July 8th, 2008 by Dr. Val Jones in Expert Interviews
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With the recent news about the high prevalence of Post Traumatic Stress Disorder (PTSD) in military veterans returning from Iraq and Afghanistan, I decided to interview Revolution Health’s expert psychiatrist, Dr. Ned Hallowell, to find out more about PTSD and what to do about it.
*Listen To The Podcast*
Dr. Val: What is post traumatic stress disorder (PTSD)?
Dr. Hallowell: As the name implies, it is the response a person has to any traumatic experience or event. The brain really changes in response to trauma, and people can be quite crippled by it. Some will actively avoid people and situations that remind them of the event, others experience “triggers” that set them off into a panicky or dissociated state. PTSD can cause “flashbacks” where people feel as if they’re right back at the scene of the incident, they may also have nightmares or problems with relationships, job function, substance abuse, major anxiety or depression and even suicide.
PTSD exists on a spectrum. You can get fired from your job and experience mild trauma, but if the firing was really unfair and unexpected it can change you fundamentally for years to come. It isn’t the actual event that determines whether or not a person develops PTSD, it’s how you –given your particular neurochemistry and genetics – are able or not able to assimilate, accommodate, and deal with the traumatic event.
Dr. Val: How does a person know if they have PTSD?
Dr. Hallowell: If something terrible has happened to you and you’re not able to calm down, put things into perspective or get back to your old self – then you may have PTSD. Instead of getting your equilibrium back you’re rattled, anxious, and sleeping poorly. Fear builds on fear and you can even become afraid of life itself and begin withdrawing, avoiding, and shutting down, and self-medicating.
What you want to do is “name it” – in other words allow yourself to consider that you may have PTSD, and then get professional help. A mental health professional who specializes in PTSD is ideal. Dr. Bessel van der Kolk has written several excellent books on the subject.
It’s also worth noting that people can get vicarious PTSD. There have been cases where practitioners have developed PTSD simply by listening to accounts of trauma.
Dr. Val: Is early intervention important?
Dr. Hallowell: This is controversial. Some people believe that it’s important to talk about the event right away, but I’m of the belief that people should remain connected to others but not be required to talk about it until they’re ready. I could see someone after a mugging or car accident and never talk about the event – my role is just to create a “safe place” for them to be. Later on we might talk about it, or we might not. Discussing the details of a traumatic event can retraumatize you – and in a funny way you can develop a habit of reliving the trauma, almost the way that people become addicted to worry. However if the patient wants to talk about the trauma, that suggests to me that they need to – and I let them be the guide.
Dr. Val: What happens if PTSD is not treated?
Dr. Hallowell: It can wreak havoc on people. “Avoidance” as a lifestyle is very incapacitating. If you can’t go places and do things, you’re feeling anxious all the time, and having nightmares and flashbacks, you can’t enjoy life.
Dr. Val: Can PTSD be prevented? In the case of soldiers, for example, who are likely to experience horrible things in times of war – can they be mentally prepared for this kind of thing?
Dr. Hallowell: Part of what makes trauma traumatizing is that it’s unexpected. So it makes intuitive sense to me that if you’re prepared for what you’re going to see or experience that you will find it less traumatic when it happens. The surprise and lack of control are what’s overpowering about trauma. Having a plan (knowing what to do in case of a traumatic event) and knowing what to expect afterwards (and how to get help) will go a long way in reducing the damage of trauma. You can still be traumatized, however, even if you’re “ready” for it.
Dr. Val: Tell me a little bit about kids and PTSD. Do they express PTSD differently?
Dr. Hallowell: In children, the dissociative state is pretty common – they become vacant and unreachable. Sometimes the opposite happens and they are inconsolable, experiencing night terrors, crying, and temper tantrums. However, kids are remarkably resilient and I’ve seen play therapy work wonders for them after traumatic events.
For example, four-year-olds might sit on the floor and not talk to me at all about the trauma they’ve been through, and the next thing you know they’re reenacting the scene with their toys and dolls. They have no idea that they’re replaying the event this way (a form of “displacement”) – and may do it over and over again for a period of six weeks… and the next thing you know they’re over it. It’s remarkable. They use their imagination to heal themselves. It’s the greatest therapy in the world. No medication is used, and it’s a permanent fix. It’s almost like doing psychoanalysis at the point of the childhood trauma. When you’re 40 you try to relive these experiences in analysis to resolve the conflict – but as a child you’re actually doing the work near the time of the incident.
Dr. Val: What’s the most important thing for families to do for loved ones who have PTSD?
Dr. Hallowell: Connect with them. Understand them, listen to them, and don’t let them get isolated. Take their concerns seriously, and don’t judge them. Then find out what they need and get them to a mental health professional who understands PTSD.
*Listen To The Full Conversation Here*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 2nd, 2008 by Dr. Val Jones in Celebrity Interviews, Expert Interviews
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Would you know what to do if someone in your office collapsed in front of you and became unresponsive? Having a defibrillator handy could save their life – and it’s important for you to know how to use one. I interviewed Dr. Jon LaPook, Medical Correspondent for CBS Evening News with Katie Couric, to get his take. [Interesting factoid: Jon became passionate about cardiac defibrillators after a friend of his died while exercising at a gym in NYC. The health club did not have a defibrillator on site – which could have saved his friend’s life.]
*Listen to the podcast*
Dr. Val: What is a defibrillator?
Dr. LaPook: It’s a machine that can convert a life threatening heart rhythm (like ventricular tachycardia or ventricular fibrillation) back into a normal beating pattern. It uses a pulse of electricity to do this. These machines are potentially life-saving.
Dr. Val: Why is it important for offices to have them on hand?
Dr. LaPook: About 1.2 million people in the United States have a heart attack every year and 300,000 of those have “sudden death.” The reason why these people die is not because of the heart attack, but because of the irregular heart rhythm that accompanies it. When the heart isn’t beating in a coordinated fashion, it can’t pump blood effectively and people pass out and ultimately die if there’s no intervention.
If a defibrillator is used to administer a shock to the chest during one of these life threatening heart rhythms, there’s a much higer chance that the person’s life will be saved. For every minute of delay (from the time a person collapses) to receiving a shock to the chest, their chance of survival decreases by 7-10%. So it’s very important for people to get defibrillation quickly.
Dr. Val: How do you use a defibrillator?
Dr. LaPook: When you first see someone collapse and become unresponsive, all you have to do is get the defibrillator and press the “on” switch. It will talk you through the next steps. Remember that the first step is always to have someone call 911 so that EMS will be on its way while you continue CPR. Then you expose the victim’s chest so that you can apply two sticky pads, and the defibrillator will tell you where to put the pads. Then it will analyze the victim’s heart rhythm and decide if it requires a shock to get it beating in a coordinated way. If a shock is recommended, the machine will announce that and ask you to step away from the person. Once the shock has been received, it will then give you instructions for CPR (which includes chest compressions and rescue breaths) until EMS arrives or a pulse is able to be felt. If a person doesn’t require a shock, the machine will not give one – so there’s no risk of harm to the victim.
It’s important for people not to be intimidated about defibrillation because it’s really very simple and can save a life.
Dr. Val: What are a person’s chances of surviving a cardiac arrest?
Dr. LaPook: Nationally, your chances of survival (without intervention) are about 4-6%. If you receive CPR, your chances increase to 15% but with a defibrillator – especially if it’s used quickly – the chances are 40% or higher.
Dr. Val: What do you think about the new research suggesting that rescue breaths may not be as important for CPR as initially thought?
Dr. LaPook: I spoke to Dr. Rose Marie Robertson, who is the Chief Science Officer at the American Heart Association, and she said that in a “witnessed arrest” (when you actually see someone collapse) it doesn’t seem to make a {big} difference if you do rescue breathing (i.e. mouth-to-mouth resuscitation) or not. The reason they studied this is because one of the main reasons why people don’t perform CPR is the “ick” factor of mouth-to-mouth resuscitation. As it turns out, chest compressions alone are about as successful at saving lives as traditional CPR. However, if you’ve been trained to do the rescue breathing technique, you should definitely use it. The key to CPR is “hard and fast” chest compressions, about 100 compressions per minute. Whatever form of CPR you use, the key to success is using the defibrillator as soon as possible, ideally within several minutes.
Dr. Val: What should people working in an office environment know about first aid?
Dr. LaPook: The most important thing is for people to be trained in CPR, the Heimlich maneuver, and defibrillator use.
Dr. Val: Are there enough defibrillators out there nowadays?
Dr. LaPook: Not at all. At the very least, defibrillators should be in every single health club in America. I also think they should be installed in every office building and be widely available at schools.
A cardiologist friend of mine told me about some parents who lobbied for their daughter’s school to purchase a defibrillator. (They were in tune to cardiac issues in children because their daughter had an arhythmia called Wolff-Parkinson-White syndrome.) Two years after the school purchased the device, the girl – only 13 years old at the time – collapsed while walking past the nurse’s office at the school. The nurse saved her life with the very defibrillator that her parents fought so hard for. So defibrillators are incredibly important, and although they’re not inexpensive (about $1200), you really can’t put a price on life.
*Listen to the podcast*
*Check out Dr. LaPook’s defibrillator training video with Katie Couric*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 19th, 2008 by Dr. Val Jones in Expert Interviews
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I recently discussed the emerging black market for raw (unpasteurized) milk and the FDA’s crackdown on California farmers. Soon after I posted my comments, a reader asked some detailed questions about heat, enzymes, and milk’s nutritional value. At the same time I received an email from the Vice President of Nutrition Affairs-Health Partnerships at the National Dairy Council, offering to connect me with a dairy product scientist to further the discussion. Isn’t it nice when all the stars align correctly?
I just interviewed Gary Rogers, Ph.D., the Editor-In-Chief of the Journal of Dairy Science and Professor of Animal Science and Dairy Extension Leader at the University of Tennessee in Knoxville. You may listen to the podcast, or enjoy my synopsis below:
Dr. Val: What is pasteurization?
Dr. Rogers: Pasteurization is the heating of milk to a specific temperature for a specified period of time to kill harmful bacteria that may be living in the milk.
Dr. Val: Raw milk enthusiasts argue that pasteurization decreases the health benefits of milk. What exactly is lost when milk is pasteurized?
Dr. Rogers: There are really no important changes that occur (from a nutritional standpoint) to milk when it’s pastuerized. Heat treatment is simply used to kill the bacteria that may present a health risk to those of us who consume milk. Research over the years has shown that there are no significant nutritional benefits to raw milk, but there are risks associated with exposure to bacteria.
Dr. Val: Some people say that raw milk is easier to digest than pasteurized milk. Is that primarily a myth?
Dr. Rogers: Yes, that’s a myth. There is no scientific evidence to suggest that raw milk is easier to digest than pasteurized milk. In fact, many people who have digestive difficulty with fluid milk can eat cheese and yogurt without any difficulty.
Dr. Val: I’ve heard some people claim that there are certain beneficial enzymes in raw milk that are destroyed in the pasteurization process. Is there any truth to that?
Dr. Rogers: There are dozens of enzymes in milk, but most of them are proteases that are involved in the break down of milk proteins and fats. While it’s true that heating can destroy some of these enzymes, they really have no role in human digestion. The enzymes are responsible for milk spoilage, so removing them extends the shelf life of the milk.
Dr. Val: Tell me about UHT milk (the boxed milk that is stored at room temperature) – does it differ -nutritionally and chemically – from pasteurized milk?
Dr. Rogers: UHT (or “ultra-high temperature”) milk undergoes a pasteurization process at a much higher temperature than regular milk. This increases its shelf life, but nutritionally and chemically it’s no different from regular pasteurized milk. It contains all the calcium, phosphorus, and protein of regular milk. However, UHT milk does have a different flavor that some Americans don’t like. In Europe, though, they really enjoy the flavor of UHT milk and often prefer to drink it over pasteurized milk. In the U.S. we use it for flavored milk products, and for military personnel who can’t keep their milk refrigerated as easily.
Dr. Val: I think the key confusion that people have here is that they think of heating milk like heating vegetables. We all know that when we boil vegetables for a long time the nutritional value decreases because their vitamins are removed in the water. However, with milk we’re essentially heating it without removing the “water” part.
Dr. Rogers: That’s exactly right. Pasteurization doesn’t add or subtract anything from milk nutritionally, it’s just a heat treatment to destroy bacteria like listeria and salmonella.
Dr. Val: Are US cows exposed to antibiotics and hormones that could find their way into milk?
Dr. Rogers: I know that consumers are very concerned about these issues, but they need to know that every milk tanker is required by law to be tested for antibiotics. There’s a huge incentive for milk producers not to include milk from cows that may have been sick and treated with antibiotics because any tanker that’s found to have any trace of antibiotic in the milk will have its milk discarded. Not only that, but since tankers usually carry milk from multiple producers, one small contribution of contaminated milk will cause all the neigboring farms’ milk to be destroyed. So there’s a lot of peer pressure to keep the milk supply clean. Farmers who contribute milk from cows on antibiotics are fined for the losses of other producers’ milk as well.
As far as “hormones” are concerned, you’re talking about RBST (recombinant bovine growth hormone) to enhance milk production in cows. Although no lab test was ever able to distinguish milk from RBST treated cows from non-treated cows, consumers expressed such concerns about the practice that few milk producers use RBST anymore. I’d say that maybe 10-15% of dairy producers use it, and then it’s not for fluid milk sale, but rather cheese and other dairy products. Those numbers are continuing to decline.
Dr. Val: What does it mean when milk is labeled “organic?” Given the high price of groceries, are there advantages to purchasing organic milk?
Dr. Rogers: I work with both conventional dairy producers and organic dairy producers in my “day job” so I have friends on both sides. As far as nutrition and healthfulness is concerned, organic and conventional milk are equal. The “organic” label has to do with the production practices on the farms that produce the milk, not the properties of the milk itself. On organic farms, they do not use chemical fertilizers or pesticides to raise the crops that they feed to their cows. Some people like the idea of supporting organic farmers and consumers have every right to do that. But both organic milk and conventional milk are safe and equivalent nutritionally.
Milk is heavily regulated and controlled so that even on conventional farms, the pesticides do not get into the milk. All milk is tested for pesticides, and in my experience it has always contained far lower levels than the standard set for safety by the FDA.
Dr. Val: But isn’t it possible that the organic milk might have an even lower level of pesticides in it than conventional milk?
Dr. Rogers: Actually the tests that I’ve seen have not been able to distinguish organic from conventional milk as far as pesticide levels are concerned. However, I haven’t received results from all the organic farms in the U.S. But keep in mind that pesticides exist in such small quantities in milk that usually we can’t even detect them with the most sensitive instruments that we have in the laboratory.
Dr. Val: Is soy milk a good substitute for cow’s milk?
Dr. Rogers: It’s really hard to replicate the nutrition that comes from traditional milk sources. The calcium absorption, amino acids, vitamin, and mineral contents of milk provide a distinct advantage over soy milk, unless you have a specific dairy allergy. In a large recent study on baby formula, for example, there was no advantage to using soy based formulas over cow’s milk. People may prefer to use soy milk for its flavor, or because they support vegetarian food sources. But most soy milk is processed by dairy farms anyway.
*Listen to the interview with Gary Rogers*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 30th, 2008 by Dr. Val Jones in Expert Interviews, True Stories
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Revolution Health expert, Dr. Rafat Abbasi, is a reproductive endocrinologist and fertility specialist in Washington, D.C. She told me this exciting story about a miracle baby that brought great joy to a young family. She hopes that this news will bring hope to other young men and women who have spinal cord injuries and want to have children.
Dr. Val: Tell me about the fertility success story that has you so excited.
Dr. Abbasi: A young couple was referred to me because they wanted to have a baby. They had been married for about a year, and had been through one miscarriage already. Sadly, the young husband (he is about 35 years old) was then involved in a freak mountain biking accident and broke his neck, severing his spinal cord. He was paralyzed from the neck down and confined to a wheelchair, unable to function sexually. His 29 year old wife and he were devastated.
They came to me wondering if there was any way that they could get pregnant under the current circumstances. And due to the amazing advances in fertility treatments, I was pleased to report to them that there was a chance that they could. I explained how we’d do it.
First we had to collect some sperm from the testes of the husband. We could do this by using an electric current to stimulate a spontaneous ejaculation reflex and then inseminate the wife with the fluid, or if that didn’t work, we could withdraw some immature sperm directly from the testes with a needle. I explained that if we retrieved the sperm with a needle we’d need to mature the sperm in a test tube incubator overnight, and retrieve eggs from her and then use in-vitro fertilization techniques to create embryos to implant into her womb. In order to get the eggs, we’d need to use egg-stimulating hormones (for about 10-12 days) and an ultrasound-guided needle retrieval technique (under local anesthesia).
As it turns out, we used the second method for this couple. We transferred three embryos and one of them took, and she gave birth to a beautiful baby girl. The couple is now interested in having a second baby.
Dr. Val: Isn’t it true that spinal cord injury can contribute to infertility? How does that work?
Dr. Abbasi: Over time, men who’ve had a spinal cord injury suffer from testicular atrophy which affects their hormone levels and can make it much more difficult to retrieve viable sperm. Fertility rates start to decrease substantially 5-7 years after a spinal cord injury.
Dr. Val: What made this story touching for you?
Dr. Abbasi: I think the whole story is incredibly touching because this young man, who was in the prime of his life, had a freak accident that took away his hope of ever having kids. His rehabilitation medicine physician thought to refer him to a fertility specialist (because he’d heard about the technique we use to retrieve sperm from patients who’ve had spinal cord injuries) and now he’s blessed with a family. Until then he mistakenly believed that there was no hope for a pregnancy after his injury. His life is different now due to his physical limitations, but he is full of joy because of his baby daughter. It gives me goose bumps just thinking about it.
To listen to the full interview (with a step-by-step clinical account of how the fertility procedure was managed), click here.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 13th, 2008 by Dr. Val Jones in Patient Interviews
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Therese Borchard is a vibrant author, editor, and mother of two. She writes a critically aclaimed blog called “Beyond Blue” at beliefnet.com, which is devoted to supporting people who are living with bipolar disorder. Therese’s writing is engaging and humorous, as she normalizes the experience of mental illness through her own lens of motherhood. Revolution Health salutes Therese for her compassion, and I hope you enjoy getting to know her through this interview:
*Listen to Podcast*
Dr. Val: Tell me about the circumstances surrounding your diagnosis of bipolar disorder. What was it like when you received the diagnosis for the first time?
Therese: I’ve struggled with depression most of my life, though college was when I first started taking medication and came to terms with the diagnosis of major depression. However, I had a much harder time when I realized that what I had was actually bipolar disorder. This was really difficult for me because my aunt was the only person I knew with bipolar and she took her own life when I was 16. So I had a lot of resistance to that diagnosis.
In fact, I ended up seeing 7 different psychiatrists, went through 2 hospital stays, and tried a total of 23 different medications.
Dr. Val: What’s the story behind the 7 psychiatrists? Were you not connecting with them?
Therese: I strongly advise people with bipolar or anyone struggling with depression to find the right doctor. For me it was going to Johns Hopkins, an academic center that has the best research and an outstanding team of doctors. My bipolar symptoms were not clear cut or “textbook” so it took a team of specialists to really help me find the best treatment path.
Dr. Val: What have you found to be most helpful (therapeutically) to keep you feeling balanced and in control?
Therese: My three staples are diet, exercise, and sleep, because I think that with any illness you just have to make those a priority. Obviously, finding the right doctor and the right medication is important too. Another key component to my recovery was connecting with a greater mission – I see that as my blog. Reaching out to others gives back to me every day. When I read a biography of Abraham Lincoln (he struggled with major depression, but didn’t have meds back then) I was struck by the fact that he focused on the emancipation of slaves as a positive way to get through his depression.
Obviously, a good therapeutic relationship with your doctor is important, as well as finding the right medications for you when/if needed.
I’ve found Dr. David Burns’ book, “Ten Days To Self Esteem” to be really helpful. It’s a work book that you can use as a journal. He asks you to list all your distorted thoughts, how they’re distorted and then how you can think differently. For example, we sometimes engage in mind-guessing, like “Oh he hates what I just said…” when the person isn’t thinking that at all. This book is really good for people with mood disorders.
I also regularly engage in prayer, and as a Catholic it’s really important to me and my healing.
Dr. Val: What advice do you have for people living with bipolar disorder?
Therese: You have to surround yourself with people who understand your illness because it’s so easy to be hard on yourself and adopt an attitude of “I should be able to get over this problem” and then feel deflated when it doesn’t magically disappear. It is so much easier when you have friends around to remind you that bipolar disorder is an illness like arthritis or diabetes – that it can be disabling and it’s not your fault.
Bottom line: Work as hard as you can on your diet and exercise, use light therapy as needed to help elevate your mood, and educate yourself as best you can about your illness.
Dr. Val: You mention diet as an important factor. Do you follow a special diet or do you just mean ‘healthy eating’ in general?
Therese: Mostly I’m talking about a healthy diet with lots of fiber, fruits and veggies, lean protein and whole grains. Caffeine and sugar are dangerous and alcohol can really mess up psych meds. Everything nowadays seems to have high fructose corn syrup in it. I try to stay away from highly processed foods and white flour.
Dr. Val: Do you believe that there is a stigma associated with bipolar disorder? How can that be reduced/removed?
Therese: The stigma does exist. I read a recent article about celebrities basically saying that antidepressants sap your personality, creativity, and sex drive. They make it sound as if people with bipolar disorder are doomed to live a dull and mediocre life. Other articles, like those about Britney Spears, are so negative. They make you think, “Oh God, this woman is never going to be normal.” The media really does bipolar disorder a disservice. Why not say that 70-80% of people with bipolar recover completely and do beautifully? They live very fruitful and productive lives. I have a hard time with how the media presents mental illness in general.
I also find that when I tell people that I have a therapist appointment their eyes sort of bug out. But it shouldn’t be shameful, it’s no different than going to a doctor’s appointment. We have to continue to work on tolerance and acceptance for mental illness.
Dr. Val: What role can online communities play in the management of daily life with bipolar?
Therese: Online groups have proven to be beneficial to those suffering from depression. Sharing your story is therapeutic in itself. Also the anonymity offered by online groups can make sharing stories and struggles more comfortable. For people who live in remote areas or who don’t have access to transportation, online groups offer the best way to connect with others.
Dr. Val: How do your coping mechanisms change when you’re struggling with mania versus depression?
Therese: Some of them are the same, like getting good sleep, eating healthy foods and exercising. I have two little kids so I watch the movie Cars a lot with them. And I like what one of the characters says in response to a question about steering around curves. He says, “in order to go left, you need to turn right, and in order to go right, you need to turn left.” I always remember this when I’m manic or depressed because it’s counter-intuitive.
When you’re depressed, the last thing you want to do is to get yourself involved in life, and get up and get moving – but that’s exactly what you need to do. When you’re manic it’s so easy to say, “This is so great, I’m on a roll, let’s go all night!” It’s hard to shut down your computer and say, “No, I’ve worked enough, now it’s time for bed.” But that’s what you need to do.
Dr. Val: Is there any bipolar-related information or service that you’ve always wished you could get from the Internet but doesn’t exist yet?
Therese: I wish there were an Amazon.com type directory online where you could find therapists, doctors, partial stay hospital programs, and support groups in your zip code, and read reviews from others about them. A one stop resource center would be great!
Dr. Val: You work at Belief Net – tell me a little bit about what the spiritual side of the bipolar journey. How has spirituality played a role in your healing?
Therese: I grew up as a very religious kid and my “OCD” made itself manifest at a young age. I remember that when I was in fourth grade I wrote a book for my mom and her prayer group friends about how to get to heaven. I look back and laugh at that now because it probably listed things like looking at the sacred heart and praying the rosary 15 times.
But on a more serious note, when I was deeply depressed and feeling suicidal the thing that kept me from taking my life was the thread of hope that God was there. If I didn’t have that I don’t think I’d be here. I often asked God for signs of His presence during that horrible times, and believe it or not, I always received them.
*Full Interview Available Via Audio Podcast*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
