Sometimes patients shouldn't hold on to hope

Common wisdom tells us that it's good to nurture hope that things will get better. But a new study suggests that acceptance of an adverse situation, such as a serious health condition, is sometimes better for one's mental outlook than being hopeful the situation will change.

Experiencing something bad naturally causes a decline in happiness. The longer the adversity lasts, the worse one's sense of well being. But researchers at the University of Michigan decided to study a more complex question: Which is better, accepting the permanency of a bad situation or expecting that it is temporary and will change? 

The researchers followed 74 patients who had just received either a permanent or temporary colostomy or ileostomy, a surgery that affects normal bowel function. The participants completed surveys about their life satisfaction. Initially, patients with the reversible condition reported higher life satisfaction than those with a permanent colostomy. However, after the first week, the permanent colostomy patients reported increasing life satisfaction, and those with a reversible condition reported declining life satisfaction. The trend held up over the six-month study period.

Hope can interfere with a person's ability to adapt to their current situation, said the authors of the study, published in the November issue of Health Psychology.

"Hope is an important part of happiness. But there's a dark side to hope," a co-author of the study, Dr. Peter A. Ubel, said in a news release. "We think [the permanent colostomy patients] were happier because they got on with their lives. They realized the cards they were dealt, and recognized that they had no choice but to play with those cards. The other group was waiting for their colostomy to be reversed. They contrasted their current life with the life they hoped to lead, and didn't make the best of their current situation."

There's a lesson here for healthcare professionals, too, the authors wrote. Healthcare professionals want to give their patients hope and may be reluctant to correct false hopes. But patients may be better off facing the truth.

"While hopeful news may be easiest to deliver, it may not at all be in the interests of the recipients because it may interfere with emotional adaptation," the authors wrote.

-- Shari Roan

Photo credit: Mark Boster / Los Angeles Times

Now about that salmonella outbreak ... no, no, the turtle-related one

The resulting consternation was small by food-borne-illness standards, but the 2007 salmonella outbreak was the country's largest to date involving turtles. And it has proven to be excellent fodder for researchers from the Centers for Disease Control and Prevention and elsewhere to assess just how those infections came about.

Of 107 people sickened in the outbreak, the median age was 7, the researchers reported online today in the journal Pediatrics. As for the turtles, 87% were the cute little kind that kids just have to have and that they'll take really, really good care of, they promise; 34% were bought in a pet store.

One of the more interesting facts in the abstract and in an Associated Press story is that many people were unaware of the salmonella risk posed by turtles. (The Associated Press also reports that two girls swam with the turtles.)  

Interesting, considering that references to salmonella and turtles are fairly ubiquitous and have been for, oh, more than three decades now.... In fact, here's a CDC fact page on the matter. It begins: Is a turtle the right pet for your family?

The answer: "Did you know that the sale of turtles less than 4 inches has been banned in the United States since 1975? This is because turtles pose a high risk of spreading disease, especially to children. The ban by the U.S. Food and Drug Administration (FDA) has prevented an estimated 100,000 cases of salmonellosis annually in children. This ban prohibiting the sale of small turtles likely remains the most effective public health action to prevent turtle-associated salmonellosis."

So the answer would be no?

Here's the earlier news story about the outbreak: Salmonella carried by pet turtles sickens 100.

And here's a recent in-depth look from staff writer Karen Kaplan at the organism behind the outbreak: There's no escaping salmonella. It begins, quite notably: "This is salmonella’s world. We’re just living in it."

-- Tami Dennis

Photo: What's on that turtle? Perhaps salmonella. Credit: Karen Tapia-Anderson

Considering retirement? Working might keep you healthier

As baby boomers reach retirement age, more are opting to continue to work, whether for economic reasons, or because they simply like to work. That employment can provide more than a paycheck -- working, it seems, has pretty good mental and physical health benefits as well. 

A new study in this month's issue of the Journal of Occupational Health Psychology examined data on 12,189 retirees from the Health and Retirement Study, sponsored by the National Institute on Aging. The first four waves of the study (1992, 1994, 1996 and 1998) were included, in which people age 51 to 61 were surveyed about their health, finances, employment history and current work or retirement.

The researchers coined the term "bridge employment" to describe the transition period between full-time work and full-time retirement, in which people work part time, are self-employed or temporarily employed.

Men and women in that bridge employment category reported fewer major diseases and functional limitations compared with those who were in full retirement. Mental health was better as well, but only for those who kept working in their previous careers. Those who chose a different career path didn't show the same benefits. Choosing another career, the authors believe, could prove stressful while people adjust to new roles and a new workplace. Also, some who choose new jobs do so out of financial need, which may add additional stress.

In the study, the authors wrote: "when the retirees engage in bridge employment, they are likely to keep their levels of physical activities and mental activities through daily work. In addition, working after retirement increases retirees' role embeddedness, which has been shown to benefit health maintenance."

Going into full retirement, they add, could lead to less social contact and fewer daily activities, perhaps making them less likely to fight off major diseases and more likely to see a decrease in daily function.

In a news release, co-author Mo Wang of the University of Maryland said, "Given the economic recession, we will probably see more people considering post-retirement employment. These findings highlight bridge employment's potential benefits."

-- Jeannine Stein

Photo: Robert Durell / Los Angeles Times

Exercise helps speed recovery for ICU patients

The wasting away of muscle tissue can be a serious problem for people who are hospitalized and confined to bed due to a critical illness. That lack of mobility and strength can ultimately affect recovery.

But by putting patients through neuromuscular electrical stimulation and having them do simple exercises (some with the aid of devices), muscles can be shored up, speeding recuperation and getting people back on their feet. In a report in the journal Critical Care Medicine published online today, researchers examined studies, which charted patients' increased muscle strength during recuperation.

A team at Johns Hopkins Hospital in Baltimore has developed a special walker that helps severely ill patients move around more easily, and with fewer helpers. The Moving Our Patients for Very Early Rehabilitation (or MOVER) Aid was created with the help of biomedical engineering students at Johns Hopkins University. It has an equipment tower and a custom-designed walker; the walker comes with a built-in emergency seat so a staff member doesn't have to walk behind the patient with a wheelchair. The tower fits medical supplies and equipment into one neat unit that also allows for easy viewing of display screens. According to the study, "Through this technological aid, the number of staff required to ambulate a mechanically ventilated patient can be reduced from four to two."

The report also points out that cycle ergometers, cycling devices that patients can use while lying in bed, show promise for safely preserving leg muscles while bed-ridden. The machines have also been used on critically ill people who are sedated or immobile. The researchers also point to several studies that show the benefits of electrical stimulation, used often by physical therapists to preserve muscle strength.

"ICU-related muscle weakness is the number one factor in prolonging a patient's recovery and delaying their return to a normal life, including work and recreational activities," said lead author Dr. Dale Needham, a critical care specialist at Johns Hopkins Medicine, in a news release. "Our ICU patients are telling us that they want to be awake and moving," he added. "Gone are the days when we should only think of critically ill patients on complete bed rest."

-- Jeannine Stein

Nasal sprays may help prevent spread of colds

People with colds who sneeze can spread germs into the air and infect others. But there may be a way to reduce the chances of spreading your colds to others. A study presented today shows that oxymetazoline, the compound found in many over-the-counter decongestant nasal sprays, appears to reduce the levels of rhinovirus in nasal secretions.

Researchers from the University of Virginia, Charlottesville, assigned 39 volunteers, who were infected with rhinovirus, to receive either a nasal decongestant or saline spray. They received three puffs a day for five days. By the second day, those receiving the oxymetazoline had much less virus in their nasal secretions. However, people in both groups still had colds that lasted an average of 6.1 days.

Reducing the virus in nasal secretions, however, may help prevent it from spreading into the ears, chest or into the environment through sneezes and coughs.

The study was presented today at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

-- Shari Roan

JFK's Addison's probably caused by rare autoimmune disease

John F. Kennedy's Addison's disease, which came to light only after his election as president in 1960, was most likely caused by a rare autoimmune disease, according to a Navy doctor who reviewed his medical records. The disorder, called autoimmune polyendocrine syndrome type 2 or APS 2, also caused Kennedy's hypothyroidism, according to the report today in the Annals of Internal Medicine.

In today's hyperactive media environment where the smallest sneeze of a celebrity is thoroughly analyzed, it is difficult to believe that Kennedy's family and advisors were able to keep his medical history virtually a complete secret. The youngest man ever elected to the presidency at age 43, JFK was pictured as a healthy and vital young man. In reality, he suffered from a variety of problems that were kept in check only by a daily regimen of steroids and other drugs.

Addison's disease is characterized by the withering away of the adrenal glands, which produce adrenaline and other hormones. Symptoms include fatigue, dizziness, muscle weakness, weight loss, difficulties standing up, nausea, sweating and changes in mood and personality. About 20% of cases are the aftermath of tuberculosis, and the rest are autoimmune in origin.  During the 1960 campaign, Kennedy's opponents argued that he had Addison's, but his physicians released a cleverly worded statement saying that he did not have Addison's disease caused by tuberculosis, and the matter was dropped.

JFK's Addison's was initially diagnosed in the 1940s, and he suffered two severe collapses as a result, once at the end of a parade during an election campaign and once on a congressional visit to Britain. Records reveal that in 1955 he was also diagnosed with hypothyroidism -- an insufficient output of thyroid hormones. Symptoms can include many of those associated with Addison's, as well as a lack of tolerance for cold, paleness, depression and a low heart weight.

Dr. Lee R. Mandel, an endocrinologist in the U.S. Navy Medical Corps in Chesapeake, Va., was allowed to review Kennedy's medical records at the John F. Kennedy Presidential Library & Museum last year*. After synthesizing the information in the records and conducting correspondence with many of Kennedy's physicians, he concluded that both problems were the result of APS 2.

[*Correction: An earlier version said Dr. Lee R. Mandel accessed the records this year. According to the Annals of Internal Medicine report, he reviewed them in 2008.]

Mandel found that Kennedy, during his presidency, was taking a host of drugs daily: 500 milligrams of vitamin C twice daily; 10 milligrams of hydrocortisone daily; 2.5 milligrams of prednisone twice daily; 10 milligrams of methyltestosterone daily; 25 micrograms of liothyronine twice daily; 0.1 milligrams fludrocortisone daily; and diphenoxylate hydrochloride and atropine sulfate, two tablets as needed. Liothyronine is a synthetic thyroid hormone. Diphenoxylate/atropine, commonly known as Lomotil, is used to treat diarrhea. The testosterone was administered to combat the weight loss and gonadal atrophy associated with the other steroids he was given.

If Kennedy were a professional athlete, he would have been benched.

One characteristic of autoimmune diseases like APS 2 is that close relatives are often affected as well. It is well-known that JFK's younger sister, Eunice, had Addison's disease and that his son, John F. Kennedy Jr., suffered from Graves disease.

-- Thomas H. Maugh II

It's soluble fiber, not wheat bran, for irritable bowel, study says

To treat irritable bowel syndrome, most physicians recommend that patients consume dietary fiber to help keep the bowels active. But a new controlled trial suggests that the type of fiber consumed is important. Soluble fiber, such as psyllium, reduces symptoms and pain of the disorder, but insoluble fiber such as wheat bran can increase problems, Dutch researchers reported online today in BMJ, formerly known as the British Medical Journal.

Irritable bowel syndrome, which is characterized by irregular bowel movements, cramps, bloating and other problems, affects as much as 10% of the population and can be severely disabling. Few good treatments are available, in part because physicians seem unsure about its root causes.

In the first study of its kind, Dr. Rene Bijkerk of the University Medical Center Utrecht in the Netherlands and colleagues studied 275 patients, ages 18 to 65, with irritable bowel syndrome, commonly known as IBS. A third were given 10 grams of psyllium fiber every day for 12 weeks, a third were given 10 grams of wheat bran, and a third were given 10 grams of rice flour as a placebo.

Patients taking the psyllium fiber received significantly more relief than those taking placebo, and some reported that they had pain-free periods as long as two weeks while taking the fiber. Those taking wheat bran, however, showed no significant improvement, and many of them dropped out of the trial because their symptoms worsened.

-- Thomas H. Maugh II

Image credit: Visuals Unlimited/Corbis

Scared of antibiotic resistance? Here's how to get more scared

Much news and many public health warnings have stressed in recent years the rising rates of antibiotic-resistant bacteria -- and the fact that science is not coming up with new replacement antibiotics at anywhere near a fast enough clip.

People who want to learn more about the topic can go to two Southland events on Sunday at which UCLA infectious disease specialist Dr. Brad Spellberg will be talking about his book, "Rising Plague,"  which chronicles, among other things, the experiences that he and his colleagues have had treating patients with antibiotic-resistant infections and the issue of the dwindling supply of new drugs.

In Hollywood:

11 a.m. Sunday
Center for Inquiry, Los Angeles
4773 Hollywood Blvd., Los Angeles

In Costa Mesa:

4:30 p.m. Sunday
Costa Mesa Neighborhood Center
1845 Park St., Costa Mesa

The drug-resistance story is a frightening one, though it's not new. Shortly after WWII, penicillin broke onto the medical scene as a miracle drug that could drag sick patients out of the jaws of death. It didn't take many years for the first cases of penicillin-resistant Staphylococcus aureus bacteria to show up. Even Alexander Fleming (who discovered the drug after noticing bacteria didn't grow near a mold that had contaminated a petri dish) noted this happening, according this account. In his 1945 Nobel speech he said: "It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body."

When penicillin started to fail, other drugs replaced it, many garnered from molds or by chemically altering already known drugs gleaned from natural sources. 

This time, though, we're running out of drugs.

Take a peek at Spellberg's book, to be published in September. Its full name is "Rising Plague: The Global Threat from Deadly Bacteria and our Dwindling Arsenal to Fight Them."

Read more about the problem at the website for the Infectious Diseases Society of America, in a 2004 report "Bad Bugs, No Drugs."

-- Rosie Mestel

Photo: Visuals Unlimited

Michael Jackson reportedly got a Myers cocktail. So what is that exactly?

The Myers cocktail, an intravenous blend of vitamins and minerals, has become increasingly popular in the less-traditional medical world in recent years. It went public a few days ago when nurse Cherilyn Lee, who specializes in nutritional counseling, said she had given Michael Jackson an intravenous blend of vitamins and minerals called a Myers cocktail.

In the Associated Press story, she's quoted as saying: "It wasn't that he felt sick. ... He just wanted more energy." Jackson had been asking for Diprivan, Lee said. 

The concoction, based on one created by physician John Myers of Baltimore, includes magnesium, calcium, several B vitamins and vitamin C.

Here's an overview, "Intravenous Nutrient Therapy: The 'Myers’ Cocktail,'"  published in Alternative Medicine Review in 2002.

It's written by Dr. Alan Gaby, who popularized the mixture and who contends that the cocktail "has been found to be effective against acute asthma attacks, migraines, fatigue (including chronic fatigue syndrome), fibromyalgia, acute muscle spasm, upper respiratory tract infections, chronic sinusitis, seasonal allergic rhinitis, cardiovascular disease, and other disorders."

These are bold claims.

Even the paper acknowledges that the evidence of its effectiveness is largely anecdotal and that there's little in the way of published research.

And yet in his conclusion, Gaby says: "In many instances this treatment is more effective and better tolerated than conventional medical therapies. ... Widespread appropriate use of this treatment would likely reduce the overall cost of healthcare, while greatly improving the health of many individuals."

Perhaps explaining the appeal, and lack of obvious effectiveness, of such intravenous nutrients, there's this discussion-starting post on a Lyme disease support group forum from a patient who had a Myers cocktail via IV drip:

"I didn't feel much yesterday after having it administered but today I feel pretty darn good. Hard to know, though if it's the treatment or not since good and bad days alternating is my norm."

More recently, the blog Terra Sigillata, by a researcher trained in pharmacology and toxicology, explains the "Myers' cocktail" in relation to the Jackson case.

He offers some background material on the concoction and adds: "I am particularly concerned with the calcium composition of this intravenous brew; while not likely to be toxic on its own, if dosed as listed, I do have some concern if Mr. Jackson already had pre-existing cardiac problems and/or was receiving drugs such as Demerol (meperidine) or Diprivan (propofol) which each pose a risk of cardiac toxicity."

-- Tami Dennis
 

Rodent of the Week: Feeling less sick than you are

"Sickness behavior" is a term used to describe people when they don't feel well. It's the fatigue, lethargy and loss of interest in life that accompanies a range of illnesses. It's that feeling you get when you can't get out of your jammies and all you can do is watch reruns on TV. You get the picture.

Now researchers writing in this week's issue of the Journal of Neuroscience say there may be a way to escape feeling sick -- even when you're sick. The scientists, from the University of Calgary, designed an experiment to understand why sickness behavior occurs when the brain is designed to be isolated from the immune system. Scientists have long wondered how the brain senses inflammation or injury in distant parts of the body. What they found, in a study of mice with liver disease, is that immune cells called monocytes infiltrate the brain. The liver inflammation triggers brain cells called microglia to produce a chemical that attracts monocytes, which are white blood cells. Further, the inflammation stimulates cells in the blood to make an immune chemical called TNFa. When the researchers blocked the signaling of TNFa in their experiment, however, microglia produced less of the chemical that attracts monocytes. What this meant for the sick mice is that they were more active and social. No reruns for these guys!

"Sickness behavior significantly impacts quality of life," said the lead author of the study, Dr. Mark Swain, in a news release. "Our findings further our understanding and may generate potential new avenues for treatment of these often crippling symptoms."

-- Shari Roan

Photo credit: Advanced Cell Technology Inc.