll be getting some of her advice about treating flu from UNC. Charlie van der Horst and Christopher Hurt, from our much heralded Center for Infectious Diseases, are each leading the first studies of medications for IV treatment of influenza.

ID at UNC is known around the globe for groundbreaking work in HIV/AIDS and other  scourges. They’ve identified who’s most at risk for HIV and potential ways to prevent infection. But this is the first inpatient flu study.

“We’ve never had IV drugs (for flu) before. Ever,” says van der Horst, who ran his first clinical trial in 1983 at UNC. “Each year in the U.S. 35,000 people die from flu … We’ve had nothing to offer these people,” vdHorst says. “We’ve routinely had patients die.”

Novel H1N1 put a scare in the medical community because, Hurt and vdHorst say, it resembled “Spanish” flu that killed tens of millions of people around the world from 1918 to 1920. Both bugs started in spring and made a come-back in the fall. If you get the flu now, you can bet it’s H1N1, vdHorst says.

Late-20th century medicine gave us the anti-flu drugs Tamiflu, Relenza (zanamivir) and peramivir. Tamiflu is taken orally; Relenza is aerosolized. They prevent the flu or shorten its duration. So it made sense to provide them in IV form, which provides a more accurate, assurable dosage that goes directly to the bloodstream in people who are hospitalized and beyond the help of chicken soup.

Hurt is studying peramivir, a medication that had not been tested until recently. It’s only available in IV form, and the criteria for receiving the drug in the study are pretty tight; prior treatment with Tamiflu eliminates a lot of people.

But viruses mutate for a living, and novel H1N1 has beefed up its resume by showing some resistance to peramivir’s close kin, Tamiflu, in an isolated instance. One of the usual seasonal flu viruses from last year had widespread resistance to Tamiflu. Both medications operate by blocking the same protein to keep the virus from spreading.

So far, novel H1N1 hasn’t shown widespread resistance to zanamivir, the drug vdH is studying. And to get into that trial a patient has to be sick enough to be hospitalized for five days and, basically, have the flu. It’s open to pregnant women, people on ventilators, people who have received other flu meds, etc.

As for the protection against pundits, some are more innoculated than others. VdHorst waves them off. “Vaccine and medication development in the US is based on pure science, not science fiction,” he says.

** Blog update: Dr. Hurt was informed yesterday (Nov. 17, 09) that he was the first to enroll a patient in the BioCryst (peramivir) study. Way to go! We hope the patient is doing well.

Understanding why the body goes into labor is key to controlling infant mortality

Clinton wrote this …

The National Center for Health Statistics released earlier this week a report on infant mortality.

In its analysis, the U.S. ranks 30th in the world. We deliver far more babies pre-term, before 37 weeks gestation, than most countries, and don’t do as well in keeping them alive.

National Center for Health Statistics

NPR’s Brenda Wilson delivered her usual in-depth and thoughtful news story on NPR, as did Denise Grady in the NYTimes.

I asked UNC’s John Thorp, professor of ob/gyn and deputy director of UNC’s Center for Women’s Health Research, who is passionate about correcting problems caused by preterm delivery and prematurity, his thoughts on the report. Thorp has co-authored several studies lately, including one highlighting the risks of delivering prior to 37 weeks. Here’s what he said.

Clearly prematurity is the biggest contributor to infant mortality and our high US preterm birth rates fuel our poor infant mortality results. I have spent my life trying to better understand the causes of this phenomena and it is a complex problem with preterm births having multiple causes. Our team founded the rubric of spontaneous and medically indicated preterm births as a classification system and the NY Times article delineates some of the mechanisms that we know about.

 

Socioeconomic status plays a key role and there may even be intergenerational effects – the SES of one’s maternal grandfather may be the most powerful predictor. Other contributors include our propensity for elective delivery, captioned ‘late’ preterm birth, and propensity to embrace reproductive assistance technologies that culminate in multiple babies.

 

If I were given unlimited funds I would not know how to prevent the problem, thus would strongly suggest that we invest in learning the biology that causes labor to begin. Despite all the advances in medicine in our lifetimes it is amazing that these basic biologic mechanisms are unknown. Only with that knowledge would we be able to logically intervene. Trite as it sounds, if we can put astronauts on the moon or discover that a virus causes AIDS there is no reason why we should not be able to solve this universal human health issue.

 

 

 

AIDS in the U.S.; the patient profile has changed, so should testing practices

Clinton wrote this …

There is growing sentiment, and evidence, that attention to HIV and AIDS has shifted so far abroad, to Africa and in developing countries elsewhere, that Americans have overlooked a growing epidemic in our own collective backyard.

But even in the US we’re looking through bleary eyes. This isn’t the 1980s. We need to give our eyes a good rubbing and let them focus afresh. When we do, we’ll realize the “high risk” population – IV drug users, men who pay for sex and men who have sex with other men – has changed.

The question has been who to target for testing. When a diagnosis of HIV is made early people can start receiving care sooner, probably use fewer health care $$, have a better prognosis and, hopefully, remove themselves from the sex pool.

But it’s the wrong question. Everyone needs to be tested, says Yvonne Carter, M.D., an ID fellow at UNC. Carter reviewed data for more than 200 black men and women in the rural South, where the epidemic is most rampant. They were 18-61 and denied IV drug use and male-male sex. After some fancy statistics she found that socioeconomic status, health insurance status and history of incarceration were not associated with having more advanced disease.

But there was a group whose rates of advanced HIV was twice as high as others’ – the men. Women, Carter says, usually have more interaction with a health care provider. Men, especially black men, she says, tend not to go to the doctor until they’re very sick.

“This stresses that HIV testing is important, and implies that we can’t hang our hats on this person or that person,” Carter says. She presented her study Oct. 30 at the IDSA meeting.

Carter, a black woman, was drawn to disparities research after a trip to Africa as a medical student at Maryland. She came to UNC to be mentored by Ada Adimora, one of our many top HIV/AIDS doctors. Adimora leads the Rural Health Project, which continues to provide important data, including that for Carter’s work.

In 2008 Adimora told Congress that AIDS in black men represents a national emergency. Black men account for more than half of all AIDS deaths, and about 45 percent of new diagnoses. But the question about “who” to test needs to change to “how” and “when,” as in, how soon and how can we test everyone, often.

Graduating from high school, at the hospital

Ginger wrote this…

On Oct. 23 I attended a graduation ceremony – in the NC Jaycee Burn Center at UNC Hospitals. I watched Ryan Frias, a burn patient, precess down the hospital hall, lined with staff clapping and cheering, to “Pomp and Circumstance.”

Ryan’s story is an inspiring one. He was admitted to UNC almost a year ago, on Dec. 5, 2008 after a car accident that left him with burns covering close to 80 percent of his body.  Bruce Cairns, Ryan’s doctor, described the burns, which covered his chest, neck, arms and head, as “the deepest kind you can possibly have.” Since he was admitted, Ryan has undergone nine operations. But Ryan seems to take it all in stride. “Just because I’m a little handicapped now, I’m not going to let it stop me.”

Well, it clearly hasn’t. Ryan, who is from Monroe, NC, was in the middle of his senior year at the Central Academy of Technology and Arts doing a pre-engineering concentration, when the accident put his schooling on hold – for a little while. As soon as he was able, in May, he began taking senior English (the only class he needed to graduate) with a hospital school teacher who would conduct the classes orally while he learned how to write again. He was done by September.

Ryan says he looks at his graduation as the close of a chapter. Of course, graduation always signifies the close of some chapter. But he’s referring to something different. He is merely days away from discharge and is more than ready to move forward – from the accident, from the hospital – and he’ll do it with a high school diploma. Congrats, Ryan.