Born to have Baby Blues?

Mother In Nursery Suffering From Post Natal DepressionIt’ s not clear what causes postpartum depression.  The condition, which is marked by persistent feelings of sadness, hopelessness, exhaustion and anxiety, usually begins within four weeks of giving birth and can persist for weeks, months or even up to a year. An estimated 10 to 18% of all new mothers develop the condition, and the rate rises to 30 to 35% among women with previously diagnosed mood disorders.

Scientists have long believed the symptoms were related to the large drop-off in the mother’s estrogen levels following childbirth, however studies have shown that both depressed and non-depressed women have similar estrogen levels.

Now researchers from Johns Hopkins say they have discovered alterations in two genes that, can reliably predict whether a woman will develop postpartum depression.

genetic link to post-partum depressionThe genetic modifications, which alter the way genes function without changing the underlying DNA sequence, can apparently be detected in the blood of pregnant women during any trimester, potentially providing a simple way to foretell depression in the weeks after giving birth, and an opportunity to intervene before symptoms become debilitating.

By studying mice, the researchers suspected that estrogen induced genetic changes in cells of the hippocampus – the part of the brain that governs mood.  They  then created a complicated statistical model to find the candidate which could be potential predictors for postpartum depression. That process resulted in the identification of two genes, known as TTC9B and HP1BP3.

Little is known about these genes except for their involvement in hippocampal activity. However the team suspects that they may have something to do with the creation of new cells in the hippocampus and the ability of the brain to reorganize and adapt in the face of new environments. Both of these elements are known to be important in mood.

Furthermore, estrogen can behave like an antidepressant, so when it is inhibited, it adversely affects mood.

Postpartum depression can be harmful to both mother and child,” says Zachary Kaminsky, Ph.D., an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “But we don’t have a reliable way to screen for the condition before it causes harm, and a test like this could be that way.”

The findings of the small study involving 52 pregnant women are described online in the journal Molecular Psychiatry.

blood  test + pregnancyThe study involved looking for epigenetic changes tin the thousands of genes present in blood samples from 52 pregnant women with mood disorders. The women were followed both during and after pregnancy to see who developed postpartum depression.

The researchers noticed that women who developed postpartum depression exhibited stronger changes in those genes that are most responsive to estrogen, suggesting that these women are more sensitive to the hormone’s effects. Specifically, changes to the two genes – TTC9B and predicted with 85% certainty which women became ill.

We were pretty surprised by how well the genes were correlated with postpartum depression,” Kaminsky says. “With more research, this could prove to be a powerful tool.”

Evidence suggests that early identification and treatment of postpartum depression can limit or prevent debilitating effects. Alerting women to the condition’s risk factors — as well as determining whether they have a previous history of the disorder, other mental illness and unusual stress — is key to preventing long-term problems.

Research also shows that postpartum depression not only affects the health and safety of the mother, but also her child’s mental, physical and behavioral health.

antidepressants.pregnancy.giIf the results of this preliminary work pan out then a blood test for the biomarkers could be added to the battery of tests women already undergo during pregnancy.  More importantly, the results could help to inform decisions about the use of antidepressants. While there are concerns about the effects of these drugs on the fetus and their use should be weighed against the potentially debilitating consequences to both the mother and child of forgoing them.

As Kaminsky says “If you knew you were likely to develop postpartum depression, your decisions about managing your care could be made more clearly.”

SRxA-logo for web

About these ads

Fighting Flab with Flying Insects

cicada 1If, like us, you live in the East Coast of the US, you’ve probably stated to see some of the billions of bug-eyed cicadas that have returned after a 17 year absence.   Cicada sightings are trending on Facebook and other social media sites, almost as frequently as reports of the devastation in Oklahoma and the outcome of the Jodi Arias trial.

I saw my first red eyed cicada on Sunday night…not while out walking my dogs or mowing my yard but in the Emergency Department of my local hospital!  While I’m not certain if it was there as a patient or a visitor, it caused one of my EMS colleagues to run screaming from the room.

This got me thinking about what will you do when ‘swarmageddon’ hits?

cicadapocolypse-537x357-1Will you be locking yourself inside out of terror and to avoid the potential ear trauma resulting from the insects’ loud mating noises, or, will you be embracing the winged critters as a diet delicacy?

That’s right!  Cicadas are an excellent source of nutrients and apparently one of the most versatile ingredients around. They can be deep fried, stir fried, skewered, blanched and even made into ice cream.

But you’ll need to be quick.  Just like another delicacy – truffles – the season will be short. By the end of June, the 2013 cicada invasion will come to a close, and it will be another 17 years before we see them again.

Cicadas are the shrimp of the land,” says entomologist Isa Betancourt .  She explains: “They are arthropods, which means they have an exoskeleton. We regularly eat the arthropods of the sea … shrimp, lobster, and crabs.”

Better still, cicadas are high in protein and low in fat.  Apparently they have a delicate nutty flavor and buttery texture and are best when they first emerge from the ground in the morning, still soft after shedding their skin.

insect_plate_lAnd even though the thought of eating cicadas might give you the creeps, a U.N. report published this week, unrelated to cicadas, says consuming insects can help fight obesity.

More than 1,900 species of insects are eaten around the world, mainly in Africa and Asia. However, “in the West we have a cultural bias, and think that because insects come from developing countries, they cannot be good,” says  Arnold van Huis, one of the authors of the report, from Wageningen University in the Netherlands,

As well as helping in the costly battle against obesity, which the World Health Organization estimates has nearly doubled since 1980 and affects around 500 million people, the report said insect farming was likely to be less land-dependent than traditional livestock and produce fewer greenhouse gases.

It would also provide business and export opportunities for poor people in developing countries, especially women, who are often responsible for collecting insects in rural communities.

Mexican grasshoppers fried in chilis … could you?Van Huis said barriers to enjoying dishes such as bee larvae yogurt were psychological – in a blind test carried out by his team, nine out of 10 people preferred meatballs made from roughly half meat and half mealworms to those made from meat!

Share your cicada, and other insect, recipes and experiences with us.

SRxA-logo for web

Dogs Double Risk for Distracted Driving

teen texting and driving-resized-600Distracted driving is something we usually associate with teens and their cell phones, or frenzied mothers and their minivan full of kids.  However the National Highway Safety Traffic Administration defines it as “anything that could potentially remove a driver’s eyes from the road, their hands from the steering wheel or their concentration from the task of driving.”

And that includes pets…

While most states have enacted legislation to curb the use of cell phones while driving, only one – Hawaii – has laws that specifically restrict drivers from having a pet in their lap. But a new study could be about to change all that.  The University of Alabama at Birmingham, research enrolled 2,000 drivers age 70 and older, of whom 691 had pets. Participants took a survey on driving habits, and those with pets were asked about the frequency of driving with pets. They also underwent visual sensory and higher-order visual processing testing.

driving-with-dogsThe results showed that senior drivers who take a pet in the car are at increased risk for being involved in a motor vehicle collision. Both overall, and at-fault, crash rates for drivers 70 years or older were higher for those whose pet habitually rode with them.

More than half the pet owners said they took their pet with them in the car at least occasionally, usually riding on the front passenger seat or in the back seat.

That is consistent with previous studies looking at all drivers, which indicate that slightly more than half of all drivers take a pet with them at times,” said Gerald McGwin, PhD, senior author of the study. “And it’s interesting to note that earlier surveys indicate that 83% of those surveyed agreed that an unrestrained dog was likely dangerous in a moving vehicle, yet only 16% have ever used any type of restraint on their own pet.”

The crash risk for drivers who always drove with their pets was double that of drivers who never drove with a pet, while crash rates for those who sometimes or rarely drove with pets were consistent with the rates for non-pet owners.

This is the first study to evaluate the presence of pets in a vehicle as a potential internal distraction for elderly drivers,” said McGwin. “The increased crash rate for elderly drivers who always drive with pets is important in the context of increasing driver awareness about potentially dangerous driving habits. There is no direct evidence that driving with pets is or is not a threat to public safety, however, indirect evidence exists based on distracted driving research on texting, eating or interacting with electronics or even other passengers and there are certainly anecdotal reports in the news media of crashes and even fatalities caused by drivers distracted by a pet in the vehicle.”

dog in carThe authors suggest that when confronted with an increased cognitive or physical workload while driving, elderly drivers have exhibited slower cognitive performance and delayed response times in comparison to younger age groups. Adding another distracting element, especially an animal, provides more opportunity for an older driver to respond to a driving situation in a less than satisfactory way.

Given the current debate about all types of distracted driving, further study of pet-related distracted driving behaviors among drivers, is warranted to appropriately inform the need for policy regulation on this issue.

Do you have thoughts on driving with pets?  Please let us know.

SRxA-logo for web

www.Can-I-Help-You-With-That?

worldwideweb-20thbday-top640There’s days when reading the news makes you feel old. Today is one of those days.

It started out with the realization that the world wide web just celebrated its 20th birthday. Can it really be 20 years ago?  At launch, there were only 17 “subjects” on the Web, including music, law, religion, and literature. Today the internet is so ubiquitous that we take it for granted…unless of course it goes down, at which point we literally become paralyzed. iphone

Next, I heard that Apple has just declared the first iPhone obsolete.  Really?  What was considered so cutting edge a few short years ago is now obsolete!

So I guess I shouldn’t have been that surprised to hear that robots are ready to take over patient care.  Yes, I know that many of them already perform surgery, but hands-on patient care?

Apparently, roboticists are developing machines that can help patients with tasks, such as housework, feeding and walking. And, according to a Georgia Institute of Technology study, more than half of healthcare providers said that if they were offered an assistant, they would prefer it to be robotic rather than human.

However, they don’t want robots to help with everything.  Activities of daily living such as helping with housework and reminding patients when to take medication, were acceptable, but activities involving direct, physical interactions such as bathing, getting dressed and feeding, were considered better for human assistants.

This study mirrored the lab’s earlier research that found older people are generally willing to accept help from robots, but their preferences depended on the task. These tech-savvy seniors said they preferred robotic help over human help for chores such as cleaning and doing laundry. However, they preferred human help with bathing and getting dressed.

One open question was whether healthcare providers would reject the idea of robotic assistants out of fear that the robots would replace them in the workplace,” said Tracy Mitzner, one of the study’s leaders and the associate director of Georgia Tech’s Human Factors and Aging Laboratory. “This doesn’t appear to be a significant concern. In fact, the professional caregivers we interviewed viewed robots as a way to improve their jobs and the care they’re able to give patients.”

robot giving medicationFor instance, nurses preferred a robot to help them lift patients from a bed to a chair. They also indicated that robotic assistants could be helpful with some medical tasks such as checking vitals. feeling oldJust like the internet it seems robots are going to take over our lives.

Not sure that I’m looking forward to a future where doctors have been replaced by nurses who have been replaced by robots… SRxA-logo for web

Fluffy Therapy

animal-therapyThese days, therapy dogs and cats are often brought into health care facilities to help boost their health and happiness of people suffering from mental and physical illnesses or disabilities.

The results are often so amazing, they are almost inexplicable. I vividly remember, Laura, a patient from many years ago. She was a sweet old lady, who was deaf, dumb and blind and had recently been diagnosed with advanced breast cancer. Following surgery, in a strange hospital environment she seemed to be lost in her world of diminished senses, and appeared to be giving up. She wasn’t eating, or drinking. IV fluids were keeping her alive and diamorphine was keeping her pain free. Anticipating she didn’t have much longer to live, I called the next of kin listed in her records and spoke to her sister. The younger sibling, who lived half-way around the country, agreed to come but asked if she could bring Laura’s service dog. At the time, this was unheard of on a surgical unit and would certainly have been frowned upon by hospital authorities. Never one to follow the rules, and a self-confessed animal lover, I immediately agreed. I’d deal with the consequences later if need be.

DocTheDog041_t607A few days later, Grace arrived on the ward with Honey, a calm and happy Golden Labrador. Without any directions, Honey led Grace straight to Laura’s bed and laid her big head on her mistresses’ frail outstretched arm. Laura’s eyes opened, she sat up, and began talking to the dog.

This wasn’t a miracle in the conventional sense, the dog had not restored the power of speech, it turned out that Laura, while blind, could hear and speak perfectly well. However, separated from her faithful companion, she’d become profoundly depressed, and simply stopped communicating.

Honey stayed in the hospital for several weeks, barely leaving Laura’s bedside, until they were both ready to go home. During those weeks, other patients benefitted from Honey’s presence too. Even the medical and nursing staff even seemed to be cheerier as they went about their work.  So not a conventional miracle, but one of the closest things I’ve ever seen to one.

Did I get into trouble for harboring and concealing a canine?  Sure!  Would I do it again?  In a heartbeat!

Therapy animal programs are designed to promote improvement in human physical, social, emotional, or cognitive function, according to the American Veterinary Medical Association. Therapy can occur in a group setting or individually, and can benefit patient populations from the young to elderly, to those in hospitals, nursing homes, assisted-living homes and rehabilitation facilities.

RojocroppedSo, I was more than a little curious when I read that Providence Children’s Center in Oregon is employing two unique therapy animals to help patients smile: an alpaca named Napoleon, and a llama named Rojo.  The unique pair light up every room they enter at the hospital.

I never realized the power animals have to bring healing and joy to people like this,” said Kelly Schmidt, a social worker at the Children’s Center. “I truly believe they are given a purpose more than just entertainment.”

Rojo is an “old pro” at making children happier. From the day he was born in April of 2002, Rojo has enjoyed being around people of all ages. His owner, Lori Gregory, of Mtn Peaks Therapy Llamas and Alpacas in Vancouver, WA along with handler, Shannon Hendrickson, trained Rojo and entered him in local and state level fairs in the Public Relations and Handler Classes. While at the fair, a spectator observed Rojo’s exceptionally gentle temperament, and suggested that he become certified as a therapy animal. The rest, as they say, was history. Rojo even has his own Facebook page!

Gregory, just like the patients, feels a rush when she introduces her animals – which are often dressed in funny hats and other silly outfits – at hospitals and other medical facilities.  “When you realize that they have this amazing ability to create a natural response therapeutic-wise to get people to do things they normally wouldn’t do.”

napoleon alpacaHer stable also includes two other llamas and two more alpacas.  On its website, Mtn Peaks says its animals have made more than 650 therapeutic visits to patients since the organization was founded in 2007.  They add “Our Therapy Teams might take a walk with an adolescent struggling with difficult issues, or motivate a patient recovering from a stroke to reach farther, or calm a child with autism so that they can focus, and achieve new goals. By offering friendship and warm touch, our llamas help alleviate loneliness, lower blood pressure and reduce stress. Their presence brings a sense of normalcy to institutional settings.

therapy elephantIn researching this post, I also came across other unique therapy animals including miniature horses, elephants (which have been used in Thailand to help some children with autism), helper monkeys and animals with disabilities.

Have you worked with or been helped by therapy animals?  If so we’d love to hear from you and share your stories.

SRxA-logo for web

Radioactive Bacteria:1 – Pancreatic Cancer:0

pancreatic cancer facesYears ago, when I was just starting my healthcare career, I worked with a team specializing in the management of patients with pancreatic cancer.  Despite the dedication and compassion of our team, revolutionary surgical techniques, and top-notch palliative care, all too often our patients died. Even today, some 30 years later, pancreatic cancer has a poor prognosis. It’s seldom detected in its early stages, and often spreads rapidly. Signs and symptoms frequently don’t appear until the disease is advanced and surgical removal isn’t possible.

Pancreatic cancer touches so many people. It killed my childhood mentor and one of my best friends. It’s taken the lives of many household names, from astronauts to actors, entrepreneurs to opera singers.  For example, Patrick Swayze, Randy Pausch, Luciano Pavarotti, Dizzy Gillespie, Count Basie, Michael Landon, Joan Crawford, Sally Ride and of course, Apple CEO – Steve Jobs.

So, I was excited to hear about new research into a targeted anti-cancer therapy that promised limited side effects. The study, published April 22 in the Proceedings of the National Academy of Sciences found that treating mice with an attenuated, radioactively labeled bacteria –  Listeria monocytogenes - drastically reduced the number of metastases, while leaving normal tissue unscathed.

The notion of using bacteria to attack tumors is not new. Robert Hoffman, a cancer biologist at the University of California, San Diego, who was not involved in the current study, has shown that Salmonella can kill mouse cancer cells, including metastases of pancreatic cancer.

Other research has shown that a Listeria strain known as CRS-207 has the ability to stimulate an immune response in Phase 1 and 2 trials.

listeria.monocytogenesIn the new study, researchers at Albert Einstein College of Medicine have paired this technique with a radioactive isotope to selectively kill tumor cells, focusing on the metastatic cells that so often elude current treatment regimens.

It’s this combination of approaches that synergistically target metastases, that’s new. Claudia Gravekamp, an immunologist at Albert Einstein College of Medicine who led the study with nuclear medicine researcher Ekaterina Dadachova had previously demonstrated that an attenuated strain of Listeria monocytogenes, a type of bacterium that penetrates host cells during infection, selectively killed breast cancer cells without damaging normal tissue. The bacteria’s ability to target only diseased cells raised the possibility that it could be used to treat metastatic cancer by both directly killing cells and by carrying anti-tumor therapies—like radiation—to cancer cells.

pancreatic_cancerGravekamp and Dadachova tested the bacteria against highly metastatic pancreatic cancer in mice. First, they demonstrated that the bacteria proliferated well in the animals’ metastases, but poorly in the primary tumor, and not at all in normal tissues like spleen, suggesting the bacteria would be good candidates for delivering a therapy to far-flung metastases.

Then, the researchers armed the Listeria with the Rhenium-188, a radionuclide that kills cells by releasing DNA-damaging. Sure enough, regular injections of the Rhenium-188 labeled bacteria decreased metastases by 90% versus controls.

While this implies that bacteria have to potential to be used to deliver therapeutic radiation doses to metastases, the bacteria were administered before metastases were established, notes Donald Buchsbaum, a radiation biologist at the University of Alabama at Birmingham who was not involved in the study.  “So to some extent it’s a prevention model.”

Future work will need to focus on targeting established metastases, possibly by exploring other radioisotope options.  Gravekamp and Dadachova are currently refining their protocol and examining alternative radioisotopes to achieve a 100% reduction of metastases, but have high hopes for their bacteria.

Though primary tumors are often removed surgically, even small pieces left behind can produce new metastases. It might be possible that one day radioactive Listeria could be part of an “early second-line treatment after surgery to prevent further metastases,” says Gravekamp.

ListeriaWhich is great news in the war against cancer and not a bad deal for the Listeria bacteria which normally gets a bad rap for causing the infection listeriosis  – the leading cause of death among food-borne bacterial pathogens – responsible for approximately 2,500 illnesses and 500 fatalities annually in the United States.

Exciting stuff!

SRxA-logo for web

Pumped Up about Promising new Parkinson’s Pump

parkinson-disease60Parkinson’s disease, as many of our readers know is a chronic, progressive neurological disease that causes sufferers to lose control of body movements, resulting in tremors, muscle stiffness, loss of balance and a host of other problems. Currently, there is no cure for Parkinson’s disease and treatment options are limited. Therapy is directed at treating the symptoms that are most bothersome and for this reason, there is no standard or “best” treatment for that applies to every patient.

Treatment approaches include medications and surgery (deep brain stimulation) as well as general lifestyle modifications (rest and exercise), physical, occupational and speech therapy.

levodopaAmong the drug-related therapies, levodopa is considered one of the most effective for relieving the symptoms of Parkinson’s disease. It helps reduce tremor, stiffness, and slowness and helps improve muscle control, balance, and walking. Levodopa does not slow the disease process, but it improves muscle movement and delays severe disability. So far, levodopa, which had been used to treat Parkinson’s since the 1970’s, has only been available in pill form.

But a new Cleveland Clinic study finds that using a pump to administer a gel form of levodopa directly into the small intestine is much more effective.

Neurologist Hubert Fernandez, MD, who led the study, says, “The levodopa pump decreased or improved what we call the ‘bad time’ in Parkinson’s patients by up to four hours per day.” The levodopa can control this ‘bad time’ — the tremors, muscle spasms and other movement disorders that makes it difficult for Parkinson’s patients to function on a daily basis.

parkinsons-gel-drug-pump-190x155This is an amazing finding,” says Fernandez. “We know of no other oral therapy that will improve the bad time in Parkinson’s by an average of four hours daily.”

The levodopa pump is external. It sits in a pouch under the patient’s shirt and provides a steady dose of the drug. The levodopa gel is administered directly into the small intestine, where most of the drug is absorbed. The constant dose makes the body’s movements more controlled and predictable, making it easier for people with the disease to plan and go about their day without worrying that the drug’s effects will wear off.

The biggest advantage of the levodopa is its efficacy,” Dr. Fernandez says. “We’re trying to deliver it on a continuous basis so the patients don’t need to take it every hour.” parkinsons gel pump

69-year-old Bob Van Housen has been living with Parkinson’s disease for over 12 years.  Prior to enrollment in the study he was having to take up to five levodopa pills every three hours to control his symptoms. Even then, his symptoms progressed to the point where it was hard to keep up.  “He was ‘off’ for at least seven hours,” said Van Housen’s wife, Carol. “Seven hours is a long time to not be able to function every day.”

The couple often had to cut their trips together short and limit their social outings outside of the house. Van Housen says that being part of the trial at Cleveland Clinic has been life-changing. “We can predict better how I’m going to feel and how I’m going to act and can plan trips and work around those times when I otherwise would have been problematic.”

The gel pump which is not yet available in the United States is currently under review by the Food and Drug Administration. Let’s hope it doesn’t hit any hurdles along the way, so others with Parkinson’s can avoid the roller-coaster of symptoms and enjoy the type of benefits that Bob has experienced.

SRxA-logo for web