Pap test lost its value?

 

Has the Pap test lost its value?

By John Biemer and Guliz A. Barkan   source
The Pap test — a staple of women’s health checkups for generations — is one of medicine’s greatest success stories, saving the lives of countless women by detecting abnormal cells on the cervix that could turn into cancer. Yet the Pap test could be on the decline due to changing technology.
The Pap test is widely considered the most effective cancer screening test. As recently as 2000, an estimated 61 million Pap tests were performed in the United States, according to surveys conducted by the National Center for Health Statistics. But if recent proposals from the United States Preventive Services Task Force are approved, fewer Paps may be performed going forward, with a molecular test replacing them.
This month, the task force proposed that screening healthy women ages 30 to 65 for cervical cancer could be performed by either a Pap test or by a human papillomavirus DNA test instead — although a Pap would be performed every three years while the HPV test alone could be performed every five years.
The task force proposals, which are now in a public comment period, follow a study of 47,208 women undergoing routine cervical exams that demonstrated that a DNA test for HPV was more sensitive than the Pap at picking up lesions on the cervix that could progress into cancer.
However, critics of the HPV molecular test say it also is more likely to turn up with erroneously “positive” results (when there is no precancerous condition), which may lead to unnecessary treatment such as colposcopies and biopsies for patients who don’t need them. There also are concerns that setting the screening at five-year intervals may lead to women failing to follow up with gynecological checkups, which are also important for other health concerns besides cervical cancer screening. As a result, for the patient’s benefit, it may be better to have co-testing — both a Pap test and HPV testing at the same time — to ensure higher sensitivity in detecting cancer.
Cervical cancer was the most common cause of cancer deaths of women in the United States in the 1930s, but deaths dropped dramatically after the introduction of the low-cost, easily performed Pap test, which was developed by Dr. George Papanicolaou, a pathologist who emigrated from Greece.
In the Pap test, commonly referred to as a “Pap smear,” cells collected from the uterine cervix with a tiny brush are later placed on a glass slide.
Cytotechnologists and pathologists examine those slides under a microscope, scouring thousands of cells for any abnormality. From the perspective of patients, collecting cells for the HPV molecular tests also requires a speculum exam, so they won’t notice much difference.
Some strains of the human papillomavirus — the same virus that causes warts — have been linked to the development of cervical cancer. Infection by HPV, which is spread by sexual contact, still is common, especially in sexually active young men and women.
At least half of sexually active people will have HPV at some point in their lives, but the infection is usually transient and the body clears it on its own. That’s why the Pap test, rather than the HPV DNA test, is still preferable in women under 30 to see if precancerous changes in cervical cells already have taken place.
Some women, however, do develop persistent infections that can progress over time into invasive cancer. There are still nearly 13,000 new cases of cervical cancer in the United States each year and more than 4,000 deaths due to the disease, according to the American Cancer Society — though it now ranks as the 21st most common of cancers in women, according to the National Cancer Institute.
The biggest reason for its precipitous decline is vigilant surveillance. Although HPV vaccines and the HPV testing ultimately may lead to fewer Pap tests being performed, the goal remains the same: to stop a deadly disease in its tracks.
John Biemer, M.D., a former Tribune reporter, is a cytopathology fellow at Loyola University Medical Center in Maywood; Guliz A. Barkan, M.D., is the director of cytopathology at LUMC.

Deafening mystery grows in Cuba

Physics of injuries, methods don’t add up, officials say
Secretary of State Rex Tillerson said Sunday the Trump administration is considering closing the U.S. embassy in Havana. (Desmond Boylan/AP 2015)
By Josh Lederman, Michael Weissenstein and Matthew Lee Associated Press
WASHINGTON — The blaring, grinding noise jolted the American diplomat from his bed in a Havana hotel. He moved just a few feet, and there was silence. He climbed back into bed. Inexplicably, the agonizing sound hit him again. It was as if he’d walked through some invisible wall cutting straight through his room.
Soon came the hearing loss, and the speech problems, symptoms both similar and altogether different from others among at least 21 U.S. victims in an astonishing international mystery still unfolding in Cuba.

The top U.S. diplomat has called them “health attacks.” New details learned by The Associated Press indicate at least some of the incidents were confined to specific rooms or even parts of rooms with laser-like specificity, baffling U.S. officials who say the facts and the physics don’t add up.
“None of this has a reasonable explanation,” said Fulton Armstrong, a former CIA official who served in Havana long before America re-opened an embassy there. “It’s just mystery after mystery after mystery.”
Suspicion initially focused on a sonic weapon, and on the Cubans. Yet the diagnosis of mild brain injury, considered unlikely to result from sound, has confounded the FBI, the State Department and U.S. intelligence agencies involved in the investigation.
Some victims now have problems concentrating or recalling specific words, several officials said, the latest signs of more serious damage than the U.S. government initially realized. The United States first acknowledged the attacks in August — nine months after symptoms were first reported.
It may seem the stuff of sci-fi novels, of the cloak-and-dagger rivalries that haven’t fully dissipated despite the historic U.S.-Cuban rapprochement two years ago that seemed to bury the weight of the two nations’ Cold War enmity.

But this is Cuba, the land of poisoned cigars, exploding seashells and covert subterfuge by Washington and Havana, where the unimaginable in espionage has often been all too real.
The Trump administration still hasn’t identified a culprit or a device to explain the attacks, according to interviews with more than a dozen current and former U.S. officials, Cuban officials and others briefed on the investigation. Most weren’t authorized to discuss the probe and demanded anonymity.
“The investigation into all of this is still under way. It is an aggressive investigation,” State Department spokeswoman Heather Nauert said last week. “We will continue doing this until we find out who or what is responsible for this.”
On Sunday, Secretary of State Rex Tillerson said the Trump administration is considering closing down the U.S. embassy in Havana. Tillerson’s comments were the strongest indication to date that the United States might mount a major diplomatic response, potentially jeopardizing the historic restart of relations between the U.S. and Cuba.
“We have it under evaluation,” Tillerson said of a possible embassy closure. “It’s a very serious issue with respect to the harm that certain individuals have suffered.”
Investigators have tested several theories about an intentional attack — by Cuba’s government, a rogue faction of its security forces, a third country like Russia, or some combination thereof.

Yet they’ve left open the possibility an advanced espionage operation went horribly awry, or that some other, less nefarious explanation is to blame.
Aside from their homes, officials said Americans were attacked in at least one hotel, a fact not previously disclosed. An incident occurred on an upper floor of the recently renovated Hotel Capri, a 60-year-old concrete tower steps from the Malecon, Havana’s iconic, waterside promenade.
The cases vary deeply: different symptoms, different recollections of what happened. That’s what makes the puzzle so difficult to crack.
In several episodes recounted by U.S. officials, victims knew it was happening in real time, and there were strong indications of a sonic attack.
Some felt vibrations, and heard sounds — loud ringing or a high-pitched chirping similar to crickets or cicadas. Others heard the grinding noise. Some victims awoke with ringing in their ears and fumbled for their alarm clocks, only to discover the ringing stopped when they moved away from their beds.
The attacks seemed to come at night. Several victims reported they came in minute-long bursts.
Yet others heard nothing, felt nothing. Their symptoms came later.
The scope keeps widening. Last week, the State Department disclosed that doctors had confirmed another two cases, bringing the total American victims to 21. Some have mild traumatic brain injury, known as a concussion, and others permanent hearing loss.
Even the potential motive is unclear. Investigators are at a loss to explain why Canadians were harmed. Fewer than 10 Canadian diplomatic households in Cuba were affected, a Canadian official said. Unlike the U.S., Canada has maintained warm ties to Cuba for decades.
Sound and health experts are equally baffled. Targeted, localized beams of sound are possible, but the laws of acoustics suggest such a device would probably be large and not easily concealed. Officials said it’s unclear whether the device’s effects were localized by design or due to some other technical factor.
And no single, sonic gadget seems to explain such an odd, inconsistent array of physical responses.
“Brain damage and concussions, it’s not possible,” said Joseph Pompei, a former MIT researcher and psychoacoustics expert. “Somebody would have to submerge their head into a pool lined with very powerful ultrasound transducers.”
Other symptoms have included brain swelling, dizziness, nausea, severe headaches, balance problems and tinnitus, or prolonged ringing in the ears. Many victims have shown improvement since leaving Cuba and some suffered only minor or temporary symptoms.
After the U.S. complained to Cuba’s government earlier this year and Canada detected its own cases, the FBI and the Royal Canadian Mounted Police traveled to Havana to investigate.
FBI investigators swept the rooms, looking for devices. They found nothing, several officials briefed on the investigation said.
In May, Washington expelled two Cuban diplomats to protest the communist government’s failure to protect Americans serving there. But the U.S. has taken pains not to accuse Havana of perpetrating the attacks.
Cuba’s government declined to answer specific questions about the incidents, pointing to a previous Foreign Affairs Ministry statement denying any involvement, vowing full cooperation and saying it was treating the situation “with utmost importance.”
“Cuba has never, nor would it ever, allow that the Cuban territory be used for any action against accredited diplomatic agents or their families, without exception,” the Cuban statement said.

Violence to Nurses

 

 

Note–Through my many surgeries, starting at age 4 (1939), I’ve gained a lot of respect for nurses, men and women.  We’ve had nurses in the family: my mother Marjorie, my sister Carol, my sister-in-law Jenny and her son Chris, and my daughter Laura.

When I had an appendectomy at age 12, I  fell in love with a student nurse from Indiana who was kind to me but I sensed  did not reciprocate my passion.

Before colleges entered nursing education, girls trained in hospital programs. Mom and Carol had tuition, room and board free at St. Francis Hospital in Evanston and worked long hours at such tasks as cleaning beds as well as nursing duties. They wore white dresses, stockings, and shoes.  At graduation they received their white caps to which they added a stripe after a period of service.  Laura trained at Lutheran General Hospital in Niles, Illinois, and worked there  in the cancer unit.

Now we have highly trained advanced practice nurses who do much of the work of a primary care doctor.  Rachel Foote treated patients in Spanish at a clinic in Boston. Nurses can earn master and doctor degrees in nursing.  Some physicians don’t like to have nurses addressed as doctor.

RJN

 

______________________________________________________________________

On the front line of hospital violence, nurses seek reform  Chicago Tribune 8/11/17

‘Part of the job’ culture in health care must change, advocates say

Carina Johannessen, 40, said being a nurse is rather like “being in an abusive relationship.”

By Kate Thayer and Hannah Leone Chicago Tribune

One woman describes getting slapped and groped on the job. Another was punched in the head repeatedly. A third was bitten so hard that a spike in blood pressure burst an aneurysm in her brain, altering her life forever.

All three are nurses, who say their jobs place them in harm’s way as the rate of violent incidents at hospitals appears to be growing.

U.S. Bureau of Labor Statistics data show that the rate of hospital employees intentionally injured on the job at the hands of another person is significantly higher than the rate across all private industries. In 2015, the most recent year available, there were 8.5 cases of injuries per 10,000 full-time hospital workers, versus 1.7 cases for all private industries.

The data also show that injury number for hospital workers steadily rose from 2011 to 2014 but dropped slightly the following year.

According to an Occupational Safety and Health Administration guide on addressing violence in hospitals, 70 to 74 percent of workplace assaults between 2011 and 2013 happened in health care settings.

And hospitals in the Chicago area have not been immune to such violence in recent years.

In May, two nurses at Northwestern Medicine Delnor Hospital in Geneva were taken hostage by a Kane County jail inmate after he got hold of the gun of a corrections officer guarding him. One of the nurses was sexually assaulted, according to a lawsuit filed in the case, before the inmate was fatally shot by police, authorities said.

Less than a month later at Presence St. Joseph Medical Center in Joliet, a convicted murderer who was there for treatment used a makeshift weapon to hold a corrections officer and a nursing assistant hostage.

In 2014, a man who had been taken to NorthShore Highland Park Hospital after a car crash was shot and killed by police after removing a gun from his waistband, according to police accounts.

Experts say facilities across the country have been affected. In June, a disgruntled doctor opened fire at a New York City hospital, killing another doctor and injuring several other people before taking his own life. In 2015, at a Boston hospital, a man shot and killed the surgeon who’d operated on his mother before she died.

While such extreme examples are rarer, many health care workers — especially nurses — say they deal with more minor incidents of physical aggression or verbal abuse on an almost daily basis. Many have stories of intoxicated or delusional patients who spit, claw and hit, or angry family members who threaten lawsuits or even lives.

For too long, nursing advocates say, aggression toward hospital workers has been chalked up to just an unfortunate part of the job, and patients are rarely held accountable.

Yet a movement to change this culture seems to be gaining momentum, with nurses groups speaking out at protests and on social media, and lobbying for legislation that aims to curtail violence against health care workers.

The Delnor attack seems to have been the tipping point for many activists locally, and in response to it, a nonprofit group called Show Me Your Stethoscope plans to gather nurses at a rally Friday in front of the Kane County sheriff’s office to shed light on their efforts.

Nurses point out that they’re the ones with the most contact with patients and their families, often during times of crisis and intense stress. Heartbreak over a serious diagnosis, anger over a long emergency room wait or even a general disdain for the health care and insurance fields — all can translate into hostility toward nurses, experts say.

“Just going into work is a high-risk endeavor,” said Lisa Wolf, director at the Institute for Emergency Nursing Research at the Emergency Nurses Association and a registered nurse who has studied emergency room violence. “You’re going to work and people are in some ways feeling like they can kill you.”

Nurses groups generally would like to see more staffing and more training. Other observers say there’s no single solution that would work for all hospitals — an industry struggling to do more with fewer resources.

While many states, including Illinois, have enhanced penalties for offenders who attack nurses, there’s also a push for federal legislation or an OSHA standard that would regulate hospital staffing levels and install other violence prevention measures.

Some who’ve studied the problem say it’s even worse than the statistics suggest. Verbal abuse is not included in government reporting, and while many hospitals have a system for employees to report acts of violence, nurses say they often don’t have or take the time to take advantage of them.

‘Part of the job’

Trauma nurse Carina Johannessen said her job is somewhat like “being in an abusive relationship.”

Nurses get hurt, but they keep going back to work, said Johannessen, 40, who is employed by an RN placement firm and has worked in several Illinois hospitals.

While on a shift at the emergency room at St. Joseph in Joliet, she said, a large male patient punched her in the head five times after he attacked someone else and she tried to intervene.

Johannessen, of Joliet, said she didn’t suffer severe injuries and felt she had to finish her shift, despite a “raging headache.” No one suggested she file a police report, she said, or even go home for the day. And if she had left, she said there wouldn’t have been enough nurses to cover the rest of her shift.

“This just seems to be the culture. It’s part of the job,” Johannessen said, adding her “greatest fear” is that violence against nurses will only escalate.

On May 13, Tywon Salters, a Kane County jail inmate admitted to Delnor for medical treatment, was left unshackled by a corrections officer, according to a lawsuit filed by Delnor nurses.

Salters, 21 and in jail for alleged car theft, got hold of the officer’s 9 mm handgun, and while the officer ran down the hall and hid, Salters found a nurse in a nearby office, threatened her with the gun and made her remove her clothes, the complaint states. When another nurse entered, he led her to another room, where he held her captive for hours in the dark, raping her and beating her at gunpoint, according to the lawsuit.

A SWAT team officer eventually shot and killed Salters. The fatal bullet also struck the nurse in the arm, according to the lawsuit.

Johannessen said the Delnor incident was partly what prompted her to speak out. She said she sometimes struggles to remember why she chose to be a nurse in the first place.

“It is so incredibly rewarding,” she said, “but it’s sad because it’s becoming more and more infrequent that you get the patient who reminds you why you wanted to be a nurse.”

ER nurse Valerie Zage said she’s been subjected to regular verbal abuse in her 10-year career.

“People scream at you, they swear at you. I’ve been called so many names,” she said. “It seems the culture of hospitals in general is, you kind of have to just take it.”

Zage, 33, of Bensenville, said two incidents prompted her to file official reports, not just with her employer but also with police.

The first occurred a few years ago at Advocate Condell Medical Center in Libertyville, where Zage said a patient charged at her and slapped her across the face after being denied a pain pill prescription.

Zage was shaken and called police. She said the patient received a minor ordinance violation ticket but never appeared in court so the matter went unresolved.

More recently, while working at Advocate Lutheran General Hospital in Park Ridge, Zage said an intoxicated patient grabbed her breast while she was setting up an IV. Zage also went to police but said she found it “frustrating” that he, too, merely received a ticket and was fined $100.

“You go through nursing school and you think, ‘Wow, I’m going to help people and save lives,’ ” she said. “No one really warns you in school that people are as mean and horrible as they’re going to be.”

Sally Griepentrog, 52, of downstate Eureka, is an educator trying to prepare nurses for those realities of the profession. A workplace violence course she teaches to employees at OSF St. Francis Medical Center in Peoria includes techniques for recognizing cues for possible violence and de-escalation methods.

Griepentrog said she’s uniquely suited for the job, as an act of workplace violence changed her life.

In 2015, Griepentrog was staffing a medical tent at a summer music festival. A young woman came in, topless, saying she had been taking drugs all day and was dehydrated. When Griepentrog tried to start an IV, she said, the woman clamped her teeth down hard into the nurse’s shoulder and would not let go.

It took the intervention of multiple staff members to eventually wrestle the woman away.

Griepentrog was treated for the gash in her shoulder, but a lingering headache led to further testing. Days later, doctors learned the pain from the bite caused her blood pressure to spike, bursting an undiagnosed aneurysm in her brain.

She underwent surgery and spent weeks in the ICU. She was left with short-term memory loss and said she can no longer read more than a sentence at a time.

“I’ve been swatted at, hit, spit on, puked on, you name it,” Griepentrog said. “But this was the first time it almost cost me my life.”

It might have cost her career, too, had Griepentrog not already had a master’s degree and experience teaching. She can no longer treat patients but now works solely as an educator, using computer software that reads aloud to her.

The woman who attacked Griepentrog was eventually convicted of a misdemeanor and sentenced to six months in jail, court records show.

“Now that this has happened, I think, no more. This can’t be considered part of our jobs anymore. I think too many of us are being hurt,” Griepentrog said.

Alice Johnson, executive director of the Illinois Nurses Association, said it’s time for hospitals to make nurses’ safety a priority and dedicate resources accordingly.

“Nurses are taking action on their own as part of a grass-roots efforts to address this issue,” she said.

Hospitals and other employers, on the other hand, “have a long way to go,” Johnson said, adding they seem focused on the bottom line but not enough on the care of the workforce.

Adequate staffing is one key way to improve hospital safety, she said.

Pam Cipriano, American Nurses Association president, said mandatory staff training and better record-keeping should be done at all hospitals — whether voluntary or through federal legislation.

“We need to be able to reverse the culture to make sure no nurse should … be exposed to violence on the job,” she said.

More research needed

Emergency medicine physician James Phillips started studying hospital violence after the surgeon was killed at the Boston hospital. At the time, he was working at nearby Harvard University, writing about mass shootings.

But when he turned his attention to medical settings, “I came across a plethora of nursing literature of violence in hospitals,” he said. Last year, he published an article in the New England Journal of Medicine arguing that hospital violence is under-reported, tolerated and ignored.

Phillips notes that government statistics on workplace violence only track incidents that result in injuries and time off of work. He said more accurate tracking is important to persuade hospitals to put more resources toward security and violence prevention methods.

During Phillips’ residency in Chicago with the University of Illinois hospital system, he was working a shift at a suburban hospital and was trying to calm an agitated, intoxicated patient when the man “spit a mouthful of blood right into my eye.” Phillips soon learned the man was infected with hepatitis C.

The doctor never contracted the virus but had to undergo testing multiple times for months.

“I blew it off at the time. I thought it was part of the job,” he said. “No one ever said, ‘Did you file a police report? You were a victim of a violent crime.’ ”

Later, Phillips was working in Massachusetts when a patient spit in his face and threw a cellphone at him. In that case, he said he did call police, and the man was charged and served community service.

“I’m so sick and tired of being yelled at, screamed at and threatened,” he said. “I finally thought it was time to stand up for myself.”

Phillips said nursing and medical schools “should be the first place future doctors and nurses learn about the fact that they are entering into a violent industry and have a significant chance of being verbally and physically assaulted in their careers.”

Active shooters in hospitals are rare, he stressed, but assaults on staff by patients and visitors are much more common.

Wolf, of the Emergency Nurses Association, said hospitals need to assess risk factors, down to things like poor lighting, and should implement detailed reporting systems and encourage staff members to use them. Hospitals also need adequate staffing and should take “a firmer stance on patients who start acting out.”

Wolf said it’s a challenge for hospitals to acknowledge any risks because “everyone wants to feel like the community is safe.”

Wolf’s group surveyed thousands of nurses across the country, and the results, published in 2009, showed more than half were physically assaulted at work. “This is a very, very common, deeply disturbing aspect (of the job),” she said.

No single solution

Several Chicago-area hospitals contacted by the Tribune declined to comment on security measures and staff training relating to workplace violence.

Advocate, Presence and Northwestern health systems issued statements, noting security is a priority and they take precautions, including de-escalation techniques and drills, and continue to study the issue.

“Unfortunately, this is something that continues to be seen more and more, and we continually have to talk about it,” said Melissa Granato, associate vice president of security for Amita Health.

In 2015 at Alexian Brothers Medical Center in Elk Grove Village, one of the hospitals under the Amita banner, a man locked his estranged wife in a bathroom and stabbed her to death with a screwdriver.

Granato said the case prompted the security team to review and improve its procedures. Those approaches vary by location, she said, but can include drills and simulation training with staff. She also said they work closely with local law enforcement.

At the Chicago-based American Hospital Association and the Illinois Health and Hospital Association, the issue of workplace violence is taken seriously, officials said. Members can access resources on how to address security at their facilities.

But every facility is different, said Dr. Jay Bhatt, AHA president. That’s why he and others question whether a national standard on staffing levels or violence prevention for hospitals would work.

“Nurses aren’t widgets, neither are patients,” said Cathy Grossi, a vice president at the IHA. “One size fits all rarely ever works.”

However, California recently enacted legislation that many nurse advocates say is groundbreaking and a potential model for a national standard. The law addresses the reporting of violent acts, staff training and correcting any violence hazards, including staffing levels. The union that lobbied for it is also pushing for OSHA to come up with a standard.

The Joint Commission, the Oakbrook Terrace-based nonprofit that accredits hospitals across the country, does not have a uniform standard related to workplace violence. But the commission does address safety and security when accrediting hospitals, and offers violence prevention resources, said Dr. Ana Pujols McKee, the commission’s chief medical officer.

“We expect our organizations to understand security risks and respond in a proactive way,” she said.

McKee said one challenge is finding a uniform way to gather data and use it to set guidelines. She uses the example of a nurse being hit by a patient with a brain tumor that has altered the patient’s behavior. “Is that violent? To me, it is, but it may be perceived as a patient who has uncontrollable behaviors.”

McKee said she’s watching California as a “test site,” to see if the new law leads to a decrease in hospital violence.

Are hospitals secure?

Security experts also agree more study is needed to determine the best way to keep hospitals safe.

“The historic feeling that places like … hospitals (are) sacred ground is gone,” said Kevin Tuohey, president-elect of the International Association for Healthcare Security and Safety.

The Glendale Heights-based group researches and offers guidelines for the security industry, including hospital guards.

Another association official, Tom Smith, who runs a health care security consulting company, said hospitals are typically subjected to few regulations dealing with security, and some don’t place enough emphasis on it.

“Family-friendly and patient-centered doesn’t mean it shouldn’t be secure,” he said.

The association has provided feedback to OSHA as the workplace safety agency contemplates hospital security regulations. Some local law enforcement agencies, though, have already made changes in how they handle inmates who need outside medical care.

Within weeks of the Delnor attack, Kendall County updated their policies, including requiring detainees to remain handcuffed or shackled at all times unless medical staff specifically orders restraints removed or the detainee is giving birth.

Deputies who are guarding inmates at hospitals are also barred from using the phone unless there’s an emergency and may not use social media or the internet or play games. According to the lawsuit filed by the Delnor nurses, corrections officers assigned to guard Salters were seen sleeping or on the computer.

Sheriff offices in Cook and McHenry counties also listed several guidelines for transporting and guarding inmates who need outside medical attention.

The Illinois Department of Corrections, as well as DuPage, Kane, Lake and Will counties, declined to provide their policies, citing security concerns.

Kate Thayer is a Chicago Tribune reporter; Hannah Leone is an Aurora Beacon-News reporter. kthayer@chicagotribune.com

Bugs on our Bills (and dope)

The dirt and dope that’s on your cash

By Johanna Ohm  Chicago Tribune 6.22.17

We live in a dirty world. Wherever we go, we are among microbes. Bacteria, fungi and viruses live on our phones, bus seats, door handles and park benches. We pass these tiny organisms to each other when we share a handshake or a seat on the plane.
Now, researchers are finding we also share our microbes through our money. From tip jars to vending machines to the meter maid — each dollar, passed person to person, samples a bit of the environment it comes from, and passes those bits to the next person, the next place it goes.
The list of things found on our dollars includes DNA from our pets, traces of illegal drugs, and bacteria and viruses that cause disease.
The findings demonstrate how money can silently record human activities, leaving behind so-called “molecular echoes.”
What’s on a $1 bill?
In April, a new study identified more than 100 different strains of bacteria on dollar bills circulating in New York City. Some of the most common bugs on our bills included Propionibacterium acnes , a bacteria known to cause acne, and Streptococcus oralis , a common bacteria found in our mouths.
The research team, led by biologist Jane Carlton at New York University, also discovered traces of DNA from domestic animals and from specific bacteria that are associated only with certain foods.
A similar study recovered traces of DNA on ATM keypads, reflecting the foods people ate in different neighborhoods in New York. People in central Harlem ate more domestic chicken than those in Flushing and Chinatown, who ate more species of bony fish and mollusks. The foods people ate transferred from fingers to touch screens, where scientists could recover a bit of their most recent meals.
We don’t leave only food behind. Traces of cocaine can be found on almost 80 percent of dollar bills. Other drugs, including morphine, heroin, methamphetamine and amphetamine, can also be found on bills, though less commonly than cocaine.
Identifying foods people eat or the drugs people use based on interactions with money might not seem all that useful, but scientists are also using these types of data to understand patterns of disease. Most of the microbes the researchers in New York identified do not cause disease.
But other studies have suggested that disease-causing strains of bacteria or viruses could be passed along with our currency.
Bacteria that cause foodborne illness — including salmonella and a pathogenic strain of E. coli — have been shown to survive on pennies, nickels and dimes and can hide out on ATMs. Other bacteria, such as MRSA, a drug-resistant staph infection, are found on bank notes in the U.S. and Canada, but the extent to which they could spread infections is unknown.
Try as we may to avoid exposure to germs, they travel with us and on us. Even if disease-causing microbes can survive in places like ATMs, the good news is that most exposures don’t make us sick.
Money laundering
Disease transmission linked to money is rare, and no major disease outbreaks have started from our ATMs. Although it doesn’t seem common for diseases to transmit through money, there are ways we could make our money cleaner.
Researchers are working on ways to clean money between transactions. Putting older bills through a machine that exposes them to carbon dioxide at a specific temperature and pressure can strip dollar bills of oils and dirt left behind by human fingers, while the heat kills microbes that would otherwise linger.
U.S. money is still made from a blend of cotton and linen, which has been shown to have higher bacterial growth than plastic polymers. Several countries are transitioning from money made of natural fibers to plastic, which may be less friendly to bacteria. Canada has had plastic money since 2013, and the United Kingdom transitioned to a plastic-based bank note last year.
Even if our money is not directly responsible for spreading disease, we can still use the dollar’s travel history to track how we spread disease in other ways.

The website WheresGeorge.com, created in 1998, lets users track dollar bills by recording their serial numbers. In the almost 20 years since the site’s creation, WheresGeorge has tracked the geographic locations of bills totaling more than a billion dollars.
Now, physicists at the Max Planck Institute and University of California at Santa Barbara are using data from the WheresGeorge site to track epidemics. Information on human movement and contact rates from WheresGeorge was even used to predict the spread of the 2009 swine flu.
Although we don’t know the extent to which money allows diseases to spread, Mom’s advice is probably best when handling cash: Wash your hands and don’t stick it in your mouth.
The Conversation
Johanna Ohm is a graduate student in biology at Pennsylvania State University.

Veterans Day and Suicide etc.

Today, 20 military veterans will commit suicide.  I heard that on NPR’s Morning Edition.  Our country’s treatment of, or failure to care for, veterans is a long-standing shame.

I’m a veteran though I don’t think of myself that way.  I was in the army for 21 months in the late 1950’s when there seemed to be no war, though the U.S. was active in Viet Nam and dropped paratroops on Lebanon when an election didn’t go our way. My weapon was a typewriter and my battlefield was  the compound of the Corporal Missile (training) Battery in Oklahoma. I drew the veteran benefit for courses I took when I got out.

Who’s a real veteran?  My nephew Jeffrey Nugent who served in Iraq and our new Senator Tammy Duckworth who lost her legs there. My brother John who graduated from the Naval Academy and transferred to the Marines.  And my friend Larry who served in Viet Nam.   And a lot of those people sleeping in a park or on the warm grates of city sidewalks, asking for change on street corners, talking to themselves in public libraries.  Or sitting in jail cells with no hope.

What’s being done for all those suffering as a result of military service? Not enough..

Mental Health Concerns
  • Postraumtic Stress Disorder (PTSD). Traumatic events, such as military combat, assault, disasters or sexual assault can have long-lasting negative effects such as trouble sleeping, anger, nightmares, being jumpy and alcohol and drug abuse. …
  • Depression. …
  • Traumatic Brain Injury (TBI).

RJN

 

 

 

 

Good Things to Do With Your Body

Donating body for research

People’s reasons and science’s uses are many

Students from Texas State University’s Forensic Anthropology Center search for the remains of a missing person. ( Texas State University)
Image 1 of 4

By Kay Manning  Chicago Tribune 10.26.16

Patricia Kelly had to watch her husband, William, descend into dementia, but he never wavered from a desire to give his body to science, and what followed his donation inspired her — and now their daughter — to not only pledge to do the same but to become fierce advocates of the idea.

When William Kelly died in 2011 and Patricia Kelly in 2015, they became part of an unusual program at the Indiana University Northwest in Gary, which teaches anatomy while encouraging communication with donor families through letters, visits and a memorial service.

Her mom cherished the letters she received from International Human Cadaver Prosection Program students, said daughter Susan Ellingsen, of Munster, Ind., “taking a big magnifying glass (she was legally blind) and reading them over and over. They were very personal and told us all they discovered about my dad.”

“My mother made a video to let students know why she donated her body and what hope she had for them to be the best they could be and to always take their patients’ lives and families seriously,” she said.

Ernest Talarico, who runs the prosection program, said he was troubled in medical school when all he knew about a cadaver was a number and maybe a cause of death. Fellow students disrespectfully named bodies, he said.

“The tradition in anatomy lab is to focus on the science, not to get too attached,” Talarico said. “What we do is a new paradigm. And research shows it makes better doctors.”

Many bodies donated for research have poignant back stories. William Kelly had a number of ailments and wanted science to more fully explore them.

Judy Clemens, of Hebron, Ind., had a progressive form of multiple sclerosis that so frustrated her that she took her life, but not before asking that her body be studied to better understand the disease.

Other donors are educators, scientists and members of law enforcement who know the importance of hands-on learning to solve crimes, find missing people or bodies, and bring closure to aggrieved families. They even designate that their corpses be used for such studies as how fast vultures decimate a body, or how cold or hot weather affects decomposition. Still others specify that their remains be used to train cadaver dogs.

Some bodies are donated by families seeking to save money since many programs pay for transportation and stage a memorial service for the deceased or return the cremated remains.

A future purpose for donated bodies involves recomposition, the turning of human bodies into nutrient-rich compost. A prototype for what the project director sees as an environmentally friendly alternative to burial and cremation is expected to be built in Seattle in the spring and will accept bodies for a pilot program to fully test the process.

“There’s scientific value to donating your body, but there’s a huge educational value,” said Cheryl Johnston, director of an outdoor facility at Western Carolina University, where eight bodies are in various stages of decomposition. The training they afford “is benefiting people by applying things in the real world.”

Daniel Wescott runs the largest so-called body farm in the country at Texas State University, where researchers and cameras document the rate of decay of 70 bodies above and below ground, bodies clothed, unclothed and wrapped in tarps, bodies protected by wire cages and bodies left vulnerable to scavengers. When reduced to skeletons, the bones become part of a permanent research collection.

The Forensic Anthropology Center simulates conditions under which bodies or people may be found if they are victims of crime, or are missing after wandering off or a natural disaster, such as a flood. A decomposed body produces soil that’s darker in color and vegetation that reflects light differently, allowing a drone to pinpoint a location to be searched. That saves time and money, Wescott said, and then experts can determine how long a body might have been there, leading to quicker identification and finding or eliminating suspects in criminal cases.

“It’s all for justice, not just for law enforcement, but to keep somebody from going to jail if innocent,” he said.

Decomposition research and technology have better prepared Texas to handle the border-crossing deaths of immigrants, Wescott said. Bodies are buried without names, leaving loved ones uncertain as to the refugees’ fate. The facility is trying to identify some 80 corpses, but “the very, very slow process” has led to only 10 names so far, he said.

Donated bodies also help train dogs that can detect human remains. Lisa Briggs, a professor of criminology at Western Carolina University, started training her golden retriever Laila at 7 1/2 weeks, and the 2-year-old has found three bodies and several people alive.

Briggs said she feels fortunate to have whole bodies with which to teach Laila because using synthetic versions of decomposed remains or even a single body part such as teeth or a placenta, as some trainers have to do, is inadequate.

“Drug dogs are trained on one scent — maybe marijuana — but with humans, there are so many variables, such as what they had on, whether it was cold or hot, medicines they were taking, if they drowned,” Briggs said. “No one can understand how important it is” for dogs to be exposed to all those factors.

She said she remembers an instance in which Laila was looking for two people presumed by police to be dead. The dog found the bodies in water by smelling the gases bubbling to the surface, Briggs said, adding she can be asked to help on up to 20 cases a year.

She’s seen the pain families go through when a loved one is missing. “I can only imagine what it’s like not knowing,” she said.

Brittany Winn said she knew her adopted “nana,” Clemens, was donating her body to Indiana University Northwest in hopes that something could be learned about multiple sclerosis. But Winn was unprepared for Clemens’ suicide in 2011 and the quick disappearance of her body.

“We didn’t know where her remains were. It was heart-wrenching for us,” Winn said.

Months later, a Manila envelope arrived from Talarico’s program, and his students’ first contacts with the family “had us in tears,” said Winn, who has gone on to participate in the program for four years as a student and team leader and is working as a medical scribe for a Fort Wayne, Ind., endocrinologist. She wants prosectors to understand the donor and those closest to him or her.

“It’s not just a cadaver but a person who meant the world to my family,” Winn said. “Words from the prosectors are the beginning of closure. And seeing that they get everything they can from the program makes me feel better. What they learned will be with them for life.”

She has registered as a donor, she said, but donations also can be arranged after death. Requirements vary, but programs generally will not take the bodies of severe accident victims, those with infectious diseases or bodies that have been autopsied, embalmed or had organs removed. Some have weight limitations; some will take cremated remains and body parts, such as amputated limbs.

Katrina Spade, founder and executive director of the Seattle-based Urban Death Project, started searching as an architecture student for a new way to look at death, out of concern that the existing options of burial and cremation are expensive, harmful to the environment and often shortchange traditional rituals surrounding a death. She realized the method used to compost dead livestock could be adapted for humans.

“All of nature is based on dead material being turned into new life,” Spade said. “It’s a renewal, but we’ve destroyed it through cremation or by pumping bodies full of chemicals and burying them in concrete boxes. It couldn’t be farther from what nature wants to do.”

She envisions nonprofit recomposition facilities being built in urban areas where land is scarce and there are unused structures such as churches or warehouses. Bodies could be carried by family members in a quiet candlelit ceremony or to the accompaniment of a brass band, she said, and then covered in wood chips to begin the transformation into soil.

“It’s a really beautiful way to treat bodies after death,” Spade said.

Kay Manning is a freelancer.

Eating Deer, Elk, and People Spreads Disease

A sign said DEPOSIT DEER AND ELK HEADS HERE at a government building next door to our hotel in Fort Collins, Colorado.  The heads were to be used in the study of chronic wasting disease which is related to mad cow disease and kuru.  RJN

___________________________________________

WHEN PEOPLE ATE PEOPLE, A STRANGE DISEASE EMERGED

In 1962, a local leader in the Eastern Highlands of Papua New Guinea asks Fore men to stop the sorcery that he believes is killing women and children.  Courtesy Shirley Lindenbaum

Most of the world didn’t know anyone lived in the highlands of Papua New Guinea until the 1930s, when Australian gold prospectors surveying the area realized there were about a million people there.

When researchers made their way to those villages in the 1950s, they found something disturbing. Among a tribe of about 11,000 people called the Fore, up to 200 people a year had been dying of an inexplicable illness. They called the disease kuru, which means “shivering” or “trembling.”

Once symptoms set in, it was a swift demise. First, they’d have trouble walking, a sign that they were about to lose control over their limbs. They’d also lose control over their emotions, which is why people called it the “laughing death.” Within a year, they couldn’t get up off the floor, feed themselves or control their bodily functions.

Many locals were convinced it was the result of sorcery. The disease primarily hit adult women and children younger than 8 years old. In some villages, there were almost no young women left.

“They were obsessed with trying to save themselves because they knew demographically that they were on the brink of extinction,” says Shirley Lindenbaum, a medical anthropologist with the City University of New York.

But what was causing it? That answer eluded researchers for years. Afterruling out an exhaustive list of contaminants, they thought it must be genetic. So in 1961, Lindenbaum traveled from village to village mapping family trees so researchers could settle the issue.

But Lindenbaum, who continues to write about the epidemic, knew it couldn’t be genetic, because it affected women and children in the same social groups, but not in the same genetic groups. She also knew that it had started in villages in the north around the turn of the century, and then moved south over the decades.

Lindenbaum had a hunch about what was going on, and she turned out to be right. It had to do with funerals. Specifically, it had to do with eating dead bodies at funerals.

In many villages, when a person died, they would be cooked and consumed. It was an act of love and grief.

As one medical researcher described, “If the body was buried it was eaten by worms; if it was placed on a platform it was eaten by maggots; the Fore believed it was much better that the body was eaten by people who loved the deceased than by worms and insects.”

Women removed the brain, mixed it with ferns, and cooked it in tubes of bamboo. They fire-roasted and ate everything except the gall bladder. It was primarily adult women who did so, says Lindenbaum, because their bodies were thought to be capable of housing and taming the dangerous spirit that would accompany a dead body.

“So, the women took on the role of consuming the dead body and giving it a safe place inside their own body — taming it, for a period of time, during this dangerous period of mortuary ceremonies,” says Lindenbaum.

But women would occasionally pass pieces of the feast to children. “Snacks,” says Lindenbaum. “They ate what their mothers gave them,” she says, until the boys hit a certain age and went off to live with the men. “Then, they were told not to touch that stuff.”

Finally, after urging from researchers like Lindenbaum, biologists came around to the idea that the strange disease stemmed from eating dead people. The case was closed after a group at the U.S. National Institutes of Health injected infected human brain into chimpanzees, and watched symptoms of kuru develop in the animals months later. The group, whichwon a Nobel Prize for the findings, dubbed it a “slow virus.”

But it wasn’t a virus — or a bacterium, fungus, or parasite. It was an entirely new infectious agent, one that had no genetic material, could survive being boiled, and wasn’t even alive.

As another group would find years later, it was just a twisted protein, capable of performing the microscopic equivalent of a Jedi mind trick, compelling normal proteins on the surface of nerve cells in the brain to contort just like them. The so-called “prions,” or “proteinaceous infectious particles,” would eventually misfold enough proteins to kill pockets of nerve cells in the brain, leaving the cerebellum riddled with holes, like a sponge.

The process was so odd that some compared it to Dr. Jekyll’s transformation to Mr. Hyde: “the same entity but in two manifestations — a ‘kind’, innocuous one and a ‘vicious’, lethal one.”

The epidemic likely started when one person in a Fore village developed sporadic Creutzfeldt-Jakob Disease, a degenerative neurological disorder similar to kuru. According to the Centers for Disease Control and Prevention, about one in a million people in the U.S. develop CJD the difference is that others rarely come into contact with infected human tissue.

Though the Fore stopped the practice of mortuary feasts more than 50 years ago, cases of kuru continued to surface over the years, because the prions could take decades to show their effects.

According to Michael Alpers, a medical researcher at Curtin University in Australia who tracked kuru cases for decades, the last person with kuru died in 2009. His team continued surveillance until 2012, when the epidemic was officially declared over. “I have followed up a few rumoured cases since then but they were not kuru,” he wrote in an email.

When Shirley Lindenbaum visited a South Fore village in 2008, one man said excitedly, “See how many children we have now?”  Courtesy Shirley Lindenbaum

But while they remain rare, transmissible prion diseases did not die out with the last kuru case, as people have found repeatedly in recent decades. People have developed variant CJD after eating the meat of cattle infected with mad cow disease. Dr. Ermias Belay, a prion diseaseresearcher with the Centers for Disease Control and Prevention, says that’s the only scenario in which there is “definitive evidence” that humans can develop a prion disease after eating the infected meat of another species.

But, he says, there are still a lot of open questions about how and why humans get prion diseases.

For one, it’s still a mystery why animals, including humans, have those proteins in the first place — the Jekylls that can be so easily turned into Hydes. One leading hypothesis, described recently in the journal Nature, is that they play an important role in the protective coating around nerves.

But here’s the bigger question, says Belay: “How many of these diseases actually jump species and affect humans?”

Kuru showed that people could get a prion disease from eating infected people. Mad cow disease showed that people can get a prion disease from eating infected cow. But what about other prion diseases in other animals? Could, say, hunters get sick from eating infected deer? That’s what researchers in North America, including Belay, are trying to find out right now.

Chronic wasting disease in North America is spreading fast,” says Belay. The disease causes infected wild deer and elk to starve to death. “In early 2000, we had about three states that reported CWD in the wild in deer and elk. Today, that number is 21.”

Belay says the disease is “a little bit concerning” because, unlike mad cow disease and kuru, where infectious prions were concentrated in the brain and nervous system tissue, in an animal with chronic wasting disease, the misfolded prions show up all over the body. They can even be found in saliva, feces and urine, which could explain how the disease is spreading so quickly among wild deer and elk.

The CDC is working with public health authorities in Wyoming and Colorado to monitor hunters for signs of prion disease.

“Unfortunately, because these diseases have long incubation periods, it’s not easy to monitor transmission,” says Belay. He says he and his colleagues have yet to find any evidence that hunters have picked up chronic wasting disease from the meat of infected wild animals.

“And that, in itself, is good news for us,” he says.

But, as with kuru, it will take years — maybe even decades — before he can know for sure.

 

The tissue-engineered robotic sting ray

 

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Synthetic Stingray May Lead To A Better Artificial Heart

(Left) The tissue-engineered robotic ray, made of gold, silicone and live muscle cells. (Right) The titanium molds that scientists used to create the rays.

(Left) The tissue-engineered robotic ray, made of gold, silicone and live muscle cells. (Right) The titanium molds that scientists used to create the rays.  Karaghen Hudson and Michael Rosnach

Scientists have created a synthetic stingray that’s propelled by living muscle cells and controlled by light, a team reports Thursday in the journalScience.

And it should be possible to build an artificial heart using some of the same techniques, the researchers say.

“I want to build an artificial heart, but you’re not going to go from zero to a whole heart overnight,” says Kit Parker, a bioengineer and physicist at Harvard University’s Wyss Institute. “This is a training exercise.”

Previous artificial hearts have been versions of mechanical pumps. An artificial heart made from living muscle cells would behave more like a natural heart, Parker says, and would be able to grow and change over time.

“The heart’s built the way it is for a reason,” he says. “And we’re trying to replicate as much of that function as we possibly can.”

A heart and a stingray may seem pretty different. But both need to overcome problems that involve fluid and motion, Parker explains. A stingray has to propel itself through the water. A heart has to propel blood through the circulatory system.

And all of that was on Parker’s mind a couple of years ago when he visited an aquarium with his daughter. At an exhibit where visitors can touch rays as they swim by, his daughter put her hand in the water. “The stingray was coming at it,” he says, “and with a quick flick of its pectoral fin it just smoothly evaded her hand.”

The coin-sized synthetic stingray (left) next to a skate that nature made, Luecoraja erinacea.

The coin-sized synthetic stingray (left) next to a skate that nature made, Luecoraja erinacea.  Karaghen Hudson/Science

Parker realized that this sort of split-second adjustment is something the heart does all the time as it senses changes in blood flow or pressure.

“The idea just hit me like a thunderbolt,” he says.

By building an artificial stingray, Parker figured, he could learn how to replicate the animal’s ability to respond instantly to changing conditions.

So he came up with a strategy and presented it to Sung-Jin Park, a researcher in his lab.

“I sat down with him,” Parker says, “and I said, ‘Sung-Jin, we’re going to take a rat apart; we’re going to rebuild it as a stingray; and then we’re going to use a light to guide it.’ And the look on his face was both sorrow and horror.”

Parker’s lab had previously built an artificial jellyfish. But a ray was much more complicated. And the team was facing tough questions like, how do you to take cells from a rat and make them swim like a fish?

Park and the rest of the team started working, though. And, eventually, they succeeded.

Their synthetic ray, which is about the size of a nickel, has a transparent body made of silicone and a rudimentary skeleton made of gold.

The ray is propelled by 200,000 heart muscle cells taken from a rat. The cells have been genetically altered to allow the hybrid creature to follow a pair of blue lights.

“We can guide this thing around,” Parker says. “It swims through obstacle courses.”

And the creature displays the rhythmic, undulating motion of a real stingray. Replicating that motion is one of the project’s key accomplishments, says John Dabiri, a professor of engineering at Stanford who worked with Parker on the artificial jellyfish.

To get the ray’s tail to undulate, the team had to come up with a way to trigger muscle cells in sequence. The effect is similar to when the crowd at a ballgame does the wave, Dabiri says.

“You have one group standing up and then the next and then the next. Well, in the case of the muscle here, they’re doing the same thing,” he says. “They’re able to get a certain section of muscle to contract and then the next and then the next.”

That coordinated movement is necessary for many biological functions, like swallowing. It’s also the way the heart beats, with areas contracting in a precise sequence.

Another advance is the ability to activate muscle cells with light rather than electricity, Dabiri says. That allows scientists to control precisely which part of a muscle contracts. So light could act as a sort of pacemaker in an artificial heart that’s made this way.

The artificial stingray is likely to make some people uncomfortable, Dabiri says, because it raises questions about when a machine becomes a living organism.

In this case, the artificial ray pretty clearly isn’t an organism, he says. It can’t grow, adapt or reproduce. But scientists should be considering the possibilities as they pursue other projects like this, he says.

“We want to make sure we think about the ethical issues hand in hand with just asking what we can do,” Dabiri says.

Worst Threat to Women

 

Hidden Heart Disease Is The Top Health Threat For U.S. Women

Tracy Solomon Clark didn't realize that the shortness of breath and dizziness she felt at age 44 was actually serious heart disease.

Tracy Solomon Clark didn’t realize that the shortness of breath and dizziness she felt at age 44 was actually serious heart disease.  Benjamin Brian Morris for NPR

Tracy Solomon Clark is outgoing and energetic — a former fundraiser for big companies and big causes. As she charged through her 40s she had “no clue,” she says, that there might be a problem with her heart.

It was about six years ago — when she was 44 — that she first suffered severe shortness of breath, along with dizziness. She figured she was overweight and overworked, but never considered heart disease.

“That was the furthest thing from my mind,” Solomon Clark says. “I was young!”

But it was her heart. Her doctor sent her to the hospital emergency room, where physicians diagnosed a blockage in a key artery. They inserted a stent to open it up and ease blood flow to her heart.

Ultimately Solomon Clark, who lives in Gardena, Calif., got several more stents to treat what turned out to be serious cardiovascular disease. Last year she had double-bypass surgery to replace the left main artery of her heart.

She’s not alone, according to Dr. Noel Bairey Merz, who directs the Barbra Streisand Women’s Heart Center at Cedars-Sinai Medical Center in Los Angeles, says she’s not surprised by Solomon Clark’s experience. Bairey Merz often meets young and middle-aged women who have no idea they are at risk for heart disease and a heart attack.

She and colleagues recently surveyed 1,011 women ages 25 to 60, a random sampling from across the U.S. Only about half of those interviewed knew that heart disease is the leading threat to women’s lives, the scientists found. Many thought breast cancer poses a bigger risk. They were wrong.

Every year in the U.S. about 40,000 women die from breast cancer, according to statistics from the Centers for Disease Control and Prevention. Meanwhile, roughly 10 times that number die from heart disease.

Greater awareness and advances in detection and treatment have dramatically decreased breast cancer deaths over the past few decades, Bairey Merz explains. But heart disease now claims the life of 1 in every 4 women.

Many women with heart disease could benefit from effective treatment, including aspirin, statins, beta blockers and the like, says Dr. Laxmi Mehta, a cardiologist at the Ohio State Wexler Medical Center. But they can be helped only if they are diagnosed.

After the stent was placed, Solomon Clark continued to have periodic bouts of dizziness, shortness of breath and even a little pain. The symptoms were eventually traced back to continuing heart trouble.

But not right away. When she returned to an ER to have the symptoms checked out, tests suggested no new blockages, and the emergency room doctors told her she might just be suffering an anxiety attack.

Last year Solomon Clark had double-bypass surgery to replace the left main artery of her heart.

Last year Solomon Clark had double-bypass surgery to replace the left main artery of her heart.  Benjamin Brian Morris for NPR

Mehta chaired a committee of the American Heart Association that this year released the organization’s first scientific statement on the problem of heart attacks among women.

Even after a heart attack, Mehta says, women are less likely than men to be referred to cardiac rehabilitation programs, though these programs significantly reduce the chances of a second heart attack.

Part of the reason women are misdiagnosed or not diagnosed at all is because heart disease looks a lot different in women than it does in men, she says. And men have been the focus of most heart disease research.

For example, men are more prone to blockages in major arteries — these are relatively easy to spot on an angiogram, and are more likely to prompt timely diagnosis, Mehta says.

Women, on the other hand, are more likely to have problems with tiny arteriesembedded in the heart, she says. These smaller blood vessels often are not visible on angiograms, and also don’t fill up with plaque.

“They don’t have enough of a wall to build up plaque,” says Bairy Merz. “That’s how tiny they are.” But these small arteries can lose flexibility and run into problems — constricting too much and cutting off blood flow to the heart.

In her survey, Bairey Merz found that 74 percent of the women had at least one heart disease risk factor, such as high blood pressure, high cholesterol, diabetes, irregular menstrual periods, early menopause or a family history of heart disease. Yet only 16 percent reported having been told by a doctor that they had an elevated risk.

Instead, Bairey Merz says, the doctors, who also were surveyed by the researchers, were more concerned about their patients’ weight and breast health than heart disease.

All primary care doctors should routinely assess a woman’s risk for heart disease, Mehta says. And if they don’t, women should take the lead and bring up the subject of heart disease and their individual risk. (You can start by using this online risk calculator.)

Pay attention to your body, Mehta tells her patients. “If something seems out of the ordinary, it’s best to seek medical attention, especially if something is occurring only with exertion — or worsening with exertion.

“I’d rather be wrong and go to the ER,” Mehta says, “than die at home.”

A Surgeon

 

As I work with the doctors I have now, people I like and trust, I remember a surgeon who was good to me a long time ago.

When I was maybe 35 years old, a neglected skin cancer, basal cell, had grown to the size of a half dollar on my left temple. My internist referred me to a surgeon who removed the tumor and grafted skin from behind my right hear to cover the wound.  Later I wrote this poem.                         {Ever see a half dollar? 1.2 inches across.}

 

Levin, you bound my head too tight about

a knot of gauze that gnawed my scalp as I

emerged from anesthetic murk. When I

complained you blamed it on the fight I gave you

coming through to conscious wrath.  When you,

who’d snipped, and patched and finely stitched,

finally spun off the swath, you called in all

the floor staff, other cutters, cops and cleaners

to my bed to look and wonder, shake your hand, allowed

in friends and neighbors, local merchants and a TV crew

to praise your nifty work. You were proud,

but at the first, when a friend had come to speak

of dread and anger, you could hear,

and in the legal instance you could bend.

Levin, I bitched, I didn’t pay you,

but I loved you and I didn’t want you dead.

______________________________________

Levin died a year later of a brain tumor.

rjn