Vacation Tips for Eating Well: Indulging Wisely Without Guilt
by Brooke Douglas RD
How to eat healthy on vacation is a challenge. Vacations are a time to enjoy and indulge in experiences that you may not otherwise have, including food. However, this does not mean you should eat the highest-calorie, highest-fat foods at every meal. Here are a few tips you can use while traveling to make sure you indulge wisely, without going overboard.
Enjoy local foods and cuisine When inRome, eat like an Italian! Why go to a major fast food or coffee chain when you are traveling, part of the fun of traveling is eating at new and different eating establishments. If you are traveling to a location with special, local foods and cuisine, make sure to enjoy those foods while you are there. You may not have another chance!
Choose how many times to indulge, not which times Half the fun of indulging is stumbling across a great restaurant when traveling and enjoying a spontaneous, delicious meal. Unless you have a specific-destination restaurant planned, simply choose the number of meals you plan to have that are more lavish, and let local recommendations/fate serve as your guide. A great rule is the 80/20 rule—try eating well 80% of the time, so you can indulge without guilt the other 20%. Having a particular number of meals in mind will keep you focused on moderation. It also will give you a greater appreciation for those special meals you have chosen.
Do not turn hunger into an indulgence Be sure to make the meal you are choosing to indulge in, one that you are really looking forward to, not one that results from you walking into the nearest restaurant because you have not eaten in 6 hours. Always pack some easy-to-carry snacks for those long days of adventures, sightseeing, or beach-going. This will ensure that you can indulge when you want to, not when your body is screaming for food.
Do not worry if you go overboard one day Sometimes one ice cream cone becomes two, becomes a pastry, and then becomes an indulgent meal out for dinner. Vacationing is a departure from the normal routine of life—if you eat too many calories one day, just brush yourself off and move on! ONE over-the-top day does not make or break a healthy lifestyle. Don’t make the mistake of trying to compensate for the rest of the vacation and restrict your food choices. This usually does not work well, because you will feel deprived and are defeating the purpose of enjoying your vacation. Treat the next morning as a new day, with a new opportunity to make healthy choices. Remember Brooke’s favorite motto – Moderation Not Deprivation!
Indulge wisely - Keep these tips in mind when on vacation:
Enjoy local foods and cuisine—when inRome, eat like an Italian.
Choose how many times to indulge, not which times—the 80/20 rule.
Do not turn hunger into an indulgence—pack snacks.
Do not worry if you go overboard ONE day—treat the next morning as a new day, with a new opportunity to make healthy choices.
If you would like to schedule a nutrition consult, contact Brooke at Nutrition Authority or call 253-227-8284. Let a ‘Registered Dietitian’ help you clear up any nutrition confusion you may have. Brooke can personalize a ‘nutrition lifestyle plan’ to meet your specific needs. Most insurance is accepted.
I always think of the AFIP, Armed Forces Institute of Pathology, as the final word in any difficult anatomic pathology case. As a medical student in the 1970’s, and as an Army physician in the 1980’s the AFIP was the final word on any diagnostic pathology question. Microscope slides were sent to the AFIP whenever there was a question as to whether a biopsy was cancer or not, what grade of cellular abnormality existed, or really any other debate or uncertainty arose about a pathologic diagnosis. When I was reminded today that the AFIP is closing in September as a casualty of the 2005 base closure decisions I was saddened to see that this proud and storied center of excellence has no longer been functioning for the last few months as the world’s premier diagnostic pathology resource.
The AFIP is most well known in recent years as a consulting resource for pathologic diagnosis to both the military and civilian medical, dental and veterinary community. Less well known is that it had a three part mission. It was also an educational center of excellence and a research facility. It has a proud history as a forensic pathology resource also.
The decision to close the AFIP was a part of the Defense Base Closure and Realignment Commission report to President Bush in 2005. The repercussions of the loss of this historic resource have been the subject of many criticisms, but the decision has stood. Some argue that we will be less able to rapidly respond to potential bioterrorism now. Others like the WHO feel the loss of a resource for third world physicians for pathologic examination of surgical specimens will make the practice of good surgical care more difficult in some areas of the world.
One of the unique advantages of the AFIP is that it has been the central repository of many of the most interesting and challenging pathologic cases in the US and the world since 1862. Over 150 years of existence the AFIP has accumulated over 3 million cases, 50 million paraffin slides, and 10 million formalin fixed tissue specimens in one location. This resource has made the AFIP one of the premier places to study pathology and has allowed the pathologists at the AFIP to be widely recognized as world leaders in their field.
For anyone interested the history of the AFIP is being celebrated and documented in a coffee-table style book available at the U.S. Government bookstore in a book called Legacy of Excellence: The Armed Forces Institute of Pathology 1862-2011. The cost is $65.00. Some of the most interesting highlights for me include:
1865: The precursor of the AFIP, the Army Medical Museum did the autopsy on President Lincoln
1866: Somewhat ironically the Army Medical Museum moved to the Ford Theatre which closed as a theatre shortly after the assassination of President Lincoln.
1870: The Surgeon General staff published The Medical and Surgical History of the War of Rebellion: 1861-1865.
1930: James Earl Ash MD was a major proponent of the role of the Army Medical Museum in diagnostic pathology. The American Registry of Pathology was established at the museum.
1946: As its role in diagnostic and forensic pathology increased the Army Medical Museum became a division of the newly formed Army Institute of Pathology.
1949: AIP renamed the Armed Forces Institute of Pathology to emphasize the tri-service role of the AFIP. A new building at the Walter Reed Army Medical Center was designated as a new building site.
1996: The AFIP teamed with Russian scientists to recreate fragments of the 1918 pandemic influenza virus.
2001: The AFIP plays a leading role in the forensic pathologic examinations after the 9-11 attacks.
2005: AFIP scientists announce that they have fully reconstituted the 1918 influenza virus genome.
2006: The AFIP received its 3 millionth pathology specimen.
The loss of the AFIP may not have a huge impact on the excellence of pathology in the U.S. healthcare system. In the information age sharing of microscopic views of specimens can be accomplished through many different vehicles. Still having a single government funded and universally respected repository of expertise and knowledge will be missed. It is a sign of tough times economically for our country and a loss of institutional pride. Myself I just feel like an era has passed and that we may regret this decision in the future.
As a physician I have to ponder how to treat diabetes when it seems like all the news about medications is bad these days? It’s not as clear cut today as it seemed a year or so ago. It seems like we are back to the basics of diet, weight loss and exercise. When we choose medications to help, it gets more complicated. Of course as with all conditions we try to choose medications which have the best risk-benefit ratio. Still the rules seem to be changing literally by the day.
The news of the last few weeks about the risks associated with medications we use in managing the risk factors in our patients with type 2 diabetes makes physicians feel like we are walking a mine field. Take a look at the headline type of news that has come out recently regarding the meds we use to address the four major risk factors for cardiovascular disease in Type 2 diabetes. It is felt to be very important in patients with diabetes to not focus only on blood sugar control, but to aggressively manage blood pressure, LDL cholesterol levels, and find a way to help diabetics who smoke to stop smoking.
Blood Sugar Control: Suboptimal blood sugar control has been a understood as a major risk for most of the major vascular, neurologic, and ophthalmologic complications of diabetes for years. Physicians are encouraged to try to keep the Hemoglobin A1C levels near or below 6.5% in our type 2 diabetes patients. To do this often requires the use of multiple hypoglycemic drugs. Recently drugs in to of the major classes used to manage blood sugars, the GLP-1 analogues including Liraglutide (Victoza) and the class of medications called the thiazolidinediones (TZDs) which included in the U.S. rosiglitazone and pioglitazone. Pioglitazone, or Actos was the 10th highest gross sales medication in the U.S. in 2008 with sales of about $2.4 billion.
Rosiglitazone (Avandia): Removed from the market over increased risks of congestive heart failure and other heart disease concerns.
Pioglitazone (Actos): Possibly related to increased risk of bladder cancer in a FDA news release just this month. Removed from much of the European market, now with increased warnings in the U.S. market.
Liraglutide (Victoza): Possibly related to increased risks of thyroid cancer and pancreatitis in a FDA news release in June 2011. Although to date the other drug in this class, marketed as Byetta has not seemed to be associated with thyroid cancer risks, the course of the Avandia first, and Actos next seems ominous to me.
Glargine insulin (Lantus): The good news is that the 2009 concerns raised about a possible cancer risk with glargine insulin were declared unfounded by the FDA this year.
Lipid Control: Ideal LDL cholesterol levels in our diabetic patients are less than 70 mg/dl, and to achieve this level most patients require treatment with a statin, often use of a high dose of simvastatin or one of the more expensive branded statins. See my prior post Simvastatin vs. Lipitor.
Simvastatin 80 mg, the highest dose of the most effective current generic statin had recent FDA restrictions imposed. Now the question is what to do for our diabetic patients with recommended low goal LDL levels. Simvastatin vs. Lipitor or Crestor is the question. Pay more or accept possible risks. Lousy choices. Fortunately Lipitor is going to be available as a generic as soon as Nov. 30, 2011.
The recent NIH decision to stop the study of niacin combined with a statin for treatment of hypercholesterolemia raises more questions than ever about how to best address suboptimal lipid profiles in our patients, especially our diabetic patients. This is a topic for another post to fully address the subject, so stay tuned.
Smoking Cessation: Our diabetic patients who continue to smoke have much higher risks of heart disease, stroke, and it is imperative that we do what we can to help them quit smoking. Now one of the more effective tools we have has come under increased scrutiny.
Chantix (varenicline) has been very helpful in some patients who have been unable to quit smoking otherwise. Its side effects including vivid dreams, GI symptoms, and depression have been ongoing concerns, but now the FDA reports just this week that the risk of MI may be slightly increased in patients with known coronary disease. This is really unfortunate, as those are exactly the patients who need to quit smoking the most. I look forward to more clarification of this issue, but for now may be more cautious in use of Chantix in my patients who need to quit smoking the most.
Hypertension control: Control of hypertension may be the single most important aspect of reduction of morbidity and mortality in our diabetic patients. So far this remains relatively free of breaking news. Actually some good news recently is more evidence that the fears of increased cancer risk in patients using ARBs are likely unfounded. This is good, because with one generic arb now available, and more on the way, this class of medication is likely to be used with increasing frequency.
Stay tuned as how to treat diabetes hopefully becomes less controversial and we get more answers about the risk/benefit decisions on medication management. Certainly diet, exercise, weight loss and medications are all going to have their place. It will be interesting to see where bariatric surgery ends up in our recommendations in the future.
Human amoebiasis is primarily a disease caused by the single cell organism Entamoeba histolytica, and remains a huge public health problem in areas of the world without good infrastructure for human waste sanitation and clean drinking water. There are an estimated 100,000 deaths (WHO estimate) annually from amoebiasis, although the vast majority of persons who carry the amoeba in their gastrointestinal tract are asymptomatic. E. histolytica is felt to be the only amoeba that causes serious amoebic disease in humans in any significant way. There are several other amoebas that can be carried by or transiently occupy the human GI tract, and these are felt not to cause disease.
The reason that amoebiasis is much more prevalent in parts of the world without good human waste sanitation and clean drinking water is that the primary route of acquiring E. histolytica is from ingesting the organism after water or food is contaminated by human feces. This is called the fecal-oral route of transmission of disease. In areas where human feces are used for fertilizer the rates of disease are much higher.
Normally when ingested the E. histolytica organism lives within the lumen of the gut, and feeds on bacteria and ingested foods. The intestine itself is protected by a layer of protective mucus. If this layer of mucus becomes disrupted the amoeba can destroy the lining cells of the gut wall, cause ulcerations and a severe colitis. Other times it can invade the bloodstream and travel to distant tissues, most often the liver, where it can lodge, destroy tissues there, and lead to abscess formation.
Cyst
Amoebiasis therefore has two common human disease manifestations. Most common is amoebic dysentery. This usually presents similarly to other causes of dysentery, with bloody diarrhea and cramping abdominal pain. The diagnosis can be made in numerous ways. The most common method in many areas of the world is by microscopic examination of the stool. In fresh stool the motile trophozoite is often seen, and the infectious cysts are shed in the stool and can often be seen. The problem with microscopic evaluation is differentiation from both Entamoeba coli, which is much more common than E. histolytica although it has morphologic differences that make it possible to differentiate, and from Entamoeba dispar which is so similar that it cannot be differentiated. It is estimated that in endemic areas E. dispar is found
Trophozoite
in the stool about 10x as commonly as E. histolytica, and E. dispar is not felt to cause disease. Still in a patient with bloody diarrhea and amoeba in the stool that resemble E. histolytica treatment is reasonable.
The other common human presentation of amoebiasis is liver abscess. All the blood from the bowel first travels through the liver circulation, so amoeba that enter the blood stream are usually trapped in the liver, and begin to destroy cells there. Giant abscesses can occur, and serious and at times live threatening disease can occur. Rupture of and amoebic liver abscess can often be fatal. Often once the amoeba spreads beyond the bowel stool tests for E. histolytica can be negative. It is felt that about 10% of amoebic dysentery spread beyond the gut, and other cases occur without apparent dysentery. Diagnosis can be done by serologic antibody testing, with antibody levels in extra-intestinal disease usually much higher than with amoebic dysentery. As with most infections, antibodies can be detected after about 2 weeks of symptoms.
Treatment of symptomatic amoebiasis is done with two types of drug. One is to clear the organism from the intestinal tract, and is called an lumenal (within the lumen or inside of the gut) agent. This is usually idoquinaol or paromomycin. In addition metronidazole is used to treat the disease outside the lumen of the gut. In endemic areas asymptomatic E. histolytica in the stool if not usually treated, but in the developed countries a luminal agent can be used to treat the asymptomatic carrier state. It’s nice to have such an inexpensive drug as metrinidazole to treat this common problem, and metrinidazole side effects are usually minimal, so it is a great choice.
Amoebiasis is felt to be a major cause of malnutrition and morbidity in the world today. It is estimated by the WHO that up to 50% of persons in some tropical areas with poor sanitation may carry the orgainsim, although there is some concern that E. dispar carriers may inflate this number. Still amoebiasis remains a major worldwide cause of morbidity and mortality, and is yet one more disease caused by poverty and lack of clean drinking water and sanitary sewerage disposal.
Here is a low tech idea for prevention of the “signature injury” of the Iraq and Afghanistan Wars, traumatic brain injury. This article in the LA Times discusses how a minor change to the size and padding of the soldier’s helmets could significantly reduce the transfer of traumatic explosive forces to the brain. Let’s hope our military leaders would prefer this to one more kazillion dollar jet or submarine. Enjoy:
A slightly larger helmet with more foam padding would better protect soldiers and Marines from traumatic brain injury, researchers find. The Department of Defense says that more than 130,000 military personnel have suffered such injuries in Iraq and Afghanistan.
This week for Grand Rounds I asked for submissions of the best work from blogger’s sites in the last week or two, and promised to judge them on Olympic scoring of 0-10. I also asked readers to submit posts from blogs other than their own (these have a *** after the score), and to agreed to give these submissions extra credit in the scoring. Each post has two scores, one for content, and one for writing. I think of content as the importance or interest of the topic of the post, and writing as how well and interestingly written the post itself is. I’ll take full blame for the fact that these are absolutely subjective, that only I did the judging, and that there is no appeal process. Nobody should feel be discouraged as I truly enjoyed every submission, and am honored to host Grand Rounds again this week. Thanks for your submissions, and keep up the great work.
Gold Medal for Content goes to John Goodman’s Health Policy Blog he writes The HMO in Your Future. He takes to task the march towards ACO’s and suggests that this is far from evidence based. We do seem to be moving quickly towards ACO’s whatever that really means. Check out this post at least to hear Aretha Franklin sing I Say a Little Prayer.
Content 9.7 Writing 9.0
Gold Medal for Writing goes to At the Road the Hellth blog where Dr. Doug Perednia writes How American Healthcare Gets Hellthier in a satire and sad but believable post where he shows the unintended consequences of instituting a three handed clock to improve patient care in a hospital. Content 9.0 Writing 9.7
Silver Medal for Content and Bronze Medal for Writing goes to Dr John M who writes about A Five Minute Cardiac Screen for Athletes where he addresses many of the issues with testing in general. It is such a shame that 100 young athletes die in America each year of sudden death primarily due to prolongued QT syndrome or Hypertrophic cardiomyopathy. He presents an elegant discussion of the issues of mass screening for uncommon problems with tests that have a significant subjective component to the results, and false-positive test rates. Nice post Dr. John. Content 9.5 Writing 9.5
Silver Medal for Writing goes to ZDoggMD who professes to be only slightly funnier than placebo, but I suspect just needs a bigger sample size to prove he is far funnier. He writes Immunize, with a video worthy of my own musical doctors page. Content 8.5, 9.6
The rest are in the order received. Better billing for more timely submission seems fair to me. Enjoy.
A Word About Morgellon’s Disease on Insureblog is a post about a disorder I suspect close to none of you have ever heard about. I certainly had not. It’s one strange disorder. Content 6.5 Writing 6.0
At Mad in America Robert Whitaker writes Andreasen Drops a Bombshell: Anti-psychotics Shrink the Brain about the release of a study in the Archives of General Psychiatry that claims that antipsychotic drug use leads to lower gray matter volume with long term use. This is especially concerning in light of the increasingly widespread use of these drugs in children and diseases other than schizophrenia. This is certainly not common knowledge among primary care physicians. If any psychiatrists have a comment about this I’d love to see it here. Content 9.0 Writing 7.5
In Diabetes Mine Allison Blass writes about Five Diabetes Dogmas that Need to Go… , an interesting discussion of some myths and dogmas that are widely believed, but have little or no science behind them. A good read for physicians and others alike. Content 8.5 Writing 7.5
In Behavoirism and Mental Health: An alternative perspective on mental disorders Philip Hickey Ph.D. writes More on So-Called Bipolar Disorder. I have to agree that patients who carry a diagnosis of bipolar disorder are a diverse and group, but he goes so far as to suggest that for these patients the focus should be on recognizing the behavior that need to be changed, and “this behavior can be identified, specified clearly, and remediated. And in this regard you have to do what we all have to do with life’s problems – exploit your strengths to counter your weaknesses. In other words – use your ingenuity. Find solutions to the problem. Don’t give in. Don’t go on doing things the same. Break patterns, etc..” He is bold in this major break from the practicing norm. See what you think. Content 6.0 Writing 6.0
Paul Aurebach MD from Healthline writes an environmentally focused post called Save the Everest 2011: Improving Waste Management in Nepal. It‘s as far off the usual topics here as Nepal is from the U.S., but I post it because it is interesting, and our environment is part of our global health. Content 6.0 Writing 7.5
Ed Silverman at Pharmalot posts Most Docs are Unaware of the “Bad Ad” Program. I certainly was unaware of an effort by the FDA to get physicians to report inappropriate, false or off-label advertising or promotion by pharma, so he is right on when he suggests for this to be more effective the FDA needs to get the word out to docs. Maybe this will help. Content 8.5 Writing 7.5 ***
The ACP Hospitalist writes about the extent of MRSA contamination of traditional white coats vs. freshly laundered short sleeved uniforms, and finds Doctor’s Garments Colonized by Bacteria Within Hours of Starting Work. I’m glad I can keep wearing my white coat and not have to wear a short sleeve uniform. I like to look like a doctor, not an orderly. Content 7.5 Writing 8.0
At Health Care Agenda Nora O’Brien-Suric writes Social Workers are Best for Care Transitions. I have to agree with her premise that physicians don’t do a great job at the details of facilitating the transition of patients from a hospital setting to a long-term care setting. Content 8.0 Writing 9.0 ***
Dr. Val at Better Health writes Don’t Treat the Number, Treat the Patient. In this case she is her own “patient” and I don’t envy her taking spin classes. My son has another name for the person screaming at the class riders, but it’s not fit for this venue. Writing 7.5 Content 9.0
At Residency Notes is Acute Gatekeeper where the blogger, apparently an annonomous neurosurgical intern writes about the role of the lower level intern or resident in care of hospitalized patients. I think the example he gives of two ways to present a case to get two potentially different responses are seen throughout medicine. Physicians, intentionally or unintentionally guide patients, consultants, and in the resident’s case attending physician supervisors to decisions of their choosing by the flavor put on the case presentation. A good read. Content 8,0 Writing 8.5
Roy at Shrink Rap posts about Running Out of Psychiatric Beds where he discusses the overall reduction of and difficulty finding inpatient psych beds when patients need them, and a new electronic registry in Eastern Ontario to help ERs find a psych bed when they need one. Content 6.5 Writing 8.0 ***
Amy Tenderich writes at Diabetes Mine a post called Losing Control as she vents about the struggle of burnout and wearing down for patients dealing with chronic diseases like Type 1 diabetes, especially when trying to do so with gluten enteropathy at the same time. Hang in there Amy, you can get back on track. Diabetes Mine gets a second post here because they host Grand Rounds next week. Thanks. Content 8.0 Writing 9.0
Elaine Schattner MD writes at Medical Lessons that Radiologists’ Experience Matters in Mammography Outcomes, She reviews and discusses a study that shows that radiologists who read a high volume of breast imaging studies have a lower false positive reading rate than those who interpret a lower volume of exams. Sounds a lot like similar studies with surgeons, hospitals, etc where high volume leads to improved outcomes. Content 7.0 Writing 7.5
From Health is Social is a post asking Will Social Media End Stigma in Health? It’s really a rhetorical question in the blog post, but one that makes you think. Thinking is not bad, unless it’s bedtime. Content 7.0 Writing 9.0 ***
Be sure to visit Grand Rounds Vol. 7 No. 25 at http://www.diabetesmine.com next week and get your submissions in to her early. Special thanks to Better Health for organizing and managing this useful forum. While you’re here be sure to follow @DrEdPullen on Twitter, like DrPullen.com on Facebook or subscribe so you don’t miss a post. Thanks for reading, and leave a comment so future hosts, maybe even me, can improve Grand Rounds.
Reducing health care costs is a hot topic with government defecit spending and the struggling economy. Thanks to my partner Dr. Aversa for pointing me to yet another great read by Atul Gawande in The New Yorker. To achieve to a large amount of savings in the health care system you can save a little bit on a lot of patients, or a lot on a few patients. Read this article to see how the latter is being done in a few pilot projects. A long but very thought provoking read. Fill your cup of tea to the brim, and get an extra tea bag, sit back and enjoy.
Medical Report
The Hot Spotters
Can we lower medical costs by giving the neediest patients better care?
Brooke is back after a month when I goofed up and didn’t get her first of the month post up is Brooke Douglas of Nutrition Authority with help to get us to eat 5 a day, fruit and vegetable helpings that is. It seems appropriate that Brooke who regularly contributes is the author of the 300th post on this health blog. Thanks Brooke.
15 Ways to More Fruits and Vegetables
Have 1 cup of fruit (fresh or frozen) for breakfast every day.
Take 1 cup of fruit/1 piece of fruit with you in the car (for work or when you are running errands).
Eat at least one cup of vegetables at lunch. This could be a salad or vegetable soup. Try dipping raw vegetables of your liking in to your favorite low fat or fat free salad dressing.
Eat at least one cup of vegetables for dinner.
Make one vegetarian recipe each week; don’t be afraid to try new ones!
Take the time once a week to shop for, clean, separate and/or cut up into bite size pieces and bag (in a large baggie) a variety of your favorite vegetables.
Keep freshly prepared (from tip #6) vegetables on hand for snacking at home, at work or in the car and for quick side dishes, to throw in pasta, casseroles or soup during the week.
Start shopping in the produce section of the grocery store and build your meal ideas from what you find.
As a goal, aim for at least 1/3 of your grocery cart to be from the produce section.
Keep fresh or dried fruit on hand for grab and go snacks. Store these in your desk drawer, passenger seat, computer bag, briefcase, suitcase, locker, purse, etc…
Take fresh fruit to work with you every day for a snack. Always have a healthy fruit or vegetable snack available to grab when hopping in the car to run errands…just in case you get hungry while you are out.
The next time you visit a fast food restaurant, order a side salad or fruit cup instead of fries or chips.
Make a delicious fruit parfait as dessert once a week. Plain vanilla yogurt, your favorite berry (fresh or frozen/thawed) and sprinkle with Grape-Nut Cereal (or any favored high fiber cereal).
Make a vegetable stir fry at least once every week. Get creative with different (modest portion) lean meat choices and always add a large variety fresh or frozen veggies.
When eating, fill at least ½ of your plate with fruits and vegetables. Always. Every day.
New Ideas?
When the weather is warm, freeze some grapes and sliced bananas – these make great snacks to help everyone keep cool.
Instead of the same old boring iceberg lettuce on your sandwiches and in your salads, try some crispy fresh spinach, arugula or mixed greens.
Put some fresh vegetables on the grill whenever you decide to grill some meat. Make it a habit.
Toss some fruit in to your salad – you could use dried fruits like cranberries or fresh ones like berries, mandarin oranges, mangoes, peaches and pineapple.
Hollywood has a long history of making great movies about special people with medical conditions. This year a stuttering king, but from Rain Man about Autism
to The Elephant Man about neurofibramatosis
Oscar nominated films are often about medical conditions. As I watched the Academy Awards last night and remembered how much I enjoyed watching The King’s Speech I was prompted to review a good overview in AFP from 2008 that reviewed stuttering. The issues in the movie are those addressed by a child and then an adult, who happens to become the king of England, with a major stuttering disorder. Review of the article was helpful to put the things I saw in the movie into perspective. In summary stuttering is fairly common in young people and tends to improve by adulthood. Here are a few of the key points on the review article:
1.4% of children under 10 years old stutter.
80% of children who stutter are male.
80% of children with developmental stuttering resolve by adulthood.
Over to 80% of stuttering is classified as developmental and over 75% of preschoolers who stutter spontaneously recover within 4 years.
Some developmental stutterers develop associated tics or other physical movements
The AFP article goes over the differentiation between normal speech fluency dysfluency, mild stuttering and severe stuttering. It’s a good review for parents or physicians faced with questions about speech fluency questions.
Readers of this health blog will remember some of the posts I’ve made about my experiences as the husband of a cancer patient. See Hows Kay? and The Importance of Knowing Your Family History. The experience is one I wish on nobody, but I do look forward to this series in the NY Times by Dr. Bach, a Sloan-Kettering physician whose wife has breast cancer. He plans to journal about this in the NY Times Health blog over the next few weeks. Here is the first installment:
February 21, 2011, 3:39 PM
When the Doctor’s Wife Has Cancer
By PETER B. BACH, M.D.
As a medical student 20 years ago, I learned all about anatomy, physiology and pharmacology. My professors also taught me, implicitly, how to put on the white doctor coat as a shield against human vulnerability. With the coat on, you could get right up close to frailty, even touch it, and it wouldn’t be able to reach out and pull you in.
Residency training, with its harsh hours and unrelenting pace, added several more layers of protective shellac. But in all those years I didn’t have one class on how to be a patient, never mind how to be the spouse of one.
It was 8 a.m. on a sunny and crisp Wednesday in October when I became one. read more
