Kate Johnson's Medical Musings

Life through the eyes of a medical journalist

Can You Think Pain Away? Some Experts Say Yes.

First published on my iVillage Health Beat blog.

The Mind-Body Connection

My husband comes from a long line of herniated disks. Two of them are painfully present in his own spine, and several others have shown up in the spines of his father and brothers. Breaking free from genetic inevitability, my husband is the only family member to refuse spinal surgery – so far. He prefers a sometimes stubborn approach which involves living with what he feels is an acceptable level of constant pain, spending liberally on osteopathic and athletic therapy, pursuing high-level athletic goals which force him to stay fit, and swallowing a very large daily dose of denial along with his ibuprofen. While the rest of his afflicted family members submitted to the knife by the time they hit 30, my husband has reached his mid-40’s and still refuses it. But this week he’s bad.  This week, as a result of his latest sports championship, he is now struggling to walk, bend down, and even turn his head. Coincidentally, this week I am also attending the annual meeting of the Society of Behavioral Medicine. As a medical journalist, I track the trends, interview the experts, and write about the latest new in most fields of medicine. As I absorb what’s new at this meeting I keep thinking of my husband, who is a perfect example of the interaction of behavior with health – the cornerstone of behavioral medicine. Refusing a recommended surgery because it did too little to help his family members, his attitude is to live life to its fullest until the herniated discs force him to slow down. As it turns out, this is actually a recommended therapy in behavioral medicine. Indeed, the treatment of illness and relief of symptoms should not be simply a matter of finding and eliminating the cause, Fred Friedberg told me today. As a clinical psychologist, associate professor at Stony Brook University School of Medicine, and a specialist in treating medically unexplained illnesses, Dr. Friedberg knows a lot about healing patients without knowing the cause of their pain. In his latest book he explains how he helps patients with chronic fatigue syndrome  and fybromyalgia  relax, reduce the stress in their life, and accept their limitations. Despite no medical explanation for their illnesses, and no cure, he can promote healing attitudes which bring them relief. And, being himself a chronic fatigue syndrome patient, he presumably knows what he’s talking about. Dr. Friedberg agrees that whether there is a medical explanation for pain or not, the mind/body connection is an important one for relieving symptoms and improving a person’s quality of life. As for my husband, there may be some faulty connections in his spinal cord, but so far he’s managed to keep going with his home-made version of behavior therapy. –KJ

                           

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June 18, 2009 Posted by | Uncategorized | Leave a comment

Just a Spoonful of Happiness

First published on my iVillage Health Beat blog.

Just a Spoonful of Happiness

Mary Poppins was really onto something with her “spoonful of sugar helps the medicine go down”. Who hasn’t used their sweetest powers of persuasion to win compliance from a reluctant child, parent, boss or spouse? Even toddlers know how to get what they want with a cuddle and a sweet smile!

So why is it that doctors so often use scare tactics to strongarm their patients to diet, or to quit smoking, or to take their medication properly?

As a mother I learned quickly that force is a recipe for disaster, as I watched harried parents drag their screaming children to their first day of kindergarten. I didn’t want my daughter to comply by force and threats, I wanted her motivation and enthusiasm.

Whether it’s the first day of kindergarten, or the first day of the rest of your life, there’s hopefully a long, long road ahead for all of us, and things will go so much better if there is no kicking and screaming involved.

Experts in the field of behavioral medicine agree strongly with this idea because it produces impressive results, they told me when I attended the annual meeting of the Society of Behavioral Medicine (www.sbm.org ) last week.

While many medical doctors tear their hair out about heart patients who won’t exercise, asthma patients who won’t take their medicine, and diabetic patients who won’t lose weight, behavioral medicine specialists are getting patients to willingly comply – with a spoonful of happiness.

Inspired by the positive psychology movement (http://www.ppc.sas.upenn.edu/), which focuses on what is right in your life, rather than what is wrong. Dr. Mary Charlson and her team got patients with high blood pressure to walk 12 extra blocks per week simply by boosting their mood and confidence levels. “That’s a powerful effect,” said Charlson, who is a doctor of Internal Medicine at Weill Medical College’s Center for Complementary and Integrative Medicine in New York.

“It’s simple stuff,” added her colleague John Allegrante, PhD, professor of Health Education at Columbia University. “We know that good mood can come from very modest positive experiences and that this can influence thoughts, behaviors and motivations. So, I tell my patients that maybe life is not so bad for them, that there are lots of things to be positive about, and if they search back through their life they will discover lots of things about which they can be proud, and they should remember those things every day when they are faced with challenges.”

“By taking a moment in the morning when you get up to think about something that makes you feel good – and checking back in with that throughout your day – it can make a very big difference in your overall ability to sustain the kinds of lifestyle changes that are necessary to preserve your overall health,” said Charlson. “Doctors who scare patients are are actually having the opposite effect.”

But, for some people, taking a positive view of life is almost impossible, no matter how hard they try, because they are struggling with depression. There’s hope for them too.  More on that in my next blog! –KJ

June 18, 2009 Posted by | Uncategorized | 1 Comment

Has Low-Grade Depression Crept Up on You?

First published on my iVillage Health Beat blog.

Has Low-Grade Depression Crept Up on You?

Until you have seen major depression up close it is hard to appreciate its power. I have seen the lights go out in the faces of people I love. In my last blog I wrote about how the positive psychology movement, simply by making people feel happier, is motivating them into healthier habits. But the fact is, once true depression has set in, happy talk falls on deaf ears.

Many people think of depression as an almost catatonic, dysfunctional, suicidal state of mind. I have seen that type of depression invade a person, and I will never forget it. But, much more common, and more insidious, is low-grade depression – the kind that steals your sparkle, and burdens your soul, but does not shout out loudly enough to demand treatment.

In 2000, in his book The Science of Optimism and Hope, Dr. Martin Seligman, considered by some people to be the father of the positive psychology movement, wrote about “the remarkable epidemic of depression occurring in young people in the United States today.”

According to the National Institute of Mental Health,  approximately 30 million American adults suffer from some form of mood disorder, and 3.3 million of them live with chronic, low-grade depression, which is known as dysthymia.

Though it is sometimes referred to as “mild” depression, mental health experts take dysthymia very seriously. Unfortunately, many people with dysthymia do not. Instead, they just struggle laboriously through their lives, toughing out their fatigue, headaches, insomnia, irritability and stress. What they don’t recognize is that their depression is caused by a chemical imbalance, and it’s very unlikely to disappear on its own.

I learned last week, as I attended the annual meeting of the American Society of Behavioral Medicine that simply treating this type of depression can often relieve many of the other problems people face.

 Have you battled endlessly with your weight, or marital problems, or addictions? Do you struggle to control diabetes, or asthma, or heart disease? Do you suffer from insomnia, fatigue, headaches, or other pain? While these things are not caused by depression, behavioral medicine experts know that they are amplified in people who are depressed.

Study after study shows that people who are depressed report more pain, fail to quit smoking more often, drop out of more fitness and diet programs, and  are more likely to ignore doctor’s recommendations about their diabetes or other diseases.

 What if simply getting your mental health in shape could help you put the rest of your life in order? I recently suggested this to a friend who was complaining about her insomnia and her weight gain. “I tried antidepressants once but I didn’t really think they did anything,” she told me. “But you did lose weight, didn’t you?” I said. “Well, that was because I decided to join Weight Watchers,” she replied. Perhaps it wasn’t a coincidence that her successful step towards weight loss happened while she was treating her depression!

Antidepressant medication is certainly not the only answer. Indeed, many mental health experts believe medication alone is only a partial treatment, and should be combined with talk therapy. But even psychotherapy alone can help many people get there heads above water enough to help them regain control of their lives. I’ve seen all of these approaches work, and the lights go back on in people’s faces. It’s a small effort with huge implications for the rest of your life.

For more about depression, its symptoms and its treatment:

According to the National Institute of Mental Health, signs of dysthymia and other depression include:

                          Persistent sad, anxious or “empty” feelings

                          Feelings of hopelessness and/or pessimism

                          Feelings of guilt, worthlessness and/or helplessness

                          Irritability, restlessness

                          Loss of interest in activities or hobbies once pleasurable, including sex

                          Fatigue and decreased energy

                          Difficulty concentrating, remembering details and making decisions

                          Insomnia, early–morning wakefulness, or excessive sleeping

                          Overeating, or appetite loss

                          Thoughts of suicide, suicide attempts

                        Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

                               — KJ

                                             

June 18, 2009 Posted by | Uncategorized | Leave a comment

Butting Out. Do you have a Genetic Disadvantage?

first published on my  iVillage Health Beat blog:

Butting Out. Do you have a Genetic Disadvantage?

I’ve always felt impatient with people who constantly struggle to quit smoking and repeatedly fail. But now genetic research on this phenomenon is awakening new sympathies in me.

As a medical journalist I recently attended the annual meeting of the Society of Behavioral Medicine where I learned that not all nicotine dependence is equal.

While kicking the habit may be an uphill struggle for some people, it’s more like climbing Mount Everest for others.

Research by Caryn Lerman, Ph.D. and colleagues, from the Transdisciplinary Tobacco Use Research Center at the University of Pennsylvania, has shown that – willpower and inner strength aside – part of your battle to butt out has already been lost or won at the genetic level.

Dr. Lerman’s group has found that genes determine how quickly or slowly smokers metabolize nicotine, and thus how quickly they are driven to light their next cigarette.

Genes also determine just how good smoking makes you feel, and on the flipside, how painful it is to quit.

We know that nicotine is a feel-good drug which stimulates the release of opiates in the brain. That’s why quitting is so hard.

But for smokers with a particular genetic make-up, quitting actually reduces activity in a part of their brain – the dorsolateral prefontal cortex – which impairs their cognitive function, says Dr. Lerman.

“This brain connection may explain why they are  at such high risk for relapse,” she said, adding that, for these smokers, simply lighting up again reverses their brain fog.

For smokers whose genes make them metabolize nicotine fast, and develop cognitive problems in withdrawal, kicking the habit becomes an almost insurmountable challenge.

But soon, doctors will be able to use a simple saliva or blood test to see which quitters are starting out with this genetic disadvantage and therefore need the most aggressive help.

What kind of help?

Well, research by Dr. Lerman’s group shows that people who metabolize nicotine slowly are only mildly dependent and have a pretty good quit rate (42%) with just counseling or a nicotine patch, while fast metabolizers only have about half the chance (28%) with this approach. “Fast metabolizers are candidates for non-nicotine medications which may be more costly and have more side effects than the patch,” she says.

Similarly, smokers who get that “foggy brain” feeling from nicotine withdrawal may soon have a medication designed specifically to combat this brain chemistry.

Genetics-based tests for smokers are not yet available for widespread use, but this work by Dr. Lerman and others is paving the way. Today only 1 out of 3 quitters manages to stay off cigarettes for good. By digging deeper into the world of genetics perhaps she’ll provide reinforcement to those still in the battle. –KJ

June 18, 2009 Posted by | Uncategorized | 1 Comment

The War on Drugs: Give Peace a Chance

The War on Drugs: Give Peace a Chance

June 15, 2009

By Kate Johnson

Dr. Gabor Maté wraps a tourniquet around a patient’s arm and instructs him to pump his hand until a vein bulges below his elbow crease. Then he instructs the addict to inject himself with heroin. “I had never imagined that my  medical career would lead me to assist an addict’s self-administration of an illicit psychoactive substance in a musty Downtown Eastside hotel,”  he writes in his book “In the Realm of Hungry Ghosts”. But “under the circumstances it was the best I could do for him”.

As a staff physician at the Portland Hotel and Insite, a residence and safe-injection site in Vancouver’s Downtown Eastside, Dr. Maté has dedicated his work to treating drug abuse and addiction. But unlike the soldiers in the War on Drugs, this soft-spoken crusader has rejected all “weapons”, preferring instead the tools of acceptance and caring. It is Peace, not War that will make a difference, he insists. “The pertinent question is not why the War on Drugs is being lost, but why it continues to be waged in the face of all the evidence against it,” he writes.

“Addictions are a response to a sense of emptiness,” Dr. Maté declared at a recent seminar in Toronto for people who work with addicts. Continue reading

June 15, 2009 Posted by | Addiction, Parenting, Prevention, Psychology | , , , , | Leave a comment

Teenage Addiction: It’s All About Love

Teenage Addiction: It’s all about Love

June 13, 2009

By Kate Johnson

“Addiction is not a response to the availability of a substance, it is a response to pain.” Best-selling author, addiction treatment expert and parenting guru Dr. Gabor Maté literally brings tears to my eyes as I sit in a room full of people who care for addicted teens – and adults – every day.

Although I am a medical journalist, accustomed to hearing presentations about addiction and its treatment, Dr. Maté’s words touch a raw nerve. For Dr. Maté, the root of all addiction, whether to drugs, or tobacco, or shopping or eating, lies in emptiness – and an attempt to fill the void. Dr. Maté believes all humans feel some degree of emptiness that they attempt to fill. He has not said it, but perhaps the emptiness begins when the umbilical cord is severed, and grows with every step we take away from the womb. Continue reading

June 13, 2009 Posted by | Addiction, Parenting, Prevention, Psychology | , , , , | 2 Comments