Tom wrote this …

I never had the opportunity to meet Lillian Chason, the first-year UNC student who died at UNC Hospitals this week after being critically ill and on life support since right before Thanksgiving. By the the time I first heard of her, she was already in this precarious condition.

Lillian Chason

But because of my job, I did briefly meet her mother, father and sister. News media had requested interviews with the Chasons, and I went to discuss the issue with them.

The Chasons had started a Facebook page, called Prayers for Lillian, to keep friends and family up to date on her fight for life after falling ill with what was believed to be H1N1 flu. By this time Prayers for Lillian already had about 3,000 followers and was the primary source of information for a story in The Daily Tar Heel, the UNC student newspaper. After seeing that story, other media called my office and requested interviews with the Chason family.

The Chasons chose not to give any media interviews at that time. They told me they preferred to wait until later, when — they hoped — Lillian would be doing much better.

As we all know now, that moment never came. Lillian’s father posted the sad news of her passing Wednesday night, on the Prayers for Lillian site, which by then had more than 10,000 followers.

Many elements of this story had a profound impact on me. I found the Chasons to be very likable, and I hated to see them in such a difficult situation. And Lillian’s story — a drama enthusiast who had been cast in the lead role in an upcoming play — reminded me of my own niece, an aspiring actress just a year or two older than Lillian, whom I had just seen at Thanksgiving.

But most of all, I was struck by the tragic randomness of it all. Lillian fell ill with flu-like symptoms  as the number of new H1N1 cases was declining, both locally and nationally. Plus, I know several other people who have been ill with H1N1, including one about the same age as Lillian, and all of them recovered with no long-term adverse consequences.

We may never know exactly why this one bright, promising young woman’s life was claimed when many others who had the same illness survived. But we do know this:  the H1N1 vaccine is now widely available in the U.S. and that’s the best defense. If you want it, you shouldn’t have any trouble getting it.

But have you done so? If not, what’s holding you back?

Clinton wrote this …

It’s not that we’re piling on. We’re taking advantage of an opportunity to deliver important patient information.

So, when Anthony Galea was charged for Actovegin, which is illegal in the US, and he described treating (very) high-profile athletes post-ACL surgery, we caught up with our sports medicine docs for a little insight.

NIH

Galea said human growth hormone could be gotten in any gym in NY. Dr. Jeff Spang, assistant professor of sports medicine in Orthopaedics, says HGH is still mostly in the realm of pros, whose $10 million contract might ride on a blown knee or hip, because “it requires knowledge + money to get the product.”

Those who do take HGH, Spang says, “are so focused on the present that they are willing to accept the risks because they believe it will hasten recovery after injury,” regardless of evidence to the contrary. What are the risks? Spang says HGH could promote the growth of tumors that haven’t yet been found, and it might lead to a decrease in the sensitivity of insulin. Then there’s the Sergei Akmudov effect. 

So, what is cutting edge? Platelet therapy is promising, and we’re studying it here at UNC.

“Platelets are a naturally occurring part of the blood that are attracted to areas of injury,” Spang says. “They serve to send out chemical signals to stimulate the growth of new blood vessels and new tissue and are generally viewed as an important part of the natural healing response.”

To use platelets, blood is drawn, then spun in a centrifuge to separate the platelets, then the platelets are injected into the injured tissue. The process has proven effective in the lab, and some elite athletes have had it done, but UNC and others are testing it for long-term effects so docs and patient can be confident in its efficacy and safety.

The whole problem is that we can’t wait. People want to heal faster. It’s one thing if you’re chasing the all-time home run record (and Madonna). But if you’re trying to run down the 4-hour mark in the 26.2, or obsessing about getting back in the gym, get real.

You can heal like a tiger, but, Spang says, “patients who have suffered a serious injury have to respect the healing process.”

“There is no miracle cure that exists to shorten healing time or improve function after serious injury.  Follow through with a complete physical therapy program and respect the body’s natural capacity to heal – no additives required!”

Clinton wrote this …

When we produced the Grinch video our hopes were that 1.) it would be seen far and wide and 2.) people would, as Dr. Cindy Bulik says, learn from the Grinch that depression is manifest in many ways, and you might be prompted to help out a friend (including yourself) in need, whether or not they have termites in their teeth or garlic in their soul.

We’re still working on No. 1, but yesterday, we got confirmation that hope No. 2 is at least realistic.

I had a voice message from a counterpart at Colorado State about the video.  I called her back and discovered that the university’s community is experiencing a suicide crisis.

The concern is that people are starting to tune out the typical suicide-prevention messages, but they might watch the Grinch. The school wanted to know if we would mind if they used the concept.

Of course not! Use the concept, use the video,  strip UNC’s logo if you want, this goes beyond publicity.

The hard fact is that, for some people, the holidays make feelings of isolation, resentment, sadness, fear and anger even worse.

And a sad fact is that mental health is still a taboo topic.

From Dr. David Rubinow, chairman of Psychiatry:

The discordance between what we may feel and what we think we are supposed to feel can itself be a source of substantial distress and self criticism. The expectations surrounding Christmas and Thanksgiving are simply enormous. By contrast, people don’t seem to get depressed around the 4^th of July.

If left unevaluated and unattended, symptoms (of depression) may deepen and become more resistant to treatment. Additionally, depression is a potentially fatal illness, accounting for a large proportion of those individuals (nationally) who commit suicide.

Despite the availability of assistance and the steep downside risk of forgoing treatment, many people don’t ask for help when they’re feeling depressed.

People aren’t reluctant to ask for help if their stomach hurts, but they are if it’s their mind that’s hurting.

 Reluctance is a malignant consequence of our society’s puritanical indictment of anything related to feelings. People with any kind of mental disorder are stigmatized in this society, despite the fact that depression is currently the fourth-leading cause of morbidity and impairment, and is slated to become second only to heart disease by the year 2020. Depression is a serious illness, not a moral failing or an incapacity to appropriately manage one’s feelings.

So, while we hope you’ll find our videos creative and clever, if they’re also of practical help, all the better.

This post was written by Adam Goldstein, M.D., M.P.H, from the Department of Family Medicine in the UNC School of Medicine.

Hanukkah, the Jewish Holiday of Lights, starts Friday evening, December 11th and runs for eight nights.

A menorah and special foods are part of the Hanukkah tradition.

Hanukkah is a joyous holiday for Jewish people around the world, celebrated with lighting an increasing number of the 9 candles each night of the menorah, or candelabra.  With the singing of songs, with the tradition of playing games of a spinning top, or dreidel, with the tradition of eating fried potato pancakes, Jews celebrate the successful rededication of the second Jewish temple, liberated from Roman desecration and occupation 2,100 years ago by the Maccabees, Jewish freedom fighters of the second century BCE.

The themes of Hanukkah are ones that resonate to both Jews and non-Jews
worldwide: Fighting for liberty, fighting for religious freedom, fighting for tolerance, and fighting for the preservation of culture.
The believe in the miraculous and hope for a better world underly Hanukkah, represented by oil that should not have lasted for more than one day when Jews re-entered the Temple, but somehow, it lasted 8 days.

Thus, unlike most Jewish holidays that occur predominantly inside the home or synagogue, Jews are commanded on Hanukkah to “light the menorah” publicly, in open spaces and windows, to show the world that we must constantly move the world to a better place, join together to fight oppression of all people outwardly, or to resist the inward struggles that can enslave us daily, such as greed, jealousy, pride, or power.

As a UNC physician, this time of year has special meaning to me, because so often I see patients of mine that are depressed, facing layoffs, unemployment, and rising medical bills. Anxiety sets in when people lose faith, in themselves and their community.

Hanukkah teaches me to reach out to my patients with an extra attentive ear, to offer encouraging words, to help people see hope where it is dim.  The Hanukkah lights reaffirm the value of life and living that we know is always precious but sometimes forget in the day to day struggle for food or medicine.

All of us, patients and physicians, struggle at times. This time of year, when holidays bring pressure for gifts or additional spending, we must remember that the patient-doctor relationship is one place that can reaffirm the highest spiritual or health aspirations we seek.

Dr. Goldstein is a professor in the UNC School of Medicine, a family physician and co-host of the Here’s to Your Health radio show.

Tom wrote this …

For your viewing and reading pleasure, and just in time for Christmas and New Year’s, we of the UNC Medical Center News Office proudly offer this package of holiday-themed stories.

First, let’s talk about that guy who goes around on a special night. You know the one — special night, beard that’s white, cap on head, suit that’s red — must be Santa! Is he really up for the rigors of his trip? Santa was just here recently for a medical checkup, and here’s what our team of medical experts report:

The Grinch

Next, we turn to the guy who once impersonated Santa while trying to stop Christmas from happening. The Grinch. Just exactly what is his problem, anyway? UNC psychologist Cynthia Bulik, Ph.D., explains in this story.

On a more serious note, many of us put on unwanted pounds during the holiday season. Fighting your own battle of the bulge? Here’s Dr. Bulik again with tips for preventing holiday overeating.

Holiday eating can be problematic for many of us, but for people with eating disorders it can be especially trying. Dr. Bulik has a different set of recommendations to help people in this group navigate the holidays.

Too many of us will overdo holiday drinking.

Finally, we know that many of you will drink beer, wine or spirits as part of your celebration.  And some of you, maybe even some of us (although I’m not going to name names) might drink a bit too much.

UNC’s Dr. James C. Garbutt, a psychiatrist who specializes in alcoholism treatment and research, explains how you can enjoy a few drinks responsibly while sparing yourself, and those around you, from the potentially disastrous consequences of overdoing it.

What if you do overdo it, and end up with a hangover? Well, Dr. Garbutt has a few words of advice for dealing with that, too.

Tom wrote this …

We have indeed come a long way, baby. But probably not far enough, according to a new survey conducted by UNC Department of Family Medicine researchers.

One of the (in)famous "Long way, baby" ads for Virginia Slims

When I first started working at UNC Hospitals in 2001, I was shocked to see patients in hospital gowns, clutching IV poles and smoking cigarettes, just outside our front doors.  They couldn’t smoke inside the hospital, but there were no restrictions on smoking outside.

That began to change in July 2007, when a 100% tobacco-free policy went into effect here that prohibited smoking anywhere on the UNC Hospitals campus, including the outdoor areas. I can’t say this policy has completely stopped smoking here — I’ve recently seen people smoking within the tobacco-free zone — but I can say the policy has greatly reduced smoking.

However, North Carolina is one of only seven states nationwide where 75% or more of acute care hospitals have adopted 100% smoke-free policies, according to the survey, which was conducted by UNC’s Adam Goldstein and colleagues from the UNC School of Medicine’s Nicotine Dependence Program, with Melva Fager Okun (of Prevention Partners of North Carolina). Their article was published in the International Journal of Environmental Research and Public Health, and you can read it here.

And nationwide, only about 34% of acute care hospitals have adopted such policies, the survey found. So, we clearly still have a long way to go before smoke no longer gets in our eyes.

Two other recent studies by Goldstein et al deserve mention here.  In the first, published in the Journal of the American Board of Family Medicine,
they found that the addition of two simple questions into a patient’s electronic medical record — “Current smoker?” and “Plan to Quit”?  — greatly increased the likelihood that the patient’s doctor would counsel the patient about resources available to help them quit. You can read that study here.

In the second, UNC’s Tobacco Prevention and Evaluation Program conducted an evaluation of North Carolina’s statewide anti-tobacco campaign and concluded it was a key factor in the current, historically low levels of tobacco use among N.C. teens. You can read more about that here.

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 do 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.

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.

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.”

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!