Author Archive
May 8, 2012 | 
Author Dr. Perry Klass, a primary care doctor, and columnist for the New York Times Health recently wrote about the concern primary care doctors, as well as pediatricians, and obstetricians have in speaking to their patients about depression. ”Like many other primary care doctors I sometimes sense the shadow of depression hovering over the edges of the exam room.” The right questions may be critical in helping the patient get the correct diagnosis, without stigma.
Research into postnatal depression has underscored the importance of following up on parents’ mental health in the first month’s of a baby’s life. However, a parent’s depression can be linked to all kinds of issues, and may endure or appear in the lives of older kids. Often, people who are depressed do not seek out help. Dr. Williams Beardslee, professor of child psychiatry at Harvard medical school says “Untreated, unrecognized parental depression can lead to negative consequences for kids.” These consequences can include lowered school performance, increased visits to the emergency room, poorer peer relationships and adolescent depression. However, when depressed parents get treatment and help with parenting, families are much better off.
There are higher rates of depression in parents whose kids have chronic medical problems. This may also reflect the stress of dealing with the issues surrounding the child. Dr. Jacqueline M. Grupp-Phelan, a pediatric emergency room doctor at Cincinnati Children’s Hospital said “There is a high burden of maternal depression, and anxiety among moms bringing their kids to the emergency room.” ”It influences their own perceptions of how well they can deal with their kid’s problems.” Dr. Grupp-Phelan believes moms in the emergency room like to be asked how they are doing… it may be the only time they’ve been asked about their depression. ”The last thing in the world we should be doing is blaming parents.” ”We should be reaching out and offering hope.” And there is a lot of hope. Healthy family routines and rituals can be rebuilt, and there is extensive research to show that kids are resilient……… Ny Times Health May 7, 2012
The journal Headache recently published the results of a study of soldiers returning from Iraq and Afghanistan. The soldiers had suffered deployment-related concussions. Soldiers with chronic daily headache, defined as headaches occurring 15 or more days per month, for the previous 3 months were compared to soldiers with episodic headaches occurring less than 15 days per month.
Approximately 20% of the soldiers had chronic daily headache, while 78% had episodic headache. It was noted that the number of concussions, blast exposures, and concussions with loss of consciousness was not significant between the two groups. However, the soldiers with chronic daily headache had significantly higher average scores on the post traumatic stress disorder (PTSD) checklist compared to soldiers with episodic headaches.
The study concluded that PTSD symptoms were strongly associated with chronic daily headache, suggesting that traumatic stress may be an important point of headache chronification. A few years back John Rothrock, M.D. and editor in chief at Headache published an article asking the question “Why does migraine become chronic?” While he noted that are not clear answers, he suggested there may be a strong association between chronification and a history of early sexual abuse, and other emotional traumas early in life. It may be possible that PTSD and returning troops with head trauma may also have a link to chronic daily headache. While early emotional trauma (or sexual or physical), or in the case of soldiers the PTSD, may predispose to headache, this is not to say that the headaches are “all in your head”. They are very real, just like diabetes or asthma. These headaches involve many changes in neurological pathways and neurotransmitters.
Painkillers, particularly opioids, have been under attack in the U.S.. The media rails against overuse of pain meds, how regulatory departments do not sanction “bad” doctors enough, how many people overdose and die, etc. etc.. That all has some truth to it; the other side is, what are the pain patients supposed to do? The current environment makes it difficult for doctors to prescribe pain meds; not THAT difficult however. There are a # of reasons why many docs do not want to prescribe pain meds, some legitimate, some not so. The legitimate reasons include the increased scrutiny that prescribing opioids has brought, fear of the state dept. of regulation and DEA, fear of lawsuits, etc.. The non-legitimate reasons why docs are loathe to prescribe include not wanting to put up with diffficult phone calls and difficult patient encounters. Prescribing opioids adds complications, and many docs just say it is not worthwhile. In this environment, I do not really blame them. If a doctor says “I do not prescirbe pain meds, or if I do only 10 at a time”, it eliminates many difficult patient encounters, phone calls, problems with pharmacies, lawsuit possibilities, and fear of state and federal scrutiny. Nonetheless, that leaves the pain patients out in the cold, finding it very difficult to find docs who will prescribe. That is a major problem. Yes, there have been overdoses and overuse, but 90% of patients do not overuse the pain meds, become addicted, or overdose. Should we really punish the 90% because we have a problem with 10% of patients? I think not………..it is not fair………
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Tags: analgesics, opioid overdose, opioids, pain, pain medications | 
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Dr. Roger Cady, founder of the Headache Care Center in Springfield, Missouri, and a leader in the field of headache and migraine research recently spoke with Head Wise Magazine about the issues surrounding migraine patients. He believes the most common need people have is to understand why they get headaches….
Dr. Cady :
Why am I different than my friends? We go out and we do the same things, and I end up with a migraine and they seem to have no ill effects. When I sit down with patients, I like to make sure they understand that they were born with a brain that is unique and different than the brain of people who don’t have have migraine. The brain of a migraineur tends to be more vigilant, more sensitive to its surroundings. That often brings with it some very positive attributes if the nervous system is well controlled. Successful people in all walks of life live with migraine. Our goal is to learn to manage this nervous system successfully and bring out the good attributes – the positive side of this sensitivity. Then I like to make sure they understand why they get headaches. It’s a relationship between the genetics that nature gave them, and the environment in which those genetics function. Sometimes we think of migraine as being one thing, but a lot of times its many things that are impacting the nervous system simultaneously and putting that nervous system at risk.
Dr. Cady said if he could say one thing to a migraine patient it would be the following….
Migraine is a biologic process. There’s a lot that can be done to help manage it more successfully. Part of this, you, as the person that has this nervous system, need to take responsibility for. A lot of it, the medical system can help you discover and learn how to use. Find a partnership. Work with your healthcare professional and in almost all instances, migraine can become a well-managed and well-controlled disorder…..Head Wise Vol.1 Issue 1 2011 Gary Cohen
Recent research challenges the common belief that problems with nighttime sleep and daytime tiredness are more common in older adults. The study looked at 155,877 Americans…. of those, the people over the age of 80 were actually less likely to have sleep problems versus those between the ages of 18-24. Men over the age of 80 had less than half the frequency of sleep problems as the men aged 18-24. The octogenarian women also had fewer sleep issues than the 18-24 year old females. The study suggests that sleep problems were most closely linked to self-reported health status and depression. The young female respondents were also most likely to report feeling tired during the day. The rates of sleep problems and tiredness dropped after the age of 24 in women, and did climb as women reached their 80s, but they never reached the level seen in the youngest women. The rates of tiredness among men varied little with age, and rose only slightly in the late 70s.
It makes one wonder about the various factors affecting young people and their sleep patterns ……Tufts University Health & Nutrition Letter May 2012
When given in high doses, the drug naltrexone has been effective in blocking the effects of heroin and other narcotics in addicts. Because the person does not experience a high on naltrexone, he or she can overcome the addiction to the narcotic. Naltrexone can also help alcoholics stop drinking.
A study just published shows that a low dose of naltrexone can significantly reduce pain in people with fibromyalgia. The research, done at Stanford University School of Medicine confirms earlier, similar findings from Stanford, published in 2009.
When given in low doses, naltrexone works in a different way… it affects the immune system. As a result, naltrexone can offer patients with autoimmune diseases like multiple sclerosis, and chronic diseases with immune components like fibromyalgia or chronic fatigue syndrome some pain relief. In this newest study, women with fibromyalgia were given a daily low dose of naltrexene for 12 weeks, followed by a placebo for 4 weeks. Compared to the placebo, naltrexone decreased the pain in the women by over 48%.
French researchers have recently published results from a study looking at older women, and their vitamin D intakes. After following the women for seven years, the researchers concluded that the women who did not take a daily vitamin D supplement at the start of the study had a greater risk of developing Alzheimer’s disease compared to the women who took one. Potential brain benefits of vitamin D can also be linked to foods rich in the vitamin, such as fish.
Exposure to the sun is an important way our body manufactures vitamin D. However, weak levels of sun in wintery northern climates may not supply the amount of the “sunshine” vitamin we need. Fortified foods, as well as vitamin D supplements can help.
The results of this study suggest that vitamin D is not only essential to our bone health, but to our brain health as well…….The Journal of Gerontology MedScience April 2012
We recently blogged about the importance of “activity breaks” …. getting up and moving around every hour or so from the chair or couch. Gretchen Reynolds of the New York Times recently wrote about sedentary lifestyles… and how TV is an important factor in assessing how inactive we may be. The National Cancer Institute followed 250,000 Americans over a period of eight years. The study found that those people who watched TV for 7 or more hours a day had a much higher risk of premature death than did people who sat in front of a TV less often.
However, while exercise slightly lessened the health risks of sitting, people in the study who exercised 7 hours or more a week, but then spent at least 7 hours a day watching TV were more likely to die prematurely than the group who worked out 7 hours a week and watched less than an hour of TV a day! While exercise is important, this study seems to suggest that sitting long periods at a time is most harmful.
After gathering this information, Reynolds made some personal changes. She canceled her cable TV subscription, which horrified her 14 year old son. She felt he could find better things to do with his free time than watch the Food Network shows. Reynolds set up a music stand next to her desk. She props reading material on it, and stands there often during the day. Rather than sitting while she is on the phone, she “prowls” around the office. While these were some of her personal changes, and may not work for the rest of us, maybe it will get us thinking about some “tweaks” we can initiate to keep ourselves more vertical each day! New York Times 4/28/12
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While recent research has shown that natural settings may help to soothe and refocus kids with attention deficit disorder, new data suggests that adults can also benefit from the restorative powers of nature. Read the rest of this entry »
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Research on food and addiction is in its infancy. New studies however are suggesting that overeating may dampen your dopamine response, which can make you overeat even more.
Dopamine is a neurotransmitter that motivates us to eat (and enjoy other “rewarding” behaviors). In 2001, Nora Volkow and her colleagues at the Brookhaven National Laboratory published a groundbreaking study called “Brain Dopamine and Obesity.” The study found that very obese people had lower levels of dopamine in the “reward” areas of their brains than did people who were normal weight. ”These brain scans were game-changers,” according to Pamela Peeke assistant clinical professor of medicine at the University of Maryland School of Medicine. “Because this is precisely the same thing that happens in meth heads, cocaine addicts, alcoholics, and other addicts.” So, if dopamine makes you want to eat or take drugs, why then do obese people or drug addicts have less of a dopamine response? ”We used to believe that people were addicted because they were more sensitive to rewarding effects,” says Volkow. ”We thought they had more dopamine release, that it would be more pleasurable.” ” However, it’s the opposite.”
Researchers have wondered if some people overeat because they are born with a dopamine system that does not respond. Or, is it possible that obese people have a low dopamine response because they overeat and overstimulate their dopamine? It may be both. In a study of 26 overweight and obese young women, those who gained weight over six months had less response in the brain targeted by dopamine when they drank a milkshake than they had six months earlier. The young women also showed a reduced dopamine response compared to the overweight women who had not gained weight. A lower dopamine response may not only make it more likely to overeat, but to dampen the dopamine response even more.
So which foods can be addictive? According to Kyle Burger, a researcher at the Oregon Research Institute, those foods that are sweet, fatty and have a lot of calories – no surprise. ”It looks like the habitual consumption of food – specifically calorie – dense food – can elicit changes in brain responses that mirror drug addiction,” ways Burger. However, as humans we all crave certain foods…. and craving is not addiction. Craving is an intense desire to eat a particular food. Some studies show that among college students, approximately 60% of women crave sweet foods that are usually high in fat, while men’s sweet cravings are at about 40%.
Food addiction research is in its early stages. The hope is to continue following people over a long period of time. Says Burger: “The take – home message is that the frequent consumption of calorie – dense food may be altering your brain responses in a way that’s going to make you consume more.” Nutrition Action May 2012
