Category: Lifestyle

Categories
General Lifestyle

Nutrition 101

A 2011 Consumer Report found that 9 out of 10 Americans consider their diet healthy.5 People have become accustomed to reading product labels, estimating portion sizes, fashioning colorful meals, and some may even have a grocery list stored on their phone. Yet many still find themselves eating too much or too little. How many nutrients are we really getting and what are they doing once they enter the body? Are we sufficiently addressing nutrition with patients?

It has been rumored that people lie about what they eat 100% of the time. Consequently, it’s likely that patients’ eating habits are holding them back from health. According to a recent poll1, fewer than one-eighth of physician visits include any nutrition counseling and fewer than 25% of physicians believe they have sufficient training to discuss diet or physical activity with their patients.

These statistics have created a demand at the national level for reform. A few recommendations from the American College of Sports Medicine and the Alliance for a Healthier Generation include developing a standard nutrition and physical activity curriculum for medical and health professional schools, increased testing on nutrition and exercise for licensing and certification exams, and better insurance reimbursement for preventive care.2 While this will be a long-term shift, these are important strides in a beneficial direction.

Because of the relative neglect of nutrition in medical education, physicians tend to either ignore the subject or offer limited advice. For example, gastroenterologists may focus solely on fiber content, while nephrologists may focus on sodium intake.

“As long as the healthcare marketplace undervalues preventive care, health care professionals will lack financial support to address these issues with their patients and medical schools will have less incentive to train their students accordingly,” the report notes.1,2

Compared to the 20 hours devoted to nutrition in allopathic medical schools, Naturopathic medical students receive roughly 200 hours through courses such as nutritional biochemistry, science of diet and nutrition, and clinical nutrition.  This uniquely positions naturopathic doctors as physicians who not only specialize in preventative healthcare and chronic disease management, but also lifestyle and nutrition counseling.

For those looking to delve more into their patient’s nutrition status, one simple place to start is using a diet questionnaire for evaluation at baseline and to track changes over the course of treatment. Furthermore, there are an increasing number of online nutrition education programs directed towards practicing physicians. An example of one such resource is The Nutrition Source.

Why nutrition matters:

As one of my professors says, “You can be lean and mean with the illusion of health, but inside you can have raging inflammation.” The foods we eat turn on or off certain pathways and subsequently cause the release of chemical mediators. Over time this process lays the foundation for low-grade inflammation. Our enzymes convert dietary acids into prostaglandins, some of which create inflammation and pain. Therefore, based on these basic concepts, when we eat foods like sugar and flour that create these mediators, we are creating pain. Simply put: the food we eat changes our body chemistry. The more nutrients we can obtain through our food, the more building blocks are available to support the chemical reactions that take place in order for us to be alert and create energy.  While drugs like Tylenol and NSAIDS can be necessary and may help to reduce diet-driven pain, they do not treat the underlying cause.

As a naturopathic student, I hope to educate and inspire other medical professionals to learn more about nutrition in order to deliver more optimal clinical care to patients. Continuing medical education should include topics in nutrition research and instruction on how to critically evaluate new evidence in the field of nutrition. Physicians are simply one element of the much larger system necessary to promote health and wellness through nutrition. By emphasizing the influential role of nutrition in medical training and practice, we can further our ability to reduce suffering in patients.

References:

  1. Alliance for a Healthier Generation; American College of Sports Medicine; Bipartisan Policy Center. Teaching nutrition and physical activity in medical school: training doctors for prevention oriented care [white paper]. June 2014.
  2. Bernstein, Lenny. “Your Doctor Says He Doesn’t Know Enough about Nutrition or Exercise.” Washington Post.
  3. Devries S, Dalen JE, Eisenberg DM, et al. A deficiency of nutrition education in medical training. Am J Med. 2014 Apr 19.
  4. Katz, M.D. David. “Why Holistic Nutrition Is the Best Approach.” The Huffington Post. TheHuffingtonPost.com, 1 Apr. 2011.
  5. Ward, Tricia, and Stephen Devries. “Doctors Need to Learn About Nutrition.” Medscape, 4 Sept. 2014.
  6. http://www.consumerreports.org/cro/diet-plans/buying-guide.htm

Featured image:
National Nutrition Month Book Display by The COM Library

Categories
General Lifestyle Reflection

On Professionalism

I solemnly pledge to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude that is their due;
I will practice my profession with conscience and dignity;
The health of my patient will be my first consideration;
I will respect the secrets that are confided in me, even after the patient has died;
I will maintain by all the means in my power, the honor and the noble traditions of the medical profession;
My colleagues will be my sisters and brothers;
I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I will maintain the utmost respect for human life;
I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
I make these promises solemnly, freely and upon my honor.

-The Declaration of Geneva

My white coat ceremony changed many things for me, most notably the responsibilities I would have moving forward. I recited the Declaration of Geneva, along with my fellow colleagues. The weight of the term “colleague” laid heavily on me; those who were once classmates were now colleagues. Classmates to colleagues, such a drastic, but intentional elevation in word choice. Many things are expected of me as a medical student, but one of the top priorities is the demand to carry myself as a professional.

Professionalism can mean treating others with respect, upholding a certain academic standard, or leaving personal issues in a personal space. Cultivating a professional attitude isn’t always easy. I have screwed this up several times, like disrupting class through meaningless chatter or allowing my personal dilemmas seep into my professional work. Regardless of the mistake, I always try to learn from my shortcomings. I believe that the majority of medical students strive to act as a professional when encountering difficulty in medical school.

Recently, I wondered how this professional attitude so quickly fades when we meet colleagues of different disciplines. Although my experience is mainly anecdotal, I think we have all heard of negative interactions between physicians and nurses, physicians and physician assistants, and so on. In medical school, some of us have participated in attempts to get medical and other professional students to interact at an earlier point in their training. I personally interacted with both nursing and physical therapy students during my first year of medical school. Although I thought the reasoning behind this choice was good, it didn’t work out exactly as planned. The medical students overheard a few nursing students talking negatively about the medical student cohort. Feelings got hurt and from there the overall atmosphere worsened.

Why did this happen? I believe we forget to act professionally when outside of our immediate, comfortable setting. We know a professional attitude is demanded between colleagues within our medical school, but we don’t often carry it over to other disciplines. Yes, you could argue that interacting with other disciplines at an early career stage helps break down some common stereotypes and issues, but will early interaction really solve everything? I’m skeptical.

I believe a constant effort must be maintained throughout our training; as I stated before, a professional attitude is not easily mastered. Regardless of one’s career stage, working harder at cultivating a professional demeanor among those in our field as well as among those in others will foster teamwork within medicine. If we, as medical professionals, hold ourselves to a certain standard, then catty arguments or negative comments will never be made, because we constantly demand higher of ourselves. Hopefully, by being more self-aware and practicing on a daily basis, we will create a professional attitude that won’t break down so easily when confronted with the newness of the ever-growing medical field.

Featured image:
teamwork staffetta by Luigi Mengato

Categories
Emotion General Lifestyle

Thank you for being a patient: A reflection on gratitude and its place in medicine.

I was walking through Target a few days ago when I noticed a banner had been discarded in a pile of clearance items. “Give Thanks,” it read. Assuming that the banner was a Thanksgiving leftover, I quickly moved along to a different aisle. Later that day, I started thinking about that banner, and its lowly place in the clearance bin. Gratitude has become a seasonal commodity. From November to mid-December, we’re reminded to give thanks, be grateful, and celebrate others through food and gifts. Unfortunately, the half-off banner serves as a reminder that the notion of gratitude can become “out-of-season” as we turn the page on the calendar.

One of my personal rules for daily life is to live each and every day with a grateful heart. I think this idea comes from having practiced yoga for more than a decade, where gratitude is a foundational tenant. At the end of almost every yoga class I have ever attended, both teacher and students bow their heads and say, “‘Namaste.” Namaste is a Sanskrit word which, loosely translated, means ‘the goodness in me honors the goodness in you.’ For me, this sacrosanct moment at the end of class is what makes yoga different from any other activity I have engaged in. As the instructor thanks me for allowing him or her to share the practice of yoga, I can both thank the instructor, as well as take a moment to thank myself for taking the time to do something good for myself. In contrasting my own personal attitude of gratitude with the Hallmark-esque notion that gratitude is a seasonal commodity, I began to wonder what place gratitude might have in the practice of medicine.

In my brief time as a student doctor, I have witnessed patients struggling with complex challenges that I never even considered prior to medical school. It’s true that many patients will visit us when they have a stuffy nose or an itchy rash, but just as important are patients who see us when they are struggling to quit addictions, deal with a major life change, or manage their own healthcare on a limited budget. It is these patients, especially, with whom it is imperative that we as healthcare providers work with to build trusting relationships. I believe that the first step of building such a relationship is an expression of gratitude. I want to thank patients for being brave, for reaching out, and for asking to get help. I want to tell them how very grateful I am that they have respected themselves enough to value their health, and for trusting me, or one of my colleagues, to help them make very important and potentially challenging life changes. Essentially, I want to say Namaste.

As we leave behind the snow-dusted magic of the holiday season, we should not let gratitude melt away like a snowman. Gratitude should be a part of our daily lives and a cornerstone of our medical practice. It only takes a moment to let our patients know how thankful we are for being part of their journey to wellness, but I predict that the impact it has on our physician-patient relationships will be long lasting.

 

Featured image:
The Stethoscope by Alex Proimos

Categories
Lifestyle Public Health Reflection

Can social justice replace medicine?

‘Social injustice is killing people on a grand scale.’
– Marmot (2)

Despite the leaps and bounds that science has made over the past century, with all its shiny new techno-gadgets and ever-advancing drugs, the primary reason for our good health today lies in something much less sexy: vaccinations, clean water and sanitation- changes that we take for granted.

We live in a world that is changing every second. Bigger cars, faster phones, all the information at our beck and call: from the education that is offered to our kids, to the healthcare that is offered to our decaying bodies.

The hospital of today is a far cry from the one half a century ago. The minute you walk into a hospital your senses go haywire. You have stepped into the world of the future. The full scale of our technological advancement greets you within these four walls. The bizarre beeping overwhelms your ear canals, screaming into your brain as the alarms screech constantly in the background. The reams of wires trail along the floor of the wards, wrapping themselves around their patients like Christmas presents, offering nourishment to bodies overwhelmed with disease. We are living in the world of machines, and it is upon them that we place our hopes of immortality.

Everyone knows of the success story of Science. We are bombarded by the media, informing us of the next new cancer drug, the gene unlocked that will solve all our problems. What we forget is that we are not merely organisms residing within a vacuum. Nor are we machines ourselves, whose very pores can be zapped with electrodes, transforming our very identity. We are human beings living and breathing on this planet Earth. We digest the world around us. We are not merely scientists of the world within ourselves, of the DNA that twirls inside our cells. We are also manufacturers of the world around us; of the houses we live in, the food we eat and the lives we live. Perhaps the answer to a better, healthier life lies here instead.

But, is this the role of the doctor? Shouldn’t we leave this task to the politicians, to those who have the power to make these important decisions? Isn’t the duty of the doctor ultimately towards her patient, towards that individual who is sitting opposite, rather than to humanity as a whole? I believe Virchow, the German Doctor, described it best when he said:

‘Medicine is a social science and politics is nothing else but medicine on a large scale.’ (1)

Of course there are diseases that can only be fixed by looking inside our own bodies – diseases that come from within, that cannot be changed by any amount of control over one’s environment; Huntington’s Disease is one example.

But if you take a quick glance at the causes of mortality in both the USA and the UK, you will find that the majority of these diseases are significantly related to one’s lifestyle. The top leading cause of death in both the UK (3) and USA (4) is Heart Disease, which has very strong links with lifestyle, including smoking (5), a high-fat diet (6) and poor exercise (7).

In the past, when tuberculosis and polio wreaked havoc upon the population, the role of the doctor was to prescribe medication; to act as the priest who offered the gift of life through his knowledge and wisdom. Yet now, this power lies upon the patient. Our lives are no longer cut short by the plague, but by the pathways we choose to make while we are still alive.

The role of the doctor continues to change along with society. The doctor is the servant of the public. As our ailments in life continue to revolve around these pathways that we choose to take, so must the doctor focus her gaze away from the leaves of her prescription pad and begin to question the foundations of such paths; the reasons behind these choices, the thoughts and actions that lead a person towards their own destruction.

It is not enough to simply inform someone by saying ‘you need to do more exercise.’ Anyone who has made a New Year’s Resolution to do so will understand this. Even in the UK, a country where healthcare is free, one’s health is still dependent upon how much one earns. The richer you are, the longer you will live (8). How is it that in this day and age, this is still the case? Healthcare is a right. And as doctors, it is our duty to ensure this edict is followed. The politician may sit upon his throne and hand down his judgments, but it is the healthcare professional who is in contact day in and day out with the most vulnerable and marginalized.

Indeed, there are some excellent examples of attempts to try and balance this injustice within our society; free school meals in the UK which lead to improved nutrition in children (9) and the ban on public smoking to try and reduce passive smoking (10) are just two examples. These changes in legislation lead to the question: how much control should our government have over our own decisions towards our health? If someone wishes to smoke and drink all their life, then that is their right. Autonomy is one of the principles the doctor must follow; today’s healthcare system revolves around the patient and her choices. No longer does the doctor hold authority over the patient’s body. Yet this does not mean we cannot improve the world around us; we are still capable of building a healthier society, a society in which we will not only live longer, but be happier in as well. Free education and housing are two examples of societal changes that do not necessarily impose upon our personal rights, yet can lead to healthier childhoods and happier families.

Let’s say you are a single working mother – you are only just reaching your rent each month. You can only work part-time because you need to pick up your son from nursery every afternoon. You have no family who can look after him. This leaves little money for food, so you mainly feed your son. His diet is very poor, not only because of the little you can afford, but you yourself have never learned how to cook. Your own childhood consisted of fast food and the occasional apple or banana handed to you by a father who you rarely saw. You live in a very deprived neighbourhood. You cannot afford heating, and your son is constantly sniffling and coughing, hiding under his hole-infested jumper that you managed to grab from a local charity shop. You are isolated – your husband has left you, you have no one to talk to and your neighbours scare you. When you’re not working, you stay at home for your own safety, and ultimately for your son’s. You try to remain happy for your son. You want the best for him. But you are scared. You are scared for the future, you are scared about your next paycheck, you are scared about being burgled, being mugged, having your son taken away from you. You are scared about becoming a failure, of disappointing your son. You start drinking a glass of whiskey each evening to help you calm these anxieties. You gradually spend more and more money on alcohol, an attempt to grasp control of these spiraling criticisms that constantly call into question your ability to be a mother. But this does not always help. As the days turn to weeks, your thoughts begin to gain a voice of their own, almost screaming through your ears; you are a bad mother. A failure. Maybe you’d be better off somewhere else. Your son would have a better life without you. He wouldn’t have such an awful mother.
You eye the packet of paracetamol lying on the table. What would happen if you weren’t here? Wouldn’t your son lead a happier life? He would no longer have this dark mark tainting his existence. He might even be happy… What do you do?

In various points throughout this story, one could take out their pen and draw a mark where someone could have intervened. Not necessarily to offer medication or money, but things such as social support; someone to help look after the son in the afternoons, advice on how to apply for jobs, or housing in a more residential area. A helpful hand to hold on to during the darkest periods, a pat on the back, a shoulder to cry on, an ear to listen. How different would this story be if these simple interventions had been available?

It is very easy for us, the next generation, to caress our mobile phones and laptops that fit in both hands. It is easy to see the world as decaying pieces of rubble to improve, gadgets to insert, wires to wrap around and transform. No doubt this way of thinking has changed our healthcare; it has saved many lives. But we must never forget that humanity is not a machine itself. It cannot be controlled by our remote controls and our drugs; we must look further afield in order to truly appreciate the complexity of the human being. When we look at the human body, at a life that has been lived hard and is ending early, we see not genes that have played havoc, but decades of depression, underlying abuse, a cigarette to cope, a bottle of beer to forget. Addressing these problems is a task that requires us to go beyond our scientific skills. It requires us to understand the emotional lives of our patients.

“How wonderful it is that nobody need wait a single moment before starting to improve the world.” 
– Anne Frank

References

  1. (with acknowledgements to Siân Anis), J. R. A. (2006). Virchow misquoted, part‐quoted, and the real McCoy. Journal of Epidemiology and Community Health, 60(8), 671.
  2. World Health Organisation. 2008. Inequities are killing people on grand scale, reports WHO’s Commission [Online[. Available at: http://www.who.int/mediacentre/news/releases/2008/pr29/en/
  3. Office for National Statistics. 2013. What are the top causes of death by age and gender? [Online]. Available at: http://www.ons.gov.uk/ons/rel/vsob1/mortality-statistics–deaths-registered-in-england-and-wales–series-dr-/2012/sty-causes-of-death.html [Accessed: 13th October 2015]
  4. Centers for Disease Control and Prevention. 2015. Leading Causes of Death [Online]. Available at: http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm [Accessed: 13th October 2015]
  5. British Heart Foundation. Smoking [Online]. Available at: https://www.bhf.org.uk/heart-health/risk-factors/smoking [Accessed: 13th October 2015]
  6. World Heart Federation. Diet [Online]. Available at: http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/diet/ [Accessed: 13th October 2015]
  7. Myers, J. 2003. Exercise and Cardiovascular Health. 107:e2-e5
  8. Royal College of Nursing. 2012. Health Inequalities and the Social Determinants of Health. London: Royal College of Nursing
  9. BBC News. 2013. All infants in England to get free school lunches [Online]. Available at: http://www.bbc.co.uk/news/uk-politics-24132416 [Accessed: 13th October 2015]
  10. Bauld, L. 2011. The Impact of Smokefree Legislation in England: Evidence Review. England: Department of Health

Featured image:
Human Genome by Richard Ricciardi

 

Categories
General Lifestyle

Medical Grind

It’s 6 a.m. and your hand doesn’t quite make it to the alarm clock before the voices in your head start telling you it’s too early, too dark, and too cozy to get out of a bed.

Another voice says that there’s a reason your alarm is going off. You take a deep breath, sit up, put your feet on the floor, and get to work.

This is the grind. You have a commitment. The words normal and comfortable have been traded for unexpected and demanding. You’re in a fight towards a finish line without a ribbon and the reward outweighs any medal around your neck.

On this journey to achieve a challenging goal, it’s OK to negotiate with yourself. You’ve wanted to quit many times, but you don’t surrender. Believe the voice that says “it’s OK you didn’t do as well on that exam” or “you will eventually get through to your noncompliant patient” and “you can survive these last two hours on shift.”

Keep focused on what it takes to reach the next step in the journey. Now that you’ve headed down this path, the transformation is taking place. Don’t lose heart. Remember that this is the grind.

Featured image:
vintage alarm clock / thermometer by H is for Home

Categories
General Lifestyle

Let’s do Better for our LGTBQIA Patients

A special thanks to the panelists and physician who inspired this article.

Recently, I was involved in a collaboration between the American Medical Women’s Association (AMWA) and the American Student Medical Association (AMSA) at my school to help our students learn more about the LGBTQIA population. To clarify, this community includes individuals identifying as lesbian, gay, bisexual, transgender, queer, intersex or asexual. We invited a board-certified OB/GYN and reproductive endocrinologist to our school, along with a few of his patients. The LGBTQIA patient population has its own unique set of challenges and understanding their struggle is vital.

Unfortunately, many members of this community have anecdotes of times in which they were disrespected, turned away, or not understood by medical professionals. One of the transgender panelist had difficulty finding a fertility physician who was willing to work with him and his wife to have him carry their child. Yes, you heard me correctly. This panelist was willing to go off testosterone in efforts to regain his menstrual cycle and carry his baby. Many physicians were unwilling to assist this couple. These stories have to be put to an end; we can do better. I hope we can challenge ourselves to be more open-minded and accepting of all those who seek our help. It’s not a physician’s job to deem what is right or wrong; rather, it is our job to serve our patients in whatever capacity we can.

Having a patient panel allowed us to hear some moving and emotional stories from these brave people. I hope other LGBTQIA members can share some of their stories with medical students around the nation because it is important for us to hear these first-hand. In addition to hearing about fertility challenges and life paths, we also heard of changes we as physicians can make to better serve this patient population. I felt the need to share these with others because I realize many students never get the chance to have an open conversation with someone who identifies as part of this community.

  1. On medical intake forms, leave the sex and gender fields blank so the patient can feel comfortable telling you his or her identity here, rather than only giving them two choices.
  2. Ask the patient what his or her preferred name is. Some patients are transitioning and may not prefer their given name.
  3. Ask the patient his or her preferred pronoun and make note of this. The last thing we want to do is keep referring to someone as “she” if they have never felt like a she.
  4. Connect with the LGBTQIA community. Unfortunately, many of these patients face discrimination. Even though it seems “sufficient” to just accept them when they come to our practice, we can do more. The patients on the panel expressed that it would be nice for physicians to reach out to their community and let them know you are welcoming to their group and want to serve them. If one of your patients happens to identify as part of this community, ask them if they can connect you to other people who may need care.
  5. If you have a patient who wants to transition, be sure to at least mention fertility issues. Someone transitioning may not have thought about having a family yet, but it can be very difficult to go off hormones and later become pregnant (if transitioning from female to male). In addition, the patient panelists mentioned that it would have been nice to know more about egg and sperm donation and the costs and barriers associated with those processes. Obviously we don’t need to push our patients in either direction when it comes to transitioning, because it is their choice. But it is our job to inform them and help them understand the potential issues that may arise if they do decide to transition at a younger age.

It is difficult to learn about this population because each member is different and unique. In a struggle to find medically relevant information for health care providers, I found two good resources I found for more information are from American Medical Association (AMA) and AMSA. Click the links below to find out more about the LGBTQIA population in the medical context:

http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee/glbt-resources.page?http://www.amsa.org/advocacy/action-committees/gender-sexuality/

Featured image:
Pride Flag 1 by Ant Smith

Categories
Clinical Lifestyle Public Health

A League of Randomized Clinical Trials

Frontline recently reported on data released from Boston University and the Department of Veterans Affairs demonstrating that out of 91 former National Football League (NFL) players, 87 had Chronic Traumatic Encephalopathy (CTE).  This degenerative brain disease is believed to be the result of repetitive head trauma, and can lead to memory and mood disorders. [1] It is unclear why the disease develops in some players but not others.

The findings of the above study come with several limitations.  In particular, the gold standard for CTE diagnosis is examination of brain tissue postmortem.  The data comes from players who were concerned during their lifetimes that they showed symptoms of the degenerative disease and arranged, upon death, to donate their bodies and brains for analysis.  As a result, the prevalence of CTE suggested by the data may be skewed due to selection bias.  The brains examined post-mortem came from athletes already concerned about CTE because of their clinical symptoms, making it much more likely that the investigators would find evidence of the disease.  The ongoing work at Boston University and the Department of Veterans Affairs is a retrospective analysis that cannot determine the cause of CTE.  It is important, however, for the identification of factors that are correlated with the disease, which may spark more interest and lead to more focused research on the topic.  Even so, the disease was present in 96% of those who were tested.  This finding is both remarkable and eye-opening.  It demonstrates a real concern for athletes in contact sports like football.

Organized football poses a risk of concussions.  Chris Borland was a college linebacker and All-American drafted into the NFL in the third round in 2014. Although he only had two diagnosed concussions, one during eighth-grade soccer, and the other playing high-school football, he estimates that the actual number is closer to thirty. On March 13, 2015, Borland retired from the league via email. [2] He has since described the move as preventive and outlined his determination to prevent the degeneration of his own brain.  The NFL is aware of the risk posed by concussion and has focused on decreasing the rate of this injury.  In their 2015 Health & Safety Report, the NFL published a thirty-five percent decrease in regular-season concussions from 2012. [3] According to the data shared with Frontline, however, forty percent of those determined to have CTE were offensive and defensive linemen, players who have repetitive, sub-concussive hits on nearly every play. [1] This suggests that recurrent, lower-intensity blows may also lead to CTE.

Chronic traumatic encephalopathy is not unique to football players. It can be seen in other athletes, military veterans, epileptics, abuse victims, and circus performers who are shot out of cannons. [4] The scientific and medical communities should not delve into the controversy of any alleged cover-ups as discussed in the Frontline documentary A League of Denial. [5] Rather, our focus should be on furthering research, because our understanding of this condition is still in its infancy.

Rates of CTE in the general population or even in the professional football community have not yet been established.  The gold standard of scientific experimentation, the double-blinded, randomized controlled trial is not an ethical or practical possibility in this case.  Players without symptoms of CTE must be analyzed to allow for characterization of healthy persons as well as sub-clinical disease.  This may help identify why some people are afflicted with the condition and not others.  Those who suspect they may have CTE should be granted medical care and follow-up to help the scientific community better understand the degenerative progression of the disease.  Research should not be limited to professional athletes, as college and even younger athletes may be at risk of developing CTE.  It also should not be limited to football, as head trauma occurs in many sports.  It is important for professional organizations and sports fans to support research and efforts to implement relevant safety measures to preserve the health of their favorite athletes and to enhance the quality of the sports they enjoy.

References:

  1. Breslow, J. (2015, September 18). New: 87 Deceased NFL Players Test Positive for Brain Disease. Retrieved September 20, 2015.
  2. Fainaru, S., & Fainaru-Wada, M. (2015, August 21). Why former 49er Chris Borland is the most dangerous man in football. Retrieved September 20, 2015.
  3. 2015 NFL Health and Safety Report. (2015). Retrieved September 20, 2015, from http://static.nfl.com/static/content/public/photo/2015/08/05/0ap3000000506671.pdf
  4. Hanna, J., Goldschmidt, D., & Flower, K. (2015, October 11). 87 of 91 tested ex-NFL players had brain disease linked to head trauma. Retrieved October 12, 2015.
  5. Frontline. (2013). League of denial: The NFL’s concussion crisis [Motion picture]. United States: PBS

Featured image:
Football 10.18.08 by Mike Hoff

Categories
General Lifestyle

Semper Fi

In early medical practices, the translating of ailments into Latin and Greek amalgams created a language that set doctors apart from the general society. This boundary signified the value that doctors provided and created a group that could identify with each other because they held similar values and had comparable educations.

The use of the phrase “Semper Fidelis” in the Marine Corps serves a similar purpose.  More than just a slogan, it is a way of life for a select population. United States Marines are admired for their dedication to each other, their service, and their country. Marines are a group that is separate and unique from any other. “Semper Fi” translates to “Always Faithful.” This statement symbolizes the ability of common people to become part of a brotherhood that demands more of its members than any other comparable group.

We don’t have to be Marines to achieve the same discipline. As medical students, we can make this a practice as we transition into our careers. Marines are trusted to make significant, split-second decisions in an environment more dangerous and confusing than those in which most doctors operate. The battlefield is chaotic and information often unreliable. In a medical environment it is important to develop effective means of communication balanced with ongoing decision-making. In practice, however, this standard of communication is rare. Empowering front-line practitioners is vital to the success of the medical system. This is parallel to what Marines do. The Marines have standards; a reputation of excellence. There is a sense of being part of something much bigger than simply an organization. What the Marines understand is the same thing that the best doctors understand- success happens through failure. There is a sacrifice that comes with joining the Corps or becoming a physician. Not only must we surrender our weekend plans and sleep to meet the physical and mental demands of our chosen paths, but we are weighted with the notion that our everyday activities affect the lives of others. No matter how good our intentions, as doctors or Marines, we will not be able to overcome the problems caused by poverty, war, the spread of infectious disease, famine, or climate change. That doesn’t mean we can’t try to help people afflicted by these events. 

Why do we do all of this? Because we take pride in what we do.  Moreover, Marines and doctors alike truly care for the welfare of the human race. Veterans Day was November 11, a celebration to honor America’s veterans for their patriotism, love of country, and willingness to serve and sacrifice for the common good (Dept. of Veterans Affairs). 

 

Featured image: Marine Week Boston, 2010: A Bell UH-1N SuperCobra attack helicopter flies by in front of pinkish cloudy blue skies by Chris Devers

Categories
Disability Issues Lifestyle Reflection

Personality Disorders

In individuals, insanity is rare; but in groups, parties, nations and epochs, it is the rule.
– Friedrich Nietzsche

Personality Disorders (PDs) are defined by the DSM-V as significant impairments in the self and interpersonal functioning across time, which cannot be explained by socio-cultural environment or substance abuse (American Psychiatric Association 2012). These disorders are unique within psychiatry because, unlike many of the Axis I disorders, they did not begin to take form until the 19th century. They also tend to create controversy around their definitions, as they are molded by the behavioural standards within a society, and are therefore quite subjective. This subjectivity may be the reason why personality disorders have the lowest levels of reliability and validity among all psychiatric disorders (Alarcon et al. 1995).

There is an important difference between personality styles and disorders, and clinicians must be able to make this distinction. As society changes, roles and values are transformed, leading to the creation of new disorders. One example of this is  internet gaming disorder.

Perhaps we should start by clarifying our terms: what is personality? Is it something that is inherent and unchangeable? Or is it a malleable entity, a wisp of smoke that can never be grasped; a question to hang above the philosophers’ heads? In 1995, Alarcon et al. suggest that personality implies a way of reacting to stimuli, coping with stress and acting on one’s beliefs about oneself and the world. It has been suggested that a personality disorder is almost a caricature of the normal personality, and that it can reflect the distorted aspects of a person’s time and culture.

Society plays a very powerful role when it comes to psychological disorders. It has been suggested that prejudice can distort societies’ perceptions towards those from disadvantaged backgrounds and inflate the rates of personality disorders in these groups. For example, it has been suggested that almost half of inner city youth who have been diagnosed with antisocial personality disorder have been misdiagnosed, because their behaviors are occurring in a unique cultural context; a context which includes the prevalence of behavioral systems which value violent behavior as an acceptable survival strategy (Alarcon et al. 1995). Furthermore, antisocial behaviour could be seen as an adaptation to the excessive demands of our modern world. With the increasing expectations placed upon our youth, not only for wealth and success, but also for a ‘happy’ life with a spouse and child, a fast car and a big house, is it any wonder that many kids rebel against such idealistic expectations? Perhaps it is society that is towing the soil, encouraging the growth of such ‘pathological behaviour’ in our culture. Are we simply pushing humanity too far?

Borderline Personality Disorder (BPD) is another example of a personality disorder that has become increasingly common in the modern world (Grant et al. 2008). Those who have ever set foot on a psychiatric ward will be familiar with the label, as it is the most prevalent category of personality disorder within the mental health services (National Collaborating Centre for Mental Health, 2009).

BPD is a relatively new diagnostic entity, first described in the 20th century. Although people committed suicide in the past, self-harm in the form of wrist cutting is relatively new, only appearing on psychiatry’s radar since the 1960s (Favazza, A.R. 2011). As societies evolve, symptom banks change, and in today’s world there appears to be an increasing acceptance of self-harm as a signal of distress– a phenomenon termed ‘social contagion’ (Jarvi, et al. 2013). Traits underlying BPD are impulsivity and affective instability. In today’s world, these impulsive symptoms are one of the most common forms of expressing distress among the young. Indeed, it has been suggested that BPD risk factors are associated with modern life (Paris and Lis 2013).

Do we as a society place such high expectations on those around us that we must fall back upon psychological labels to explain away those who do not fit into our idea of perfection? I suggest that perhaps this sudden surge in personality disorders does not merely reflect our increasing awareness of such pathologies, but also a deeper issue within modern society. Perhaps we have become so obsessed with success, with money, with beauty, that we have forgotten what it means to be human. To love, to feel, to belong.

And if this is true, then the answer lies not within the leaves of a doctor’s prescription pad, nor within the four walls of a hospital ward, but in the society that we have created for ourselves. Perhaps this rise in personality disorders, this explosion of emotional distress, is a signal that the world we have created for ourselves may be doing more harm than good. The increasing emphasis on achievements, success, wealth, and fame may indeed be turning into a poison. And if this is the case, then the antidote lies beyond the physicians’ hands; it is a task that is placed on all of us, to encourage our children to create a world for themselves that is filled with love and belonging, rather than goals and desires. It is only through an increasing emphasis upon our own humanity that we can begin to combat this psychological plague.

References

  1. Alarcon, R., Foulks, E.F. 1995. Personality Disorders and Culture: Contemporary Clinical Views (Part A). Cultural Diversity and Mental Health. 1:3-17
  2. American Psychiatric Association. 2012. DSM-IV and DSM-5 Criteria for the Personality Disorders.
  3. Chavira, D.A. et al. 2003. Ethnicity and four personality disorders. Comprehensive Psychiatry. 44:483-491
  4. Favazza, A.R. 2011. Bodies under Siege: Self-mutilation, Nonsuicidal Self-injury, and Body Modification in Culture and Psychiatry. 3rd Ed. JHU Press.
  5. Grant, B. Stinson, F.S., Saha, T.D., Smith, S.M., Dawson, D.A., Pulay, A.J., Pickering, R.P., Ruan, W.J. 2008. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiological Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry. 69:522-545
  6. Jarvi, S., Jackson, B., Swenson, L., Crawford, H. 2013. The impact of social contagion on non-suicidal self-injury: a review of the literature. Archives of Suicidal Research. 17:1-19
  7. National Collaborating Centre for Mental Health. 2009. Borderline Personality Disorder, The NICE Guideline on Treatment and Management. The British Psychological Society, The Royal College of Psychiatrists.
  8. Paris, J., Lis, E. Can sociocultural and historical mechanisms influence the development of borderline personality disorder? 2013. Transcultural Psychiatry. 50:140-151

Featured image:
Female Warrior # 14 “Extinction” by CHRISTIAAN TONNIS

 

Categories
Clinical Emotion Lifestyle Narrative

A letter from a patient with anorexia nervosa

Dear Doctor,

What I need from you is validation that what I am experiencing is real; recognize this is more than just a burden for me.

At first it was a rush. The best feeling I’d ever had. I was getting compliments, attention, and my jeans felt wonderfully loose.  But it didn’t take long until it became everything; an obsession.  My eating disorder (ED) has become all I think about.  Every second of every day is consumed with what I eat, what I avoid, how I can avoid it, when I will exercise and for how long. I can’t escape.  Even if I actually wanted to gain weight back, it’s not that easy.

I know you might understand, but at least acknowledge that it’s not about the food. The truth is, when you say it’s about the food, it’s more tangible, easier to categorize, like a patient with a broken wrist.  People think that if I “just eat a sandwich” I will be fine, but this is far from accurate.

Sometimes ED hints at me, other times it screams. Either way, ED is a part of my life; it is a part of who I am right now. I have a deep connection to this diagnosis. Because of this, I will defend and validate ED, and conjure any excuse to hold on to this relationship just a little longer. For patients like me, ED becomes another member of the family, the third wheel in a relationship, or even another personality who needs attention.

I still struggle often, but I have good days too.  I am not just another girl with anorexia.  I’m a young woman who never takes life too seriously, loves road trips and playing the piano, and who fights back against anorexia every single day.  I know it’s your mission, but you cannot fix me. Only I can do that and I am going to need your support.

So right now, take a seat on my rollercoaster, listen to me, and let’s get to the end of this ride.

Sincerely,

Your ED patient

 

* Inspired by a loved one

Featured image:
Anorexia. by Mary Lock