Accidental Blogger

A Theory of All Maladies (Sujatha)

"To sleep, perchance to dream..."

Therein truly lies the rub, as Hamlet continues to muse in his famous 'To be or not to be' soliloquy.

What does that have to do with all maladies? It might sound more than a bit far-fetched, but in my opinion, every chronic condition that develops in priorly healthy people - diabetes, cancer, auto-immune diseases, Alzheimers (regrettably not HIV/AIDS) have a common starting point in that they have been preceded by sleep disturbances and circadian rhythm disruptions of some kind. Some studies investigate whether Sleep Disordered Breathing(SDB) is a symptom of those conditions, but there is increasing evidence that it is a precursor.

(Full disclosure, I work in a medical device company that makes ventilators and sleep therapy devices. My musings are a result of much reading on the subject, not a substitute for actual medical advice.)

Let's take an example.

Bob is born a healthy 8 lb baby. He grows into a healthy young man who is quite active and athletic well into his late 20's.  He becomes a successful employee, working his way up the ladder, paying the penalty of less exercise on the way, even as he continues to eat like the average American, a relatively well-balanced-if-heavy-on-meat diet. His hours of work start to stretch into the wee hours of the morning, and his sleep is no longer restorative. He becomes mildly irritable and consults a doctor to account for this loss of energy and tiredness. The doctor does all the requisite tests, which show insulin resistance building up, increased cholesterol levels and high blood pressure. He is prescribed a regimen of pills to help with lowering these, and a dietary regimen to match, with recommendations of increased exercise. He starts off with the best of intentions, but falls by the wayside a few weeks later. It is just too stressful, along with the miscellaneous side effects of the medications, to try and revert to the previous state of unconscious 'wellness' . A few years later, one of his doctors has the presence of mind to ask about whether he snores - he is at least 50 lbs overweight at this point, with medication not adequately controlling his other health issues. His wife affirms that he is a champion snorer. Out comes the prescription pad, with a recommendation for a sleep study, where he is diagnosed with severe Obstructive Sleep Apnea (OSA). He is prescribed a CPAP (abbreviation for Continuous Positive Airway Pressure) machine, which is basically a blower that maintains a near steady pressure to prevent pauses in breathing (apneas) that occur when he sleeps, due to collapse of soft tissues in his throat. It's cumbersome, inconvenient, having to wear a mask and be tethered to a machine while one sleeps. But it currently presents Bob with his surest bet at starting to get restorative sleep,and regaining energy and brain power to reverse the slide of his overall health.

If this sounds too infomercial-like, consider the alternative, which happens more frequently than not. Bob tries and fails to use the CPAP. He goes back to his medications and snoring, develops a heart condition a few years down the line and dies of a massive heart attack by age 55. Or, he develops an aggressive cancer that rapidly worsens (the deoxygenation of blood that occurs during apneas is conducive to feeding tumors) and dies after much chemotherapy/relapse of a secondary cancer.

Substitute Bob with Mary, gynecologic conditions/ breast cancer as one of the health bugbears, breathing problems during sleep not necessarily because of OSA, but issues with small upper airway anatomy, called Upper Airway Resistance Syndrome.  A very similar scenario to the above could play out, in her case, even if she is of normal weight.

The more I read, the more I am convinced that it has all to do with a good night's sleep, or the lack  therof. Once diagnosed, the treatment options are few and inconvenient with poor patient compliance (CPAP) or effectiveness ( about 50% at best, with oral appliances and/or surgery). So let's look at prevention. Is it possible to nip this in the bud?

As it turns out, there are doctors and dentists who are convinced it is possible to do so, based on the perfect dental arches they have seen in ancient skeletons vs. modern. They theorize that proper jaw alignment and dental occlusions are a major contributor in maintaining what is called 'patent airways' i.e. being able to breathe without any obstruction or restriction in air flow. Our modern lifestyles of artificial feeding for babies leads to poor craniofacial and jaw development which may be worsened by dental/orthodontic treatments to align teeth into 'perfect smiles'.

As a  net result, we end up with airways that are prone to complete collapse, worsened by accumulating fat around the throat and/or loss of muscle tone with age.

So it is perhaps part of the human condition, with preventive measures that must be applied before the kid is out of the cradle.

Either way, if you suspect a sleep problem with excessive drowsiness and/or snoring, it is well worth of checking to see if sleep apnea or UARS is a possible cause, treating it with CPAP (optimal) or dental devices or surgery,  before taking the route of medication to control the conditions that are aggravated by the breathing problems. Many a patient has found that treating the apnea has mitigated the need for other medications to control blood pressure, blood sugar, heart conditions, etc.

 

Links & Resources:

Sleep Apnea and Diabetes

Sleep Apnea and Cardiovascular Disease

Sleep Apnea and Autoimmune Disease

Sleep Apnea and Cancer

Sleep Apnea and Alzheimer's

 Apnea and Depression

Apnea and ADHD

 

 

"The Immutable, Dusty Path"

A very interesting article at 3 Quarks Daily about dust.

An Interview With Psychotherapist Louis Breger, Author Of "Psychotherapy: Lives Intersecting" - Part 1 (Norman Costa)

An Interview With Psychotherapist Louis Breger, Author Of Psychotherapy: Lives Intersecting * - Part 1

by Norman Costa PhD

* Psychotherapy: Lives Intersecting, 2012, Transaction Publishers, New Brunswick, New Jersey

    Beatrice is a woman in her mid-thirties, and a smart, sharp attorney for a major law firm. She and three other women had been together in group therapy for two years. Each woman experienced severe childhood sexual abuse. In one very emotionally difficult session Bea put a question to her therapist. In tears, and with a voice of anger, pleading, and despair she asked, “What is the point of all this [experience of abuse]?” Her therapist, Francine, answered, “There is no point to it, except what you can give to it. And you have learned so much, and gained a compassion and a wisdom that few have. You can now tell the truth to people who need to know.”

    I was extremely fortunate to observe this group for a significant period of time, with the permission of all involved. I was doing research of my own on child sexual abuse. During the time I was observing I had regular individual therapy sessions with Francine. This is an absolute necessity, in my opinion, for anyone doing research on abuse from first-person accounts.

Louis Breger, author of Psychotherapy, Lives Intersecting

    While reading Louis Breger's new book, Psychotherapy: Lives Intersecting, I kept going back to that difficult session when Bea asked her question. Yes, her question moved me, deeply. Equally significant, for me, was Francine's response. Francine is a therapist that Breger describes as having 'the touch.' Others might refer to it as 'the gift.'

    My experience with Bea's group and with Francine in individual sessions, gave me a perspective on this book. In a way, Louis Breger, PhD is the complement to a patient like Bea. As a therapist, teacher, researcher, husband, and father he has learned many things and gained much wisdom in a 50 year career. In this professional memoir, he is passing it on, and telling the truth to people who need to know.

Who needs to know?

    Certainly, Psychotherapy: Lives Intersecting is a book for psychotherapists, counselors, and others in the helping professions in psychology, social work, and psychiatry. It is for students in mental health and related majors from upper-class students at the undergraduate level to Masters and Doctoral programs. Beyond the academic and training institutions, faculty, and students, this book belongs in the hands of all friends of psychotherapy, those considering therapy for themselves, and those who are trying to help family or friends make a decision about psychotherapy. Though a professional memoir covering professional subjects, it is still accessible to an educated and interested layperson.

    If the reader can set aside preconceptions of the usual and obligatory book-jacket blurbs, they will discover that Psychotherapy: Lives Intersecting IS unique in its field. As a professional memoir he discusses substantive matters like the history of psychoanalysis, and varied schools of thought and theories of personality. Breger is as clear as he can be in his criticism of methods of psychotherapy based upon a dominating guru, inflexible dogma, and cult-like followers. He is equally clear about what is most important to a successful therapeutic outcome for the patient – Hint: It may be a surprise for many. What makes this book stand apart from others in his field are two things: 

The Feminine Hygiene Man

Do watch. It is not silly, I promise. Can't say whether his will be a "rags" to riches story but the man is an inspirational speaker and exceptionally diligent. Hope his wife and mother are back. (via 3 Quarks Daily):

Fighting fear with fear

Not so different from fighting poison with poison. Here.

Veterans Affairs Nurses [Strikeout Nurses] Management Scrutinized After Patient Deaths (Norman Costa)

Nurse - Anonymous

Veterans Affairs Nurses Management Scrutinized After Patient Deaths in Two States (Norman Costa)

A re-editing of an article by Tracy Weber and Charles Ornstein

ProPublica, April 30, 2012, 1:19 p.m. 

After a patient died last year at a Veterans Affairs hospital in Manhattan, federal inspectors discovered nurses in his unit [Management] had a startling gap in their skills [supervision and training of nursing staff]: They [Management] didn't understand [they were responsible for the competence and training of nursing staff as to] how the monitors tracking vital signs worked. 

Management - Gen. Eric Shinseki

None of the nurses [management] interviewed could accurately explain [their lapse in supervision and training of nursing staff, so that nurses could tell] what would happen if a patient became disconnected from a cardiac monitor — which allegedly occurred to the patient who died, according to an October 2011 report from the U.S. Department of Veterans Affairs' inspector general. 

The incident followed two deaths in the cardiac monitoring unit at a VA hospital in Denver that raised similar questions about nurse [Management] competency. 

Earlier this month, a broader review by the VA inspector general of 29 VA facilities found only half had adequately documented that their nurses had the needed skills. Some nurses "did not demonstrate competency in one or more required skills," but there was no evidence of [Management taking charge and providing the] retraining [for nursing staff], the report said. 

An outside nursing [management] expert who reviewed the reports at ProPublica's request called them "troubling" and said the fact that the [management] lapses weren't caught and corrected "signified much broader [management] problems." 

Save A Mother - "Beyond Sultanpur": 2012 Appeal

Progress Report for 2011 - 2012 _ Dr. Shiban Ganju, Founder of Save A Mother

SAM Activities for 2011-2012

• Last year was a turning point in the growth of Save A Mother. The program of maternal mortality reduction developed by Save A Mother (SAM) is being expanded by Mahila Vikas Parishad to 45 districts of UP with the funding from UNICEF and Melinda and Gates Foundation. SAM helped to launch this expansion and participated in 351 training sessions for new health workers, communities and public health officials.  
• 75 Health activists (Swasthya Sakhi) who had volunteered for SAM for last 4 years have been deputed as Community Health Trainers for the last one year under the UNICEF funded project.
• SAM will expand maternal mortality program to Gadag district in Karnataka in summer of 2012. The program will be funded by Deshpande Foundation. If more financial resources become available SAM may expand program to Kurkhshetra in Haryana, Ajmer in Rajasthan and Guna in MP.
• SAM has launched a TB eradication program in about 200 villages in Sultanpur area in UP. This program will be expanded to 1000 villages in next 3 years.
• SAM is helping to improve the operation of 16 rural health clinics which give free care to 1500 patients daily. These clinics are funded by Asia Heart Foundation. With the help of the doctors working in the clinics, SAM is launching a program to reduce water borne diseases by 80% in next four years.
• SAM has developed a software program to manage rural clinics and facilitate the work of public health workers in the field by giving them a GPRS phone application by which they can upload the field data and receive messages. The software will be in operation by the summer of 2012.
• Bangalore chapter of SAM is organizing a music concert by Alka Yagnik on 21 April to raise funds to expand work in Karnataka.

 

I am pleased to be part of Save A Mother (SAM) and its commendable work in reducing maternal and infant mortality in rural India. My association with the organization dates back to 2009 when I responded to Dr. Ganju's invitation urging me to become a volunteer with the Houston chapter, around the time he decided to take his outreach efforts beyond his hometown of Chicago. Since then I have met and worked with a dedicated and enthusiastic group of Houstonians who work year round to make possible the realization of the stated goals and objectives of SAM. As the report above explains and the title of this year's fundraiser suggests, the effort that began as Dr. Ganju's personal and modest mission in a village named Sultanpur in the northern Indian state of Uttar Pradesh has expanded to benefit several more villages in UP and other states.

The 4^thannual fund-raising gala for Save A Mother in Houston is scheduled for May 4, 2012.The bulk of our fund raising is achieved through direct personal contact with individuals and businesses. The blog appeal is our way of reaching friends, family and generous strangers outside the Houston area who may find it simpler to donate on-line. The response to our previous fundraisers has been very generous so far. We hope to generate similar levels of support in 2012 both here on the blog as well as in the real world. This year I have set a goal of raising $3,000 on Accidental Blogger on behalf for SAM. If you wish to help, please use the ChipIn widget on the left side column of the page to make your contribution. Any amount you give is appreciated and will be put to good use. Thank you very much.

For more information on the mission of the organization see the message from the founder here and in the excellent video above, narrated by Dr. Ganju and Indian actors Shabana Azmi and Anupam Kher. More information is available at the Save A Mother website.

Note: I plan to keep this post at the top of the page for a while. Please scroll down to see new posts that appear during this period.

(If you don't see the ChipIn logo in its entirety, adjust the zoom level on your browser. Many thanks to Rahul Singhal for his help; he puts up with my technical ineptitude each year around this time.)

Cancer in a Can (Sujatha)

Move over, BPA, make room for the new kid on the block: 4- MI ( the 'cute' name for 4-methylimidazole), a byproduct of the process used to create one of the coloring agents used in what is obliquely termed 'caramel color' on the ingredients list of many processed foods, most notably sodas like Coca Cola and Pepsi.

 The Center for Science in Public Interest had submitted a docket to the FDA, requesting that the caramel colorings with 4-MI be banned, but can claim success of a different sort from what it had hoped. Because of regulations in the state of California, where Coke and Pepsi would have had to label their drinks with warnings similar to "This product contains chemicals known to the State of California to cause cancer and birth defects or other reproductive harm."

If it causes cancer in California, surely, it must cause cancer elsewhere. Ah, the power of truth in advertisement, and the things manufacturers will do in order to not have to issue disclaimers that their product contains substances that are considered carcinogens, even it is only in California. Or is the fear that they could be sued in California by any private citizen or group over the 4-MI in their formulation? This article sheds more light on their concerns.

"Our member companies will still use caramel coloring in certain products, as always. The companies that make caramel coloring for our members' soft drinks are producing it to meet California's new standard,” the beverage association said in a separate statement.

“Consumers will notice no difference in our products and have no reason at all for any health concerns.”

The question is still up in the air as to whether the results of lab tests that show that 4-MI is indeed carcinogenic in lab rats, at high concentrations that far exceed the normal levels that even the most avid drinker of sodas would be exposed to, can be used to argue that 4-MI in caramel color is indeed responsible for a variety of cancers in the population ingesting it. My guess is that at best, it would be one of a gazillion contributing factors towards any cancers that did develop.

 

 

Thus Spake the Crocodile...(Sujatha)

 

Carefully crafted, teary-eyed sentiments indeed. As well they should be, given the outrage poured on Susan G. Komen Foundation's decision to stop giving grants to the Planned Parenthood for breast cancer screening and preventative education. This could mean a huge drop in liberal contributions to the Orgy of Pinkfulness that the Komen Foundation sustains not only in October, but year-round as part of its effort to 'eradicate breast cancer', a goal that remains muddied by the numerous partnerships it forges with corporations who don't exactly promote good health through their products.

"Critics of the decision have pointed to the fact that Komen recently hired a vice president who had pushed for the defunding of Planned Parenthood during a gubernatorial run. 

According to Komen, the decision was born not out of political pressure but rather as part of an ongoing effort to exact "stronger performance criteria for our grantees."

The outrage has so far garnered from the public a substantial proportion of the funds that Planned Parenthood stood to lose.

Planned Parenthood said Wednesday that it received more than $400,000 from 6,000 donors in the 24 hours after news broke that its affiliates would be losing grants for breast screenings from the Susan G. Komen for the Cure breast-cancer foundation.

Komen, meanwhile, incurred heated criticism from some members of Congress, numerous liberal advocacy groups and some newspaper editorial writers. But it was applauded by many conservative religious and anti-abortion groups that abhor Planned Parenthood for its role as the leading U.S. abortion provider.

If we are all a little less pinked-out after this, we can thank Karen Handel for her decision to push through the defunding 'organizations under investigation' rule. But I have a feeling that come October, the frenzy for the Pinking of America will rebound, as it always does, with the fresh legions of the newly-diagnosed.

 

Grief: Is it a mental disorder?

Some doctors now believe that extreme grief due to the loss of a loved one should be medically classified and treated like any other form of depression. Others argue that grief is a natural (and sometimes, necessary) human emotion and it should not be categorized as an ailment that needs to be corrected by "Happy Pills." I don't know whether grief is a "disorder." I am inclined to say "no." I don't think that our brains, and therefore our lives, are meant to be relentlessly cheerful. I suspect that in the absence of "negative" emotions such as sadness, fear or anger, we would also be lacking in beneficial qualities like empathy and survival skills.  We all cope with life's ups and downs in our own ways. Throughout the world social rites and religious rituals are designed to help survivors deal with suffering due to bereavement. Despite that the loss of a loved one affects different people with vastly different levels of trauma; some come to terms with it requiring no third party intervention while others may need prolonged periods of solace, and even professional counseling. Surely, a grieving person is depressed. The question however is whether such depression requires medication and if so, what carefully considered criteria ought to be in place regarding the duration of the condition and the severity of the debilitation.

Grieving the loss of a friend, family or loved one may soon be considered a form of depression. While many doctors acknowledge that grief is a very normal part of losing someone close to us, they also acknowledge that it’s important to deal with that grief.

Speaking to the New York Times one doctor explains why turning grief into a depression diagnosis could end up hurting those people suffering from some for of grief.

“This would pathologize them for behavior previously thought to be normal.” says one doctor.

Opponents to the diagnosis also say to could lead many people with short term grief receiving drug treatments that would normally be unnecessary outside of depression symptoms.

I asked my co-bloggers to weigh in with their opinions on the matter. Unsurprisingly, their responses fall on both sides of the argument.

Concrete Jungle vs Concrete Common Sense

As usual, being familiar with the living conditions in much of the Third World, I say that this makes a lot of sense.