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Tag Archives: healthcare
Posted: August 27, 2016 at 7:13 pm
Job Posting ID: 258903 Contract: Contract to Hire Our client is dedicated to ensuring the integrity of the financial market and protecting investors. With over a dozen various Best Places to Work awards, our client has proved that a position with them is more than a just a job. They are currently looking for a [insert title here] now to join their award winning team. Job Summary: The Staff D…
Job ID: 258952 Contract Length: 6+ months – Contract to Hire Our client is looking for a Development and Automation Engineer for a contract to hire role in Cincinnati, Ohio. What You’ll Do: Work with a cross functional team to: Leverage industry standard tooling to automate all manual tasks pertaining to infrastructure provisioning, in support of self-service and API-driven provisioning Imple…
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You must respond to ***** to be considered. Object CTalk Inc. is a systems integration company that provides mission, operational and IT enterprise support to the U.S. government. We design, integrate, maintain, and upgrade systems for national defense, intelligence and other high-priority government missions. Object CTalk values a diverse workforce and is an equal opportunity affirmati…
You must respond to ***** to be considered. Object CTalk Inc. is a systems integration company that provides mission, operational and IT enterprise support to the U.S. government. We design, integrate, maintain, and upgrade systems for national defense, intelligence and other high-priority government missions. Object CTalk values a diverse workforce and is an equal opportunity affirmati…
Job Description Job #: 677754 Position: Knowledge Manager Client: Leading Government Integrator Location: Ft. Meade, MD Citizenship: US Citizen Compensation: Competitive based on experience Clearance: Active TS/SCI Responsibilities: Works with high ranking government officials to create effective 7 minute drills, and improve or enhance current processes Works with high ranking officials …
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Job Description Job #: 680247 Apex Systems Inc. in Las Vegas is looking for a Digital Integration Analyst who is interested in taking on a new and exciting job! If you have a desire to learn new processes, systems, and grow with this organization please send us your resume. We’re excited to tell you more about these new career opportunities! General Requirements: Responsible for managing and p…
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Job Description Job #: 665786 **Currently seeking highly motivated and experienced ** Apex Systems, the 2nd largest IT staffing company, is seeking a with a focus on insurance services. In addition, there will be appropriate salary compensation as well as additional perks such as: technical training, certification, career development, benefits, weekly pay, and growth potential. **Interested an…
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Job Description Job #: 673159 Editorial Operations Specialist Apex Systems, the nations 2nd largest IT Staffing organization, has an immediate opportunity for a Editorial Operations Specialist to work for our client who is one of the worlds largest and most admired companies. If youre looking for an organization that focuses on innovation, social responsibility, and quality, then this is the…
Job Description Job #: 688651 Desktop Engineer Wilmington, DE Apex Systems, the second largest IT staffing company in the nation, is seeking a Desktop Engineer for a financial management client in Wilmington, DE. If you or anyone you know is interested in this role please, email Technical Recruiter, Jayme Polito, at jpolito@apexsystemsinc,com or call 215-591-9065.Job Purpose: This role will p…
Job Description Job #: 673369 Role: Scrum Master / IT PM Industry: Healthcare IT Location: Eden Prairie, MN Terms: Contract-to-Hire Salary: Competitive Scrum Master The Scrum Master will be responsible for leading the agile transformation at the team level and for the successful execution of one or more teams to support the delivery of strategic technology products. They will provide leade…
Job Description Job #: 673330 Field Design Engineer Apex Systems, the nations 2nd largest IT Staffing organization, has an immediate opportunity for a Field Design Engineer to work for our client who is one of the worlds largest and most admired companies. If youre looking for an organization that focuses on innovation, social responsibility, and quality, then this is the place for you. Pay …
Originally posted here:
Posted: July 31, 2016 at 5:51 am
The following pages might help you choose the person best suited for you:
We hope that you find the following pages helpful as well:
You may see the following links under the entries for some providers:
Before starting a professional relationship with anyone on this list, you should confirm relevant information, including credentials and accepted insurance. As with all other information on the wiki, we can’t guarantee the information in this list. When possible, we try to include links to make it easy for you to confirm the information.
Please help us improve this list by providing us with more information about yourself. See our “Updating information about yourself in our practitioner list” page for information about how to do this. General information about interacting with the wiki can be found in our “For TMS practitioners” page.
If you are a licensed TMS therapist or physician and would like to be listed on our directory please Contact Us.
Unfortunately, many people who think they may have Tension Myositis Syndrome (TMS) do not live in an area served by any TMS professionals. Luckily, some TMS professionals are able to provide services over the internet or telephone. Although diagnosis can’t be performed over the internet or telephone and distance can provide a significant barrier to psychotherapy, the following people provide coaching and other services to people who aren’t able to travel to meet a provider face to face. More information can be found in our page on Structured TMS recovery programs.
Currently, all additional practitioners listed are able to conduct sessions remotely. Click here to go to the Additional TMS Practitioners page.
Dr Rochelle is a practicing orthopedic surgeon in Arkansas. He incorporates the TMS diagnosis and treatments in his practice. He says that only when people “accept the idea that unpleasant emotions in the unconscious mind actually cause physical symptoms will we see an end to the current epidemic of TMS musculoskeletal pain in its many varieties.” He is also a contributing author to Dr Sarno’s The Divided Mind. (Source)
Address has not been verified Orthopedic Surgery 403 Morrow St N Suite F Mena, AR 71953 Main Wiki Page on Dr. James Rochelle Contributed the article, “My Perspective on Psychosomatic Medicine,” in The Divided Mind, by Dr. John Sarno. 2006.
Will Baum is a psychotherapist in the Los Angeles area. He has written a number of articles for PsychologyToday.com, the Huffington Post, and Where the Client Is. He is cross trained in psychodynamic talk therapy, Cognitive Behavioral Therapy (CBT), and Acceptance and Commitment Therapy (ACT). Will Baum’s practice is focused on anxiety/depression, relationships, chronic pain, and addiction recovery. He has experience working with an “extremely wide range of clients and concerns.” (Source)
Recent Change of Address 4448 Ambrose Ave. Los Angeles, CA 90027 (323) 610-0112 firstname.lastname@example.org TMS Wiki Profile / Website Main Wiki Page about Will Baum Will Baum has written several TMS related articles for Where the Client Is. Information about them can be found on the TMS in the Media page.
Arnold Bloch, LCSW has been in practice for over 25 years, during which time he has seen over 200 clients with TMS. He holds a master’s degree in social work from the University of Southern California, and studied under long-time TMS therapist, Don Dubin, MFT. Bloch has a close working relationship with David Schechter, MD (Source) who himself has seen over 1000 patients with TMS. He has dedicated himself to “the alleviation of chronic pain, especially when that pain can not be satisfactorily explained by conventional medical examination.” He believes in the power people have in “freeing themselves from the suffering brought about by a negatively conditioned mind,” and he seeks to help people develop the skills to choose the mind and body states they desire to have.
Bloch has been very active in the TMS community. He has attended TMS conferences and stays up-to-date on the latest mind-body research and treatment techniques. In the fall of 2012, Bloch participated in a TMS webinar, alongside Dr. Schechter. (Source)
Available via Phone and Skype 1280 Willsbrook Ct Westlake Village, CA 91361 (805) 796-9540 email@example.com Survey Response / Website TMS Webinar with Dr. Schechter and Arnold Bloch
Samantha Bothast is a psychotherapist at the Pain Psychology Center in Los Angeles, CA headed by Alan Gordon, LCSW. Samantha uses both a cognitive behavioral and psychodynamic approach in her sessions. Samantha worked as a medical social worker for 19 years prior to working at the Pain Psychology Center. (Source)
Available via Skype 9777 Wilshire Blvd. Suite 1007 Beverly Hills, CA 90212 (310) 853-2049 Contact Form
(Deceased) Don Dubin was a committed and loved TMS therapist who worked with David Schechter for many years.
Alan Gordon is a psychotherapist in private practice in Santa Monica who specializes in the treatment of chronic pain using the the TMS approach. He is a co-founder and the Executive Director of the Pain Psychology Center, a TMS treatment center in Los Angeles. He is also a board member of the Psychophysiologic Disorders Association (PPDA). He was the primary organizer (chair) of the 2nd annual TMS Conference held in LA in March 2010, where he gave a presentation entitled Cognitive-Behavioral Approaches in the Treatment of Mind-Body Disorders. His efforts were a key factor in making the conference a success. Alan also co-organized and presented at the 2013 clinical training in Los Angeles with Howard Schubiner, MD in partnership with the PPDA.
Alan developed a free multimedia TMS Recovery Program, which he donated to the TMS Wiki in 2013. He has also written an article called Miracles of Mindbody Medicine for the Healthcare Counseling and Psychotherapy Journal.
Alan is also one of the answering therapists for the Ask a TMS Therapist program.
(Source1, Source2, Source3, Source4)
Available via Skype 1247 7th St., Suite 300 Santa Monica, CA 90401 (310) 945-6811 and 9777 Wilshire Blvd. #1007 Beverly Hills, CA 90212 (310) 945-6811 Contact Form Forum Profile / Personal Website / Pain Psychology Center Main Wiki Page About Alan Gordon Ask a TMS Therapist Responses
Karen Kay is a licensed clinical psychologist with psychoanalytic training, and has a private practice in West Los Angeles. She has worked with TMS patients throughout her 25+ year career, and has been supervised by Arlene Feinblatt, Ph.D. (the psychologist who developed the psychotherapeutic approach to TMS in collaboration with John Sarno, M.D.) as well as Eric Sherman, Psy.D., and Frances Sommer Anderson, Ph.D. She has been an approved supervisor by the American Association for Marriage and Family Therapy since 1991. She says, “I have had great success in helping people who struggle with mind-body difficulties. In addition, I have specialty training in working with children, adults, and families.”
1800 Fairburn Avenue Suite 109 Los Angeles, CA 90025 (310) 446-0500 TMS Wiki Profile Survey Response Website
Suzi Kimbell is a psychotherapist with training in somatic, body-centered psychotherapy, EMDR, mindfulness-based stress reduction, and trauma and PTSD treatment from a mind-body perspective. She attended the clinical training in Los Angeles in November 2013. Suzi also suffered from chronic back pain, which she overcame using the TMS approach. She writes, “My own recovery from TMS led to my passion for helping those with chronic pain, whose symptoms are so often misunderstood by the traditional medical community. I know first hand how powerful Dr Sarnos ideas are and that recovery from pain is truly possible.” (Source)
Available via Phone and Skype 860 Via De La Paz, Suite F6 Pacific Palisades, CA 90272 (310) 463 7598 Insurance Accepted: All PPO insurances (Suzi Kimball is an out of network provider) Survey Response
Catherine Lockwood is an experienced Intensive Short Term Dynamic Psychotherapy (ISTDP) psychotherapist based in Los Angeles, California. She has studied under many notable ISTDP instructors and continues to attend workshops and seminars on ISTDP. She also attended the 2013 Clinical Training for the Treatment of Mind-Body Disorders in Los Angeles. There, she observed how Howard Schubiner, MD and Alan Gordon, LCSW, the presenters of the training, are utilizing ISTDP in their approaches to treating TMS. Catherine writes, “I am passionate and dedicated to continuing to improve my skills in ISTDP, TMS and trauma treatment.” (Source)
Available via Video 179 Barrington Place, Suite B Brentwood Village Los Angeles, CA 900049 (310) 488-5292 CatherineLockwoodMFT@GMail.com Survey Response / Website
Daniel G. Lyman is a psychotherapist at the Pain Psychology Center in Los Angeles, CA headed by Alan Gordon, LCSW. He earned a master’s degree in Social Work and in Public Administration from the University of Southern California and specializes in the treatment of mindbody pain syndromes. In describing his treatment approach, he writes, My goal in therapy is to provide a safe place to challenge our current beliefs and behaviors regarding our pain (TMS). The process is two-fold: The first part is changing the nature of our relationship to our symptoms, and the second part is discovering why the symptoms are there in the first place. These concurrent paths help to decrease the symptoms in the present as well as discourage the symptoms from recurring in the future. Daniel also specializes in working with the LGBT population, including couples and family issues. (Source)
Daniel is one of the participating psychotherapists in the Ask A TMS Therapist program. Read his responses here.
Contributed article: 10 Days of Silence: Meditation, Pain, & How You Can Become the Most Emotionally Healthy Person You Know, by Daniel G. Lyman (Part I), (Part II).
Available via Phone and Video (617) 470-6043 DanielGLyman@gmail.com Survey Response / Forum Profile Ask A TMS Therapist Responses
Gillian Marcus is a clinical therapist with a private practice in West Los Angeles specialized in TMS. She attended the Los Angeles conference When Stress Causes Pain for TMS practitioners in November 2013. Gillian also has a personal history of TMS, and used a combination techniques including psycho-education, therapy, meditation and other self-help techniques to help relieve her TMS symptoms. (Source)
Available via Phone 2001 South Barrington Avenue Los Angeles, CA 90025 (310) 288-3536 Survey Response
Brooke Mathews is an experienced psychodynamic therapist based in Southern California. A former board member of the Psychophysiologic Disorders Association (PPDA), Brooke earned her master’s degree in social work from the University of Southern California, and is a licensed clinical social worker (LCSW) in the state of California. She writes, I have devoted a great deal of my practice to working with and advocating for patients who can’t seem to find anything medically or physically wrong…My approach is to treat the whole person, whether you come in with pain and are subsequently depressed, or your pain is a result of your anxiety, I work with patients to address the source of the problem and resolve the issues with pain. Brooke also has a personal connection to TMS, suffering fro chronic migraines in the past. (Source)
Available via Phone and Skype Recent Change of Address 3331 Ocean Park #101 Santa Monica, CA 90405 (917) 692-4085 firstname.lastname@example.org Survey Response
Andrew Miller is a licensed Marriage Family Therapist (LMFT) and a TMS/PPD sufferer. He has over a decade of experience with TMS as both a patient and as a clinician. As a clinician, he received his Masters of Arts in Clinical Psychology at Antioch University in Los Angeles. Incorporating psychodynamic, cognitive behavioral therapy (CBT), mindfulness and psychodramatic techniques, he has helped his clients reduce TMS/PPD symptoms, more masterfully deal with difficult emotions, and more skillfully cope with lifes adversity. Currently, Andrew works in private practice and runs groups at treatment centers across Los Angeles.
Available via Phone and Skype Recent Change in Address 566 S. San Vicente Blvd. Suite 203 Los Angeles CA 90048 and 1314 Westwood Blvd. Suite 201 Los Angeles, CA 90024 (310) 776-5102 Website Survey Response Forum Profile / Introductory Thread / Success Story
Jessica Oifer is a Licensed Marriage and Family Therapist based in Los Angeles, California. She has worked with David Schechter, MD and in 2013 she attended the Clinical Training for the treatment of mind-body disorders in Los Angeles, CA. Jessica is also trained in the Trauma Resiliency Model, an approach that helps restores balance to the body after traumatic stress. On her general treatment approach, Jessica writes, My process often includes non-judgmental exploration of my clients past and present experiences, as well as the development of concrete skills to reduce the physical and emotional symptoms that traumatic stress can have on the body and nervous system. (Source)
Available via Phone and Skype 4640 Admiralty Way Suite 318 Marina del Ray, CA 90292 and 15300 Ventura Boulevard Suite 328 Sherman Oaks, CA 91403 (818) 538-9548 email@example.com Survey Response / Website
Colleen Perry is a licensed marriage and family therapist practicing in the Los Angeles area. She focuses on eating disorders and body image issues, along with helping people with chronic pain. She says “In individual therapy we explore the direct link of the unconscious mind to the manifestation of pain in the body. Traditional forms of pain treatment such as physical therapy, pain medications, anti-inflammatory medications and injections, surgery, acupuncture, chiropractic care, or massage, do not address the underlying emotional issues that are causing the pain in the first place. All that these other forms of pain management can give you are temporary relief…The most immediate relief for clients upon receiving the TMS diagnosis is that there is nothing structurally wrong with their body and are therefore encouraged to go about their daily activities of life without giving into the pain.”
Available via Video 1247 Seventh St. Suite 300 Santa Monica 90401 (310) 259-8970 firstname.lastname@example.org Website TMS Wiki Profile Main Wiki Page on Colleen Perry Curriculum Vitae
Dr. Pohl is a clinical health psychologist with both master and doctorate level education in health psychology and additional training in pain, chronic illness, and other health-related issues (source). Dr. Pohl also has developed a specialty in trauma and health psychology (source). She writes, “It takes a great deal of courage to ask for help. It requires facing ones problems head on and it can stir up feelings of shame and vulnerability. You may experience difficulty with trusting someone to accompany you on this journey; but also trusting that positive change is possible. It is important to find someone you can connect with to start your healing and growth. In my work with clients, I strive to create a safe and compassionate environment” (source).
2730 Wilshire Blvd, Suite 600 Santa Monica, CA 90403 (310) 709-4582 Insurance Accepted: All PPO insurances (Dr. Pohl is an out of network provider) Survey Response / Website
Arlen is a licensed psychologist in California. He has a doctorate in psychology. He says “I had been focusing on the mind body connection for a long time before I got exposed to Dr. Sarno. His thinking filled in important gaps for me. I have now spent several years specifically extending his diagnostic formulations into effective treatment for those people whose pain is caused by or worsened by emotions that have gotten directed into physical pain. I consider physical therapy, anti-inflammatory or pain deadening drugs and surgery to all have potential value. However, If you are not satisfied with the limitations of those approaches and believe that your pain has a significant emotional component, I can work with you on healing it.” (Source)
1923 1/2 Westwood Blvd, Suite 2 Los Angeles, CA 90025 and 20501 Ventura Blvd, Suite 395 Woodland Hills, CA 91364 Website (818) 999-0581 Arlen@ArlenRing.com
David Schechter is a Clinical Associate Professor in the Department of Family Medicine of the University of Southern California in Los Angeles. Dr. Schechter has over twenty five years of experience with the Tension Myositis Syndrome (TMS) diagnosis, has treated over a thousand patients has published original research on the subject and is the author of The Mindbody Workbook. While a medical student at NYU, he was a successful patient of Dr. Sarno. Dr. Schechter was a speaker at the 2nd Annual TMS Conference in March 2010. His presentation was entitled “Clinical Evaluation of Patients with Mind-Body Disorders.” (Source)
Available via Internet Video 8500 Wilshire Blvd, Suite 705 Beverly Hills, CA 90211 (310) 657-1022 310-six nine four-9814 fax and 10811 Washington Blvd, Suite 250 Culver City, CA 90232 310-836-2225 (310-836-BACK) 310-six nine four-9814 fax email@example.com TMS Wiki Profile / Survey Response / Q&A Answers / Workbook and CDs / Website Main Wiki Page About David Schechter / Board member of the Psychophysiologic Disorders Association (PPDA) / Curriculum Vitae Insurance Accepted: PPO provider for Blue Cross, Shield, United, Aetna, Cigna, Medicare. No HMO’s.
Clive Segil is an internationally renowned orthopedic surgeon from Los Angeles with 30 years of experience in the management of musculoskeletal disorders a healer not just a physician/surgeon, with creative approaches to patient problems. Dr. Segil sees the patient as a whole person not only a disease, and he places great emphasis on the mind-body connection, applying the concept of what is best for the patient. This means that he uses treatments that result in a cure, at best, and at very least, a marked improvement in their well-being. (Source)
2080 Century Park East, Suite 500 Los Angeles, CA 90067 (310) 203-5490 (310) 203-5412 fax firstname.lastname@example.org Website CURRICULUM VITAE Survey Response Insurance Accepted: All
Dr. Smith wrote one of the few doctoral dissertations on mind-body medicine (Claremont Graduate University 1998). He gives lectures and seminars on Tension Myositis Syndrome (TMS), as well as contributing to research on the subject. (Source)
The Noetic Health Institute Irvine, CA (949) 460-0820 email@example.com Website Resume
Jill is a licensed marriage and family therapist in the Los Angeles area. She says “My interest in TMS grew after my own experiences with chronic pain for many years and my frustration with the traditional medical community. I knew there were many people suffering from ‘mystery illnesses’ that needed relief, guidance and support. I read Dr. John Sarno’s book and was introduced to TMS through Dr. David Schechter in Los Angeles and Don Dubin MFCC. I am in private practice in the West Hollywood area, and chronic pain and somatization is one area of interest of mine. Unconscious ‘bad’ feelings that have been suppressed since childhood such as anger, guilt, sadness, rage, disappointment, unloveability and low self-esteem often emerge as somatic symptoms in various parts of the body.” (Source)
Available via Phone 8240 Beverly Blvd Suite #8 Los Angeles, CA 90048 (323) 692-3759 firstname.lastname@example.org TMS Wiki Profile / Survey Response / Website Insurance Accepted: Private Pay
Clark has a masters in Humanistic Psychology (Mind/Body focus) and a PhD in Clinical Psychology, California Institute of Integral Studies. He is a licensed psychologist in California. He receives most of his referrals from Dr. Parvez Fatteh in the San Francisco Bay Area, who is a Sarno adherent and is board certified in physical medicine & rehabilitation, with a sub-specialty (Board Certified) in pain medicine.
He says, “About 8 years ago I was working with a client who had a number of issues, with the most compelling one severe tendon/muscle pain in his arms. He was diagnosed with repetitive motion injury and was so incapacitated that he couldn’t even pick up his two year old daughter. This client introduced me to Sarno’s work as he worked through his pain. The philosophy of Sarno’s beliefs were familiar to me because of my background in mind/body psychologies in my Master’s program at Sonoma State University. Approximately 7 years ago I had a close family member go through excruciating back pain. She consulted with over 10 health practitioners (mainstream and alternative) and did not find any diminution of the pain until she read “The Mind Body Prescription”. She was pain free in about 2 months.” (Source)
Available via Phone 1902 Webster St San Francisco, CA 94115 (415) 923-6760 email@example.com Survey Response / TMS Wiki Profile / Website Insurance Accepted: Aetna, Managed Health Network.
Katy Wray graduated from the California Institute of Integral Studies in 1989, and has been in practice for over 20 years. She specializes in relationship issues, anxiety, chronic pain, and depression. She describes her therapeutic style as “interactive and collaborative.” She says, “We will work together on coming to a deeper understanding of what is happening in your life. Different possibilities and choices can then become available to you.” (Source)
2506 Clay Street San Francisco, CA 94115 (415) 922-8121 firstname.lastname@example.org
Santa Cruz area
Dr Eisendorf MD is a doctor with the Palo Alto Medical Foundation in California. He says: I try to understand my patients. I want to know what their experiences have been, what their joys and challenges are, and what’s getting in the way of their more full enjoyment of life. My studies with Dr. John Sarno, author of “Healing Back Pain”, “The Mindbody Prescription”, and other books, has strongly influenced my practice of medicine. The mind and emotions have a profound effect on our physical and mental health and well-being. To better understand this relationship and help patients use the mind to their advantage, I teach classes and offer monthly support groups. (Source)
2025 Soquel Avenue Santa Cruz, CA 95062 (831) 458-5524 Website Insurance Accepted: Cigna, Healthnet, Wellcare, Humana, BCBS, United Health Care, Wellpoint
Hasanna received a M.A. in Clinical Psychology in 1992 from JFK University and has been a Licensed Marriage and Family Therapist since 1995. She says “For the past fourteen years I’ve been helping people with a wide range of issues, such as relationship problems of all kinds, depression, grief and loss, anxiety, life transitions, spirituality, parenting, self esteem, and chronic physical pain. I cured my own long-standing back, neck and hip pain 10 years ago after reading Sarno’s Healing Back Pain. Unfortunately, I didn’t discover TMS in time to avoid two unnecessary shoulder surgeries in both shoulders. It has been so satisfying to help my clients avoid a similar mistake! ” (Source 1) (Source 2)
Available via Phone and Skype 2715 Porter Street Soquel, CA 95073 (831) 476-8556 email@example.com Hasanna has contributed a short article on Choosing a TMS Therapist to the TMS Wiki. Survey Response / TMS Wiki Profile / Website Insurance Accepted: Not on any preferred provider lists, but some PPO plans will reimburse at a lesser amount
A traditionally trained physician, Dr. Emmett Miller is one of the founders of modern mind-body medicine. Although Dr. Miller is not trained in the treatment of TMS specifically, his treatment methods have been very helpful to others with TMS, including author Steve Ozanich, as he mentioned in a forum post (listed below). Dr. Miller now practices in California. using different holistic approaches such as guided meditation and deep relaxation as well as cognitive behavioral techniques, his practice focuses on helping people overcome a variety of chronic illnesses and problems, including stress, anxiety, and physical pain. Dr. Miller also provides life coaching sessions. (Source) Read Steve Ozanich’s forum post mentioning Dr. Miller and mindbody medicine.
Available via Phone and Skype To make an appointment with Dr. Miller, follow the steps listed on this webpage 329 S San Antonio Road, Suite 9 Los Altos, CA 94022
18834 Rock Creek Rd Nevada City, CA 95959 (530) 478-1807 (530) 478-0160 fax Website
An experienced clinical and health psychologist, Dr. Engelman has been working in the field of psychophysiologic disorders for 30 years. Part of the medical staff at St. Joseph Hospital in Orange, CA, Dr. Engelman often works with referrals from physicians (both TMS physicians specifically and physicians in general) who think thier patients may have a psychological compontent to their pain. Her approach includes mindfulness, biofeedback and other mind body approaches to working with pain. She also conducts Animal Assisted Therapy. Dr. Engelman currently has two offices, one in Orange, CA and one in Laguna Niguel, CA. (Source)
30131 Town Center Drive, Suite 292 Laguna Niguel, CA 92677 or 1310 W. Stewart Drive, # 608 Orange, CA 92868
(949) 460-4908 firstname.lastname@example.org Survey Response / Website Insurance Accepted: Aetna (in network provider), Blue Cross (out of network provider)
Patti is a licensed clinical social worker. She says of TMS “Treatment consists of identifying and acknowledging the suppressed emotion (anger, sadness, fear, etc.). That’s it. It is not necessary to delve into the scenario which triggered those feelings in order to release the physical symptoms. Those symptoms were only there to protect your conscious mind from the feelings. So once the feelings are revealed, the symptoms simply fall away.” (Source)
Peaceful Sea Counseling 920 Samoa Blvd, Suite 209 Arcata, CA 95521 (707) 822-0370 Website Insurance Accepted: Most providers including Medicare, Blue Cross Blue Shield, AARP, Tricare
PPDA Practitioner Aimee Aron attained a Master of Arts degree in Clinical Mental Health with a special focus in multicultural counseling from the University of Colorado Denver. Her primary approaches are Multicultural and Existential Humanistic Therapies. These approaches demonstrate respect for and evaluate the individual, the relationships in their lives, the culture with which they identify, and how they make meaning of the experiences and elements of their lives. Value is found in examining the subjects of gender, age, ethnicity, spirituality, socio-economic status, and many other cultural forces in determining how a person has come to be who they are, what they believe about the world, and the troubles they are bringing to therapy. She helped found the Rocky Mountain Stress Check-Up organization, which reaches out to physicians about Tension Myositis Syndrome (TMS).
860 Emerson Street #0 Denver, CO 80218 (303) 900-8672 email@example.com Website
Pam Benison has been treating people with TMS/PPD for over 18 years. She encountered Dr. Sarno’s book, Healing Back Pain, in 1994, used the knowledge he presented to successfully treat her own back pain. Most recently, she has studied with Dr. Howard Schubiner and has incorporated his book, Unlearn Your Pain, when working with her clients. Because of her 32 years in private practice, Pam draws upon many types of therapies and relaxation techniques that eliminate stress and progress one toward satisfaction and growth. Some of these methods are: gestalt psychotherapy, cognitive behavioral therapy, insight therapy, positive psychology, couples therapy, various forms of meditation and breath work. Pam received her Bachelor of Arts from Michigan State University and her Master’s degree from the University of Denver. She is a fellow in the American Psychotherapy Association. She is willing to meet with clients via the phone or Skype.(Source)
Available via Phone and Skype 7950 So. Lincoln St., #100 Littleton, Co. 80122 and 1625 Larimer St., #2704 Denver, Co. 80202 303-797-8137 firstname.lastname@example.org Survey Response / Website
Dr. Henri has been treating people with Tension Myositis Syndrome (TMS) for over 9 years, and during that time has treated close to 200 people with TMS symptoms. She is able to draw upon her own experiences with chronic back pain, which she had for about one year, when she is treating her clientele. Henri uses several different therapy techniques to help her clients including EMDR, Solution-Focused Therapy, Mindfulness-Based Cognitive Behavioral Therapy (MBCT), and Brainspotting depending on the situation. Henri uses these multiple techniques to design a unique treatment for her patients. Dr. Henri graduated with a Bachelors in Arts from Stanford University and received her PhD in Clinical/Health psychology from Ohio State University. In addition, Henri completed her internship and Post-doctoral fellowship from UCLA. (Source)
1325 Dry Creek Dr. Suite 101 Longmont, CO 80503 (720) 771-9248 email@example.com TMS Wiki Profile / Survey Response / Website Insurance Accepted: Aetna, United Behavioral Health, Humana, Mental Health Network, Rocky Mountain Health Plans, and Anthem/BCBS
PPDA Practitioner Catherine Tilford earned a Master’s of Arts in Counseling Psychology from the University of Colorado in Denver and a Bachelor’s degree in Psychology from Colorado Mesa University. In 2011, she was trained by the PPDA to provide Stress Check-Ups and is a founding member of the Rocky Mountain Stress Check-Up Network. Through counseling, Catherine supports personal growth by helping individuals move forward with self-awareness and strength. She provides a safe place in which you can explore your experiences and the problem or painful emotions that are standing in your way of living a personally meaningful and fulfilling life.
Available via Skype 2010 W 120th Avenue Suite 100 Denver, CO 80234 (303)720-9424 firstname.lastname@example.org Website
Dr. Denkin has seen over 500 patients with PPD/TMS symptoms over a nine year span. She continues to receive education and training on treating PPD. Her speciality is in mind-body work, chronic pain, somatic disorders, anxiety, diet and nutrition to help others. In addition she does treat patients via skype.
Available via Phone and Skype 51 Locust Avenue Suit 302 New Canaan, CT 06840 email@example.com Survey Response
Dr Zagar is the Director, Neuropsychology Services at The Associated Neurologists of Southern Connecticut, P.C. They offer Mind-Body Medicine, which typically focuses on interventions believed to promote health and wellness such as Yoga, Relaxation, Biofeedback, Clinical Hypnosis, and Cognitive Behavioral Therapies. The Mind-Body Medicine perspective views illness as an opportunity for personal growth and healthcare providers are guides in this transformative process. Frequently, Mind-Body Medicine focuses on the impact of stress and the development of illness and the worsening of symptoms such as pain. (Source)
Associated Neurologists of Southern Connecticut 75 Kings Highway Cutoff Fairfield, CT 06824 (203) 333-1133 Website Insurance Accepted: Aetna, Cigna, Healthnet, Medicaid, Medicare, BCBS, United Health Care, Wellpoint
Nicole Sachs is a graduate of the University of St. Thomas, and has been treating people with TMS for over 10 years. During that time she has seen over 100 clients with TMS. Sachs is the author of the book, The Meaning of Truth, which describes her practice and treatment methods. She is also a recovered TMS patient herself, and a previous member of Dr. Sarno’s Alumni Panels, where she would tell Dr. Sarno’s new patients about her own experience with TMS. In 2013, the PTPN recorded an interview with Nicole Sachs, where she again described her battle with chronic pain, and her success with the TMS approach.
Available via Phone firstname.lastname@example.org Website Survey Response / Profile Page / Forum Threads Nicole Sachs’s Recovery Story (video)
Dr. Leonard-Segal graduated with honors from the George Washington University Medical School and is Board Certified in Internal Medicine and Rheumatology. She has practiced medicine since 1982 and has devoted the past twenty years to helping patients overcome back and neck pain, fibromyalgia, chronic tendon complaints and similar conditions. She emphasizes the mind-body connection and is one of a handful of physicians nationally who uses an approach that closely parallels the pioneering work of John E. Sarno, MD at the New York University Medical Center and the Rusk Institute. She brings her interest and expertise in mind-body medicine to the Center for Integrative Medicine. (Source1, Source2)
George Washington University Center for Integrative Medicine 908 New Hampshire Avenue, N.W. Suite 200 Washington, D.C. 20037 (202) 833-5055 (202) 833-5755 fax Website Contributed the article, “A Rheumatologist’s Experience with Psychosomatic Disorders,” in The Divided Mind, by Dr. John Sarno. 2006. Insurance Accepted: none
Dr. Brady is no longer accepting new patients. (Source) Dr Brady is the founder and Director of the Brady Institute for Health at Florida Hospital in Celebration, Florida. Dr. Brady has practiced Emergency Medicine and Urgent Care Medicine throughout Central Florida for over fifteen years and is board certified in Internal Medicine. He is the Administrator and Senior Medical Director of Florida Hospital’s sixteen Centra Care urgent care clinics. (Source)
With William Proctor, he has written a book entitled Pain Free for Life. In it, Dr. Brady describes how he overcame his own pain:
“Turn on your TV!” she said. “John Stossel is interviewing Dr. John Sarno,who says he can cure back pain like yours.” the Stossel interview of Dr. Sarno can be viewed for free here.
I wasn’t optimistic … But the more he talked, the more I listened–and the more intrigued I became. Following the show, I remembered that a friend had given me one of Sarno’s books, and after a little rummaging around, I managed to find it. … His ideas set me on a journey of healing that eventually cured my pain, and led me to where I am today. (p. 33)
Dr. Brady refers to TMS as Autonomic Overload Syndrome (AOS), but the explanation that he gives for AOS is fundamentally the same explanation that Dr. Sarno gives for TMS. (Scott Brady. Pain Free for Life. New York: Hachette Book Group. 2006.)
The Brady Institute for Health P.O. Box 2982 Windermere, FL 34786 (407) 876-1888 DrBrady@BradyInstitute.com Website
Board Certified in Psychiatry, Addiction Psychiatry, Forensic Psychiatry, Internal Medicine and Nutrition 3188 Atlanta Road Smyrna, GA 30080 (770) 319-6000 Insurance Accepted: US Healthcare, Blue Cross Blue Shield, Humana HMO, Humana PPO, Blue Choice Senior, Cigna HMO, Cigna PPO, One Health Plan of Georgia, Inc HMO / POS / Choice/ PPO
Pocatello, Idaho 208 234-1099
Dr. Stracks believes that the mind and body are intimately connected and that almost all disease processes involve an interplay between the two. His training in integrative medicine has taught him that all treatment plans must include not only a mind and body component but a social and spiritual component as well. In addition, Dr. Stracks believes that the most powerful interventions involve changes in nutrition, activity level, and other lifestyle areas, and he works to partner with patients to effect these changes. Dr. Stracks believes that many conditions can be controlled or even reversed with mind-body techniques, lifestyle changes, and other integrative therapies, and he likes working with patients and their primary physicians to safely reduce medication use whenever possible. (Source)
Northwestern Memorial Physicians Group Center for Integrative Medicine and Wellness 1100 E. Huron Street Suite 1100 Chicago, IL 60611 312-926-DOCS (3627) email@example.com Co-host of first TMS conference. TMS Wiki Profile / Survey Response / Q&A Answers / Website Insurance Accepted: Aetna, Blue Cross Blue Shield, Cigna, Humana, Medicaid, Medicare, TriCare, Unicare, UnitedHealthcare, and other PPO network plans
Dr Herzog has extensive training in Physical Medicine and Rehabilitation, and has managed thousands of impairments and disabilities from common soft tissue injuries to spinal cord injury, traumatic brain injury, joint replacement, amputation and stroke. He now focuses on outpatient musculoskeletal and neurologic conditions, frequently occupational in nature. He has delivered such care to patients throughout Maine since 1993.
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Posted: at 5:48 am
(For an alternative version of theses entries, see the Short and Irreverent E-dition, part 1, sCAM [so-called Complementary & Alternative Medicine])
A acupuncture alkaline diet allopathy alphabiotics “alternative” health practice angel therapy animal quacker anthroposophic medicine applied kinesiology aromatherapy astrotherapy aura therapy Ayurvedic medicine B Bach’s flower therapy Jon Barron bio-ching bioharmonics Blaylock, Russell Body Code of Bradley Nelson Rashid Buttar, D.O. C chelation therapy chi chiropractic Hulda Clark complementary medicine complex homeopathy coning (ear candling) Consegrity craniosacral therapy cupping
D Day, Phillip dental amalgam detoxification therapies DHEA dolphin-assisted therapy Dr. Dragon Dabic E Emotional Freedom Technique Emotion Code of Bradley Nelson Dr. Fritz – “energy healing” Eye Movement Desensitization Reprocessing (EMDR) F facilitated communication faith healing frontier medicine functional medicine G Gerson therapy Jay Gordon gua sha H healing touch holistic medicine homeopathy Leonard Horowitz hypnosis I immune system quackery integrative medicine integrative oncology intuitive (intuitionist) intuitive healer iridology isopathy Issels Immuno-Oncology treatment J joy touch K Rauni Kilde kinergetics Kirlian photography L Lightning ProcessTM M macrobiotics magical thinking magnet therapy massage therapy Joseph Mercola microacupuncture moxibustion N natural cancer cures naturopathy Bradley Nelson neuro-linguistic programming New Age psychotherapies noni fruit and juice nosode O osteopathy P prayer psychic surgery Q quackery R Reams, Carey reflexology Rader, William C., M.D. reiki Rolfing S shark cartilage as a cancer cure T therapeutic touch thought field therapy traditional Chinese medicine trepanation U urine therapy V vibrational medicine vitamin and mineral supplements W Andrew Wakefield Joel D. Wallach, “The Mineral Doctor” Y Robert O. Young Z zenreiki
Last updated 03-Jan-2016
Myth 2. Prescription drugs are one of the leading causes of death.
Myth 3. Most medical treatments have never been clinically tested.
Myth 19. Medical doctors typically know nothing about nutrition.
Myth 21. Faith healing works.*
Myth 22. Dr. Randolph Byrd scientifically proved that prayer can heal.
Myth 23. Even if Dr. Byrd failed, others have succeeded in proving scientifically that prayer heals.
Myth 25. Transplant organs carry personality traits which are transferred from donors to receivers.
Myth 31. Crimes, mental illness, suicides, and emergency room visits increase when there is a full moon.
Myth 43. Suicide increases over the holidays.
Myth 46. Switching to a low-tar cigarette will reduce one’s chances of being exposed to the carcinogens in cigarette smoke.
Myth 47. Vaccination*of children with the (MMR) vaccine to prevent measles, mumps and rubella causes autism.*
Myth 53. Sugar causes hyperactivity in children.
Myth 54. Alcohol, especially red wine, is good for your health.*(read this one carefully and to the end) and *
Myth 55. A migraine is a bad headache.
Myth 58. The moon can trigger ovulation and bring on fertility depending on what phase the moon was at when you were born.
Myth 59. The mercury in dental amalgam is poisoning people.*
Myth 60. You should drink eight glasses of water a day for good health.* One study, however, does seem to have good evidence that drinking five glasses a day is better than drinking two or fewer with respect to fatal coronary heart disease.
Myth 71. A diet low in animal fat will prevent high cholesterol which will prevent atherosclerosis which will make you immune to having a heart attack.
Myth 72. Pasteur renounced all his works on his death bed.
Myth 73. Laetrile is an effective cancer treatment whose humanitarian discoverer has been persecuted, depriving millions of people of the benefits of this wonder drug.
Myth 74. Peptic ulcers are caused by stress and eating spicy food.*
Myth 83. A study was published in the Western Journal of Medicine that showed changing the letters EPHO (each letter representing a drug being used to treat small-cell lung cancer) to HOPE led to a spectacular increase in positive response to the treatment.
Myths 86-89, thanks to the British Medical Journal:
Myth 86. There are several effective cures for a hangover.
Myth 87. People who eat late at night gain more weight than those who eat the same amount of food earlier in the day.
Myth 88. More heat escapes from the head than any other part of the body.
Myth 89. Poinsettias are poisonous.
Myth 92. Fruit must be eaten on an empty stomach in order for the body to absorb it properly.
Myth 93. Drinking cold water after meals causes cancer.
Barrett, Stephen and William T. Jarvis. eds. The Health Robbers: A Close Look at Quackery in America (Amherst, N.Y.: Prometheus Books, 1993).
Barrett, Stephen and Kurt Butler (eds.) A Consumers Guide to Alternative Medicine : A Close Look at Homeopathy, Acupuncture, Faith-Healing, and Other Unconventional Treatments; edited by (Buffalo, N.Y. : Prometheus Books, 1992).
Bausell, R. Barker. (2007). Snake Oil Science: The Truth about Complementary and Alternative Medicine Oxford. (review)
Ernst, Edzard MD PhD, Max H. Pittler MD PHD , Barbara Wider MA. 2006. The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach. 2nd ed. Mosby.
Randi, James. The Faith Healers (Amherst, N.Y.: Prometheus Books, 1989).
Raso, Jack. “Alternative” Healthcare: A Comprehensive Guide (Amherst, NY: Prometheus Books, 1994).
Sampson, Wallace and Lewis Vaughn, editors. Science Meets Alternative Medicine: What the Evidence Says About Unconventional Treatments (Prometheus Books, 2000).
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Posted: June 17, 2016 at 5:03 am
SUPPORT THE PATIENTS RIGHTS COUNCILLatest additions to web site: 6/7/16.. Site Map ..
Death Doctor to Charge $2000 for Suicide Prescription(National Review June 5, 2016)Lonnny Shavelson is or was a part time emergency room physician and photo journalist. Now, hes going to be a death doctor for pay. [H]e once witnessed what can only be described as a murder of a disabled man by a Hemlock Society suicide assister and did nothing about it as he reported beginning at page 92 of his book. More on California.
Scroll down for more of the latest developments and featured articles ..List of states where bills have been proposed this year: 2016 Doctor-Prescribed Suicide Bills Proposed
In addition to bills that had been pending in New Jersey, doctor-prescribed suicide bills were proposed in 2015 in more than twenty states. For a listing of those bills, see 2015 Doctor-Prescribed Bills Proposed. For all doctor-prescribed suicide bills that have been proposed since 1994, see Attempts to Legalize. ..
Scroll down for other Recent Developments, and for Featured Articles. For additional information, see Site Map.
The Latest PRC Update (2016 Volume 30, No. 2,):
Who will speak for you? Imagine you are in an accident tomorrow and so seriously injured that you arent able to communicate about your health care wishes for several weeks. Who would make health care decisions for you during that time? Do you need an advance directive?
To obtain a durable power of attorney for health care for the state in which you are a resident, call the Patients Rights Council (800-958-5678 or 740-282-3810) between 8:30am and 4:30pm (eastern time). .
Recent Major Developments
Brain scans reveal hidden consciousness in patients(AP Central Ohio, The Source May 26, 2016) A standard brain scanning technique is showing promise for helping doctors distinguish between patients in a vegetative state and those with hidden signs of consciousness.The researchers checked the patient status again a year later. They found that 8 of the 11 vegetative patients who had scored above the cutoff, which had been associated with minimal consciousness, had in fact recovered consciousness.
Savinos end-of-life bills: Cruel choices, deadly mischief(Staten Island Advance May 16, 2016) The latest proposed doctor-prescribed suicide legislation is titled the Medical Aid in Dying Act. More on New York and text of proposed bill [Note: As with SB 3685, one of New Yorks previous bills, this latest bill (A10059) would not require that a person be a resident of New York to qualify for doctor-prescribed suicide. Therefore, if passed, New York could easily become a national suicide destination.]
Cancer breakthrough: Duke clinical trial destroys SC womans brain tumor(WNCN television CBS May 16, 2016) The FDA is calling a clinical trial that killed a cancerous brain tumor (Stage 4 Glioblastoma) a medical breakthrough. Stephanie Lipscomb, now a nurse has now been cancer free for 4 years and considers herself cured. Dozens of patients responded positively to the trial and because of the success with Stephanie, the FDA has deemed the trial a medical breakthrough. [Note: This was the same type of cancer that Brittany Maynard had.]
UNICEF Canada lobbies lawmakers to make physician-assisted dying (which includes doctor-prescribed suicide and euthanasia by lethal injection) available to children.In its May 11, 2016 brief, UNICEF states,In our view, this would be consistent with a cautious and balanced child rights-based approach to the question of medically-assisted death, having regard to the lessons learned in the Netherlands and Belgium. It further notes that in 2014, Belgium amended its legislation and became the first country in the world to remove any age restrictions on physician-assisted death. More on Canada
Netherlands sees sharp increase in people choosing euthanasia due to mental health problems'(Telegraph May 11, 2016) The Netherlands has seen a sharp increase in the number of people choosing to end their own lives due to mental health problems such as trauma caused by sexual abuse. Whereas just two people had themselves euthanised in the country in 2010 due to insufferable mental illness, 56 people did so last year, a trend which sparked concern among ethicists. More on Holland Assisted Suicide MDs Would Never be Convicted of Fraud(National Review May 9, 2016) The Justice Department has convicted two doctors for falsely diagnosing patients as terminal to qualify for hospice care.The motive there was clearly money. But this same kind of false terminal diagnosis could also happen with assisted suicide as a matter of ideologyIt already has. More on Terminal Illness
Medical errors may kill 250,000 a year, but problem not being tracked(Modern Healthcare May 4, 2016) A study published in the BMJ found that medical mistakes in the U.S. trailed heart disease and cancer. More on Medical Errors
Chambers promises to keep pushing for aid-in-dying law (Brown County Democrat April 4, 2016) Sen. Ernie Chambers of Omaha filed a motion Monday to pull his aid-in-dying bill out of a legislative committee where it remains stuck. The motion won only nine of the needed 25 votes to bring the bill to the floor for debate. More on Nebraska
Remove organs from euthanasia patients while theyre still ALIVE’ (Daily Mail March 31, 2016) Those who want to be killed should be sedated in hospital then allowed to die after the removal of their vital organs, according to the proposal published by a British-based medical ethics journal. Using organs for transplant surgery from patients who have been helped to die is allowed in Belgium and Holland.[A]n article in the Journal of Medical Ethics yesterday advocated heart-beating organ donation euthanasia. This would involve an operation in which organs would be taken from still-living patients who have given permission. More on Organ Donation and Organ Transplant
Oregon releases its 2016 death with dignity stats(BioEdge February 20, 2016) Oregon is the model for assisted suicide legislation throughout the United States, so its annual Death with Dignity report for 2015 deserves close scrutiny.For about 80% of the 132 deaths there is no information on how long it took or whether there were difficulties. More on Oregon
Featured Articles Hospital(Townhall April 21, 2016) I get excellent medical care here. But as a consumer reporter, I have to say, the hospitals customer service stinks.Customer service is sclerotic because hospitals are largely socialistic bureaucracies. Instead of answering to consumers, which forces businesses to be nimble, hospitals report to government, lawyers and insurance companies. More on government Health Care Reform
Are You a Hospital Inpatient or Outpatient? If you have Medicare Ask!(Medicare.gov) Did you know that even if you stay in a hospital overnight, you might still be considered an outpatient? Your hospital status affects how much you pay for hospital services and may also affect whether Medicare will cover care you get in a skilled nursing facility following your hospital stay. More on Medicare
Weak Oversight Lets Dangerous Nurses Work in New York(ProPublica April 7, 2016) New York lags behind other states in vetting nurses and moving to discipline those who are incompetent or commit crimes. Often, even those disciplined by other states or New York agencies hold clear licenses. More on New York More on Nurses
e: An idea that loses appeal as it becomes tangible (Star Tribune March 15, 2016) SF 1880 is sponsored by a group of DFL legislators, led by Sen. Chris Eaton of Brooklyn Center, who claims that assisted suicide enjoys overwhelming support from the American public. This is overconfidence. The truth about assisted suicide is that it 1) takes time to understand and that it 2) turns political stereotypes on their head But then something remarkable happened. The people of Massachusetts began to understand the issue. More on Minnesota
Dutch documentary awakens euthanasia debate about wider rules (Dutch News February 29, 2016) A recent Dutch television documentary on euthanasia in which a 68 year-old woman suffering from semantic dementia was given a lethal injection may well herald a turning point in what many consider to be an increasingly broader and unacceptable interpretation of the rules. More on Holland
Where the prescription for autism can be death (Washington Post February 24, 2016) Thus did a man in his 30s whose only diagnosis was autism become one of 110 people to be euthanized for mental disorders in the Netherlands between 2011 and 2014. Thats the rough equivalent of 2,000 people in the United States. More on Holland
Teen Survived Kalamazoo Shooting after Being Pronounced Brain Dead(ABC7 February 23, 2016) The hospital was in the process of preparing her organs for donation when the girl squeezed her mothers hand. More on Organ Donation
Elder Guardianship: A Shameful Racket'(Diane Dimond February 20, 2016) Betty Winstanley is a well-spoken, elegant and wealthy 94-year-old widow. And as she told me from her room at the Masonic Village retirement facility Elizabethtown, Pennsylvania, I feel like I am in prison. My life is a living hell. Welcome to Americas twisted world of court-appointed guardians for the elderly.
Assisted Suicide Study Questions Its Use for Mentally Ill (New York Times February 10, 2016) [I]n more than half of the approved cases, people declined treatment that could have helped, and many cited loneliness as an important reason for wanting to die. People who got assistance to die often sought help from doctors they had not seen before, and many used what the study called a mobile end-of-life clinic a nurse and a doctor, funded by a local euthanasia advocacy organization. More on Holland
RNs and CNAs Work Fewer Hours in Nursing Facilities that Serve Predominately Ethnic and Racial Minorities(Center for Medicare Advocacy January 27, 2016) A December 2015 Health Affairs study of freestanding Skilled Nursing Facilities (SNFs) found that registered nurses (RNs) were less likely to work at nursing homes with high concentrations of racial and ethnic minorities.Racial and ethnic minority nursing home residents have not been receiving the same quality of skilled care as white patients and the consequences of this disparity have been significant. More on Medicare More on Minorities and the Poor
A bit of irony or tragedy in Canada?(January 2016) Although Canadas new health minister has acknowledged that there is evidence that only 15 percent of Canadians have access to high quality pain control, parliament has been told that special traveling teams should be available to deliver physician-assisted death to the countrys remote regions to guarantee that patients can have their lives ended.
The sole survivor: Fort Lee woman beats the deadliest form of brain cancer(NorthJersey.com December 13, 2015) Nearly a decade after learning she had only three months to live, Sandy Hillburn grabbed a taxi last Sunday to LaGuardia Airport for one of her regular business trips to North Carolina.
The vulnerable will be the victims(USA Today October 20, 2015) California required legislative sleight of hand to pass physician-assisted suicide in a special legislative session that bypassed committee votesOregon reports that pain doesnt even make the top five reasons people seek doctor-assisted suicide. Instead, people are afraid of losing autonomy and dignity. Notably, theyre afraid of becoming a burden on others. In the face of a youth-worshipping country that marginalizes the sick and dying, we should resist making the vulnerable feel like a burden not make it easier for them to kill themselves. Dignity doesnt come from the illusion of power and control, but from mutual dependence and love. More on California
Suicide by any other name(USA Today October 13, 2015) Right to die proponents take advantage of human vulnerability, obfuscate reality of assisted suicideBut verbal cloaking is the stock in trade of the right-to-die forces. The Orwellian-speak they employ to describe their effort is telling. It is death by euphemism. More on Verbal Engineering
Oregon claim of assisted suicide safeguards has critics(CalWatch October 9, 2015) A key argument spurring Gov. Jerry Browns recent decision to sign a bill allowing physician-assisted suicide in California, and the Legislatures desire to enact such a law, was that a similar law had worked well in OregonBut what was rarely acknowledged in the California media is that the Oregon law while wining positive notices from that states media has a solid core of skeptics who complained of skewed or inadequate data backing up assertions that the safeguards work. More on California More on Oregon
Governor should have talked to Holland before signing bill(Press Democrat October 7, 2015) By: Theo Boer, Professor of Health Care Ethics at Kampen University in The Netherlands. In 1994, the Dutch were the first in the world to officially legalize assisted dyingI was convinced that legalizing assisted dying was the wisest and most respectful routeHearing of Browns decision, and without doubt any of his good intentions, my thoughts go back to our own pioneering years. As I said, we have been naive. More on The Netherlands More on California
A Doctor-Assisted Disaster for Medicine(Wall Street Journal August 17, 2015) As a professor of family medicine at Oregons Health & Science University in Portland, as well as a licensed physician for 35 years, I have seen firsthand how the law has changed the relationship between doctors and patients, some of whom now fear that they are being steered toward assisted suicide. More on Oregon
Previously Featured ArticlesAlso see site map to access specific topics which include previously featured articles.
Have you heard about VSED? It stands for voluntarily stopping eating and drinking. VSED is being promoted by assisted-suicide activists who are also working to force health care providers to participate in it. Important Questions & Answers about VSED
From the bookshelfTwenty-four years ago, Ann Humphry, the co-founder of the Hemlock Society (now called Compassion and Choices) committed suicide. Her death made headlines worldwide.
Prior to her death, Ann contacted Rita Marker, a staunch euthanasia opponent. Over time, the two became close friends, and Ann asked Rita to make public secrets about the right-to-die movement secrets that had weighed heavily on Ann.
Two years after Anns tragic death, the book, Deadly Compassion: The Death of Ann Humphry and the Truth About Euthanasia was published. It recounts Anns personal story, the founding of the Hemlock Society, and activities of euthanasia and doctor-prescribed suicide advocates. Thousands of copies of the book were sold in the United States, England, Canada and Australia. (Read excerpts from reviews of the book.)
Now, for the first time, you ca
n read Deadly Compassion in its entirety on line in PDF format.
Go here to read the rest:
Posted: June 10, 2016 at 12:44 pm
Cystic fibrosis (CF) is a genetic disorder that affects mostly the lungs but also the pancreas, liver, kidneys, and intestine. Long-term issues include difficulty breathing and coughing up mucus as a result of frequent lung infections. Other signs and symptoms include sinus infections, poor growth, fatty stool, clubbing of the fingers and toes, and infertility in males, among others. Different people may have different degrees of symptoms.
CF is inherited in an autosomal recessive manner. It is caused by the presence of mutations in both copies of the gene for the cystic fibrosis transmembrane conductance regulator (CFTR) protein. Those with a single working copy are carriers and otherwise mostly normal. CFTR is involved in production of sweat, digestive fluids, and mucus. When CFTR is not functional, secretions which are usually thin instead become thick. The condition is diagnosed by a sweat test and genetic testing. Screening of infants at birth takes place in some areas of the world.
There is no cure for cystic fibrosis. Lung infections are treated with antibiotics which may be given intravenously, inhaled, or by mouth. Sometimes the antibiotic azithromycin is used long term. Inhaled hypertonic saline and salbutamol may also be useful. Lung transplantation may be an option if lung function continues to worsen. Pancreatic enzyme replacement and fat-soluble vitamin supplementation are important, especially in the young. While not well supported by evidence, many people use airway clearance techniques such as chest physiotherapy. The average life expectancy is between 42 and 50 years in the developed world. Lung problems are responsible for death in 80% of people with cystic fibrosis.
CF is most common among people of Northern European ancestry and affects about one out of every 3,000 newborns. About one in 25 people are carriers. It is least common in Africans and Asians. It was first recognized as a specific disease by Dorothy Andersen in 1938, with descriptions that fit the condition occurring at least as far back as 1595. The name cystic fibrosis refers to the characteristic fibrosis and cysts that form within the pancreas.
The main signs and symptoms of cystic fibrosis are salty-tasting skin, poor growth, and poor weight gain despite normal food intake, accumulation of thick, sticky mucus, frequent chest infections, and coughing or shortness of breath. Males can be infertile due to congenital absence of the vas deferens. Symptoms often appear in infancy and childhood, such as bowel obstruction due to meconium ileus in newborn babies. As the children grow, they exercise to release mucus in the alveoli.Ciliated epithelial cells in the person have a mutated protein that leads to abnormally viscous mucus production. The poor growth in children typically presents as an inability to gain weight or height at the same rate as their peers and is occasionally not diagnosed until investigation is initiated for poor growth. The causes of growth failure are multifactorial and include chronic lung infection, poor absorption of nutrients through the gastrointestinal tract, and increased metabolic demand due to chronic illness.
In rare cases, cystic fibrosis can manifest itself as a coagulation disorder. Vitamin K is normally absorbed from breast milk, formula, and later, solid foods. This absorption is impaired in some cystic fibrosis patients. Young children are especially sensitive to vitamin K malabsorptive disorders because only a very small amount of vitamin K crosses the placenta, leaving the child with very low reserves and limited ability to absorb vitamin K from dietary sources after birth. Because factors II, VII, IX, and X (clotting factors) are vitamin Kdependent, low levels of vitamin K can result in coagulation problems. Consequently, when a child presents with unexplained bruising, a coagulation evaluation may be warranted to determine whether there is an underlying disease.
Lung disease results from clogging of the airways due to mucus build-up, decreased mucociliary clearance, and resulting inflammation. Inflammation and infection cause injury and structural changes to the lungs, leading to a variety of symptoms. In the early stages, incessant coughing, copious phlegm production, and decreased ability to exercise are common. Many of these symptoms occur when bacteria that normally inhabit the thick mucus grow out of control and cause pneumonia. In later stages, changes in the architecture of the lung, such as pathology in the major airways (bronchiectasis), further exacerbate difficulties in breathing. Other signs include coughing up blood (hemoptysis), high blood pressure in the lung (pulmonary hypertension), heart failure, difficulties getting enough oxygen to the body (hypoxia), and respiratory failure requiring support with breathing masks, such as bilevel positive airway pressure machines or ventilators.Staphylococcus aureus, Haemophilus influenzae, and Pseudomonas aeruginosa are the three most common organisms causing lung infections in CF patients. In addition to typical bacterial infections, people with CF more commonly develop other types of lung disease. Among these is allergic bronchopulmonary aspergillosis, in which the body’s response to the common fungus Aspergillus fumigatus causes worsening of breathing problems. Another is infection with Mycobacterium avium complex (MAC), a group of bacteria related to tuberculosis, which can cause a lot of lung damage and does not respond to common antibiotics.
Mucus in the paranasal sinuses is equally thick and may also cause blockage of the sinus passages, leading to infection. This may cause facial pain, fever, nasal drainage, and headaches. Individuals with CF may develop overgrowth of the nasal tissue (nasal polyps) due to inflammation from chronic sinus infections. Recurrent sinonasal polyps can occur in as many as 10% to 25% of CF patients. These polyps can block the nasal passages and increase breathing difficulties.
Cardiorespiratory complications are the most common cause of death (~80%) in patients at most CF centers in the United States.
Prior to prenatal and newborn screening, cystic fibrosis was often diagnosed when a newborn infant failed to pass feces (meconium). Meconium may completely block the intestines and cause serious illness. This condition, called meconium ileus, occurs in 510% of newborns with CF. In addition, protrusion of internal rectal membranes (rectal prolapse) is more common, occurring in as many as 10% of children with CF, and it is caused by increased fecal volume, malnutrition, and increased intraabdominal pressure due to coughing.
The thick mucus seen in the lungs has a counterpart in thickened secretions from the pancreas, an organ responsible for providing digestive juices that help break down food. These secretions block the exocrine movement of the digestive enzymes into the duodenum and result in irreversible damage to the pancreas, often with painful inflammation (pancreatitis). The pancreatic ducts are totally plugged in more advanced cases, usually seen in older children or adolescents. This causes atrophy of the exocrine glands and progressive fibrosis.
The lack of digestive enzymes leads to difficulty absorbing nutrients with their subsequent excretion in the feces, a disorder known as malabsorption. Malabsorption leads to malnutrition and poor growth and development because of calorie loss. Resultant hypoproteinemia may be severe enough to cause generalized edema. Individuals with CF also have difficulties absorbing the fat-soluble vitamins A, D, E, and K.
In addition to the pancreas problems, people with cystic fibrosis experience more heartburn, intestinal blockage by intussusception, and constipation. Older individuals with CF may develop distal intestinal obstruction syndrome when thickened feces cause intestinal blockage.
Exocrine pancreatic insufficiency occurs in the majority (85% to 90%) of patients with CF. It is mainly associated with “severe” CFTR mutations, where both alleles are completely nonfunctional (e.g. F508/F508). It occurs in 10% to 15% of patients with one “severe” and one “mild” CFTR mutation where there still is a little CFTR activity, or where there are two “mild” CFTR mutations. In these milder cases, there is still sufficient pancreatic exocrine function so that enzyme supplementation is not required. There are usually no other GI complications in pancreas-sufficient phenotypes, and in general, such individuals usually have excellent growth and development. Despite this, idiopathic chronic pancreatitis can occur in a subset of pancreas-sufficient individuals with CF, and is associated with recurrent abdominal pain and life-threatening complications.
Thickened secretions also may cause liver problems in patients with CF. Bile secreted by the liver to aid in digestion may block the bile ducts, leading to liver damage. Over time, this can lead to scarring and nodularity (cirrhosis). The liver fails to rid the blood of toxins and does not make important proteins, such as those responsible for blood clotting. Liver disease is the third most common cause of death associated with CF.
The pancreas contains the islets of Langerhans, which are responsible for making insulin, a hormone that helps regulate blood glucose. Damage of the pancreas can lead to loss of the islet cells, leading to a type of diabetes that is unique to those with the disease. This cystic fibrosis-related diabetes (CFRD) shares characteristics that can be found in type 1 and type 2 diabetics, and is one of the principal nonpulmonary complications of CF.Vitamin D is involved in calcium and phosphate regulation. Poor uptake of vitamin D from the diet because of malabsorption can lead to the bone disease osteoporosis in which weakened bones are more susceptible to fractures. In addition, people with CF often develop clubbing of their fingers and toes due to the effects of chronic illness and low oxygen in their tissues.
Infertility affects both men and women. At least 97% of men with cystic fibrosis are infertile, but not sterile and can have children with assisted reproductive techniques. The main cause of infertility in men with cystic fibrosis is congenital absence of the vas deferens (which normally connects the testes to the ejaculatory ducts of the penis), but potentially also by other mechanisms such as causing no sperm, teratospermia, and few sperm with poor motility. Many men found to have congenital absence of the vas deferens during evaluation for infertility have a mild, previously undiagnosed form of CF. Approximately 20% of women with CF have fertility difficulties due to thickened cervical mucus or malnutrition. In severe cases, malnutrition disrupts ovulation and causes a lack of menstruation.
CF is caused by a mutation in the gene cystic fibrosis transmembrane conductance regulator (CFTR). The most common mutation, F508, is a deletion ( signifying deletion) of three nucleotides that results in a loss of the amino acid phenylalanine (F) at the 508th position on the protein. This mutation accounts for two-thirds (6670%) of CF cases worldwide and 90% of cases in the United States; however, there are over 1500 other mutations that can produce CF. Although most people have two working copies (alleles) of the CFTR gene, only one is needed to prevent cystic fibrosis. CF develops when neither allele can produce a functional CFTR protein. Thus, CF is considered an autosomal recessive disease.
The CFTR gene, found at the q31.2 locus of chromosome 7, is 230,000 base pairs long, and creates a protein that is 1,480 amino acids long. More specifically the location is between base pair 117,120,016 to 117,308,718 on the long arm of chromosome 7, region 3, band 1, sub-band 2, represented as 7q31.2. Structurally, CFTR is a type of gene known as an ABC gene. The product of this gene (the CFTR) is a chloride ion channel important in creating sweat, digestive juices and mucus. This protein possesses two ATP-hydrolyzing domains, which allows the protein to use energy in the form of ATP. It also contains two domains comprising 6 alpha helices apiece, which allow the protein to cross the cell membrane. A regulatory binding site on the protein allows activation by phosphorylation, mainly by cAMP-dependent protein kinase. The carboxyl terminal of the protein is anchored to the cytoskeleton by a PDZ domain interaction.
In addition, there is increasing evidence that genetic modifiers besides CFTR modulate the frequency and severity of the disease. One example is mannan-binding lectin, which is involved in innate immunity by facilitating phagocytosis of microorganisms. Polymorphisms in one or both mannan-binding lectin alleles that result in lower circulating levels of the protein are associated with a threefold higher risk of end-stage lung disease, as well as an increased burden of chronic bacterial infections.
There are several mutations in the CFTR gene, and different mutations cause different defects in the CFTR protein, sometimes causing a milder or more severe disease. These protein defects are also targets for drugs which can sometimes restore their function. F508-CFTR, which occurs in >90% of patients in the U.S., creates a protein that does not fold normally and is not appropriately transported to the cell membrane, resulting in its degradation. Other mutations result in proteins that are too short (truncated) because production is ended prematurely. Other mutations produce proteins that: do not use energy normally, do not allow chloride, iodide, and thiocyanate to cross the membrane appropriately, degrade at a faster rate than normal. Mutations may also lead to fewer copies of the CFTR protein being produced.
The protein created by this gene is anchored to the outer membrane of cells in the sweat glands, lungs, pancreas, and all other remaining exocrine glands in the body. The protein spans this membrane and acts as a channel connecting the inner part of the cell (cytoplasm) to the surrounding fluid. This channel is primarily responsible for controlling the movement of halogens from inside to outside of the cell; however, in the sweat ducts it facilitates the movement of chloride from the sweat duct into the cytoplasm. When the CFTR protein does not resorb ions in sweat ducts, chloride and thiocyanate released from sweat glands are trapped inside the ducts and pumped to the skin. Additionally hypothiocyanite, OSCN, cannot be produced by the immune defense system. Because chloride is negatively charged, this modifies the electrical potential inside and outside the cell that normally causes cations to cross into the cell. Sodium is the most common cation in the extracellular space. The excess chloride within sweat ducts prevents sodium resorption by epithelial sodium channels and the combination of sodium and chloride creates the salt, which is lost in high amounts in the sweat of individuals with CF. This lost salt forms the basis for the sweat test.
Most of the damage in CF is due to blockage of the narrow passages of affected organs with thickened secretions. These blockages lead to remodeling and infection in the lung, damage by accumulated digestive enzymes in the pancreas, blockage of the intestines by thick faeces, etc. There are several theories on how the defects in the protein and cellular function cause the clinical effects. The most current theory suggests that defective ion transport leads to dehydration in the airway epithelia, thickening mucus. In airway epithelial cells, the cilia exist in between the cell’s apical surface and mucus in a layer known as Airway Surface Liquid (ASL). The flow of ions from the cell and into this layer is determined by ion channels like CFTR. CFTR not only allows Chloride ions to be drawn from the cell and into the ASL, but it also regulates another channel called ENac. ENac allows sodium ions to leave the ASL and enter the respiratory epithelium. CFTR normally inhibits this channel, but if the CFTR is defective, then sodium will flow freely from the ASL and into the cell. As water follows sodium, the depth of ASL will be depleted and the cilia will be left in the mucous layer. As cilia cannot effectively move in a thick viscous environment, there is deficient mucociliary clearance and a buildup of mucous, clogging small airways. The accumulation of more viscous, nutrient-rich mucus in the lungs allows bacteria to hide from the body’s immune system, causing repeated respiratory infections. The presence of the same CFTR proteins in pancreatic duct and skin cells are what cause symptoms in these systems.
The lungs of individuals with cystic fibrosis are colonized and infected by bacteria from an early age. These bacteria, which often spread among individuals with CF, thrive in the altered mucus, which collects in the small airways of the lungs. This mucus leads to the formation of bacterial microenvironments known as biofilms that are difficult for immune cells and antibiotics to penetrate. Viscous secretions and persistent respiratory infections repeatedly damage the lung by gradually remodeling the airways, which makes infection even more difficult to eradicate.
Over time, both the types of bacteria and their individual characteristics change in individuals with CF. In the initial stage, common bacteria such as Staphylococcus aureus and Haemophilus influenzae colonize and infect the lungs. Eventually, Pseudomonas aeruginosa (and sometimes Burkholderia cepacia) dominates. By 18 years of age, 80% of patients with classic CF harbor P. aeruginosa, and 3.5% harbor B. cepacia. Once within the lungs, these bacteria adapt to the environment and develop resistance to commonly used antibiotics. Pseudomonas can develop special characteristics that allow the formation of large colonies, known as “mucoid” Pseudomonas, which are rarely seen in people that do not have CF.
One way infection spreads is by passing between different individuals with CF. In the past, people with CF often participated in summer “CF Camps” and other recreational gatherings. Hospitals grouped patients with CF into common areas and routine equipment (such as nebulizers) was not sterilized between individual patients. This led to transmission of more dangerous strains of bacteria among groups of patients. As a result, individuals with CF are now routinely isolated from one another in the healthcare setting, and healthcare providers are encouraged to wear gowns and gloves when examining patients with CF to limit the spread of virulent bacterial strains.
CF patients may also have their airways chronically colonized by filamentous fungi (such as Aspergillus fumigatus, Scedosporium apiospermum, Aspergillus terreus) and/or yeasts (such as Candida albicans); other filamentous fungi less commonly isolated include Aspergillus flavus and Aspergillus nidulans (occur transiently in CF respiratory secretions) and Exophiala dermatitidis and Scedosporium prolificans (chronic airway-colonizers); some filamentous fungi like Penicillium emersonii and Acrophialophora fusispora are encountered in patients almost exclusively in the context of CF. Defective mucociliary clearance characterizing CF is associated with local immunological disorders. In addition, the prolonged therapy with antibiotics and the use of corticosteroid treatments may also facilitate fungal growth. Although the clinical relevance of the fungal airway colonization is still a matter of debate, filamentous fungi may contribute to the local inflammatory response and therefore to the progressive deterioration of the lung function, as often happens with allergic broncho-pulmonary aspergillosis (ABPA) the most common fungal disease in the context of CF, involving a Th2-driven immune response to Aspergillus.
Cystic fibrosis may be diagnosed by many different methods including newborn screening, sweat testing, and genetic testing. As of 2006 in the United States, 10 percent of cases are diagnosed shortly after birth as part of newborn screening programs. The newborn screen initially measures for raised blood concentration of immunoreactive trypsinogen. Infants with an abnormal newborn screen need a sweat test to confirm the CF diagnosis. In many cases, a parent makes the diagnosis because the infant tastes salty.Trypsinogen levels can be increased in individuals who have a single mutated copy of the CFTR gene (carriers) or, in rare instances, in individuals with two normal copies of the CFTR gene. Due to these false positives, CF screening in newborns can be controversial. Most states and countries do not screen for CF routinely at birth. Therefore, most individuals are diagnosed after symptoms (e.g. sinopulmonary disease and GI manifestations) prompt an evaluation for cystic fibrosis. The most commonly used form of testing is the sweat test. Sweat-testing involves application of a medication that stimulates sweating (pilocarpine). To deliver the medication through the skin, iontophoresis is used to, whereby one electrode is placed onto the applied medication and an electric current is passed to a separate electrode on the skin. The resultant sweat is then collected on filter paper or in a capillary tube and analyzed for abnormal amounts of sodium and chloride. People with CF have increased amounts of sodium and chloride in their sweat. In contrast, people with CF have less thiocyanate and hypothiocyanite in their saliva and mucus (Banfi et al.). CF can also be diagnosed by identification of mutations in the CFTR gene.
People with CF may be listed in a disease registry that allows researchers and doctors to track health results and identify candidates for clinical trials.
Couples who are pregnant or planning a pregnancy can have themselves tested for the CFTR gene mutations to determine the risk that their child will be born with cystic fibrosis. Testing is typically performed first on one or both parents and, if the risk of CF is high, testing on the fetus is performed. The American College of Obstetricians and Gynecologists (ACOG) recommends testing for couples who have a personal or close family history of CF, and they recommend that carrier testing be offered to all Caucasian couples and be made available to couples of other ethnic backgrounds.
Because development of CF in the fetus requires each parent to pass on a mutated copy of the CFTR gene and because CF testing is expensive, testing is often performed initially on one parent. If testing shows that parent is a CFTR gene mutation carrier, the other parent is tested to calculate the risk that their children will have CF. CF can result from more than a thousand different mutations, and as of 2006 it is not possible to test for each one. Testing analyzes the blood for the most common mutations such as F508most commercially available tests look for 32 or fewer different mutations. If a family has a known uncommon mutation, specific screening for that mutation can be performed. Because not all known mutations are found on current tests, a negative screen does not guarantee that a child will not have CF.
During pregnancy, testing can be performed on the placenta (chorionic villus sampling) or the fluid around the fetus (amniocentesis). However, chorionic villus sampling has a risk of fetal death of 1 in 100 and amniocentesis of 1 in 200; a recent study has indicated this may be much lower, approximately 1 in 1,600.
Economically, for carrier couples of cystic fibrosis, when comparing preimplantation genetic diagnosis (PGD) with natural conception (NC) followed by prenatal testing and abortion of affected pregnancies, PGD provides net economic benefits up to a maternal age of approximately 40 years, after which NC, prenatal testing and abortion has higher economic benefit.
While there are no cures for cystic fibrosis, there are several treatment methods. The management of cystic fibrosis has improved significantly over the past 70 years. While infants born with cystic fibrosis 70 years ago would have been unlikely to live beyond their first year, infants today are likely to live well into adulthood. Recent advances in the treatment of cystic fibrosis have meant that an individual with cystic fibrosis can live a fuller life less encumbered by their condition. The cornerstones of management are proactive treatment of airway infection, and encouragement of good nutrition and an active lifestyle. Pulmonary rehabilitation as a management of cystic fibrosis continues throughout a person’s life, and is aimed at maximizing organ function, and therefore quality of life. At best, current treatments delay the decline in organ function. Because of the wide variation in disease symptoms, treatment typically occurs at specialist multidisciplinary centers, and is tailored to the individual. Targets for therapy are the lungs, gastrointestinal tract (including pancreatic enzyme supplements), the reproductive organs (including assisted reproductive technology (ART)) and psychological support.
The most consistent aspect of therapy in cystic fibrosis is limiting and treating the lung damage caused by thick mucus and infection, with the goal of maintaining quality of life. Intravenous, inhaled, and oral antibiotics are used to treat chronic and acute infections. Mechanical devices and inhalation medications are used to alter and clear the thickened mucus. These therapies, while effective, can be extremely time-consuming.
Many people with CF are on one or more antibiotics at all times, even when healthy, to prophylactically suppress infection. Antibiotics are absolutely necessary whenever pneumonia is suspected or there has been a noticeable decline in lung function, and are usually chosen based on the results of a sputum analysis and the person’s past response. This prolonged therapy often necessitates hospitalization and insertion of a more permanent IV such as a peripherally inserted central catheter (PICC line) or Port-a-Cath. Inhaled therapy with antibiotics such as tobramycin, colistin, and aztreonam is often given for months at a time to improve lung function by impeding the growth of colonized bacteria. Inhaled antibiotic therapy helps lung function by fighting infection, but also has significant drawbacks like development of antibiotic resistance, tinnitus and changes in the voice. Oral antibiotics such as ciprofloxacin or azithromycin are given to help prevent infection or to control ongoing infection. The aminoglycoside antibiotics (e.g. tobramycin) used can cause hearing loss, damage to the balance system in the inner ear or kidney problems with long-term use. To prevent these side-effects, the amount of antibiotics in the blood is routinely measured and adjusted accordingly.
Several mechanical techniques are used to dislodge sputum and encourage its expectoration. In the hospital setting, chest physiotherapy (CPT) is utilized; a respiratory therapist percusses an individual’s chest with his or her hands several times a day, to loosen up secretions. Devices that recreate this percussive therapy include the ThAIRapy Vest and the intrapulmonary percussive ventilator (IPV). Newer methods such as Biphasic Cuirass Ventilation, and associated clearance mode available in such devices, integrate a cough assistance phase, as well as a vibration phase for dislodging secretions. These are portable and adapted for home use.
Ivacaftor is an oral medication for the treatment of cystic fibrosis due to a number of specific mutations. It improves lung function by about 10%; however, as of 2014 is expensive.
Aerosolized medications that help loosen secretions include dornase alfa and hypertonic saline. Dornase is a recombinant human deoxyribonuclease, which breaks down DNA in the sputum, thus decreasing its viscosity.Denufosol is an investigational drug that opens an alternative chloride channel, helping to liquefy mucus. It is unclear if inhaled corticosteroids are useful.
As lung disease worsens, mechanical breathing support may become necessary. Individuals with CF may need to wear special masks at night that help push air into their lungs. These machines, known as bilevel positive airway pressure (BiPAP) ventilators, help prevent low blood oxygen levels during sleep. BiPAP may also be used during physical therapy to improve sputum clearance. During severe illness, a tube may be placed in the throat (a procedure known as a tracheostomy) to enable breathing supported by a ventilator.
For children, preliminary studies show massage therapy may help people and their families quality of life. It is unclear what effect pneumococcal vaccination has as it has not been studied as of 2014.
Lung transplantation often becomes necessary for individuals with cystic fibrosis as lung function and exercise tolerance decline. Although single lung transplantation is possible in other diseases, individuals with CF must have both lungs replaced because the remaining lung might contain bacteria that could infect the transplanted lung. A pancreatic or liver transplant may be performed at the same time in order to alleviate liver disease and/or diabetes. Lung transplantation is considered when lung function declines to the point where assistance from mechanical devices is required or someone’s survival is threatened.
Newborns with intestinal obstruction typically require surgery, whereas adults with distal intestinal obstruction syndrome typically do not. Treatment of pancreatic insufficiency by replacement of missing digestive enzymes allows the duodenum to properly absorb nutrients and vitamins that would otherwise be lost in the feces. However, the best dosage and form of pancreatic enzyme replacement is unclear, as are the risks and long-term effectiveness of this treatment.
So far, no large-scale research involving the incidence of atherosclerosis and coronary heart disease in adults with cystic fibrosis has been conducted. This is likely due to the fact that the vast majority of people with cystic fibrosis do not live long enough to develop clinically significant atherosclerosis or coronary heart disease.
Diabetes is the most common non-pulmonary complication of CF. It mixes features of type 1 and type 2 diabetes, and is recognized as a distinct entity, cystic fibrosis-related diabetes (CFRD). While oral anti-diabetic drugs are sometimes used, the only recommended treatment is the use of insulin injections or an insulin pump, and, unlike in type 1 and 2 diabetes, dietary restrictions are not recommended.
Development of osteoporosis can be prevented by increased intake of vitamin D and calcium, and can be treated by bisphosphonates, although adverse effects can be an issue. Poor growth may be avoided by insertion of a feeding tube for increasing calories through supplemental feeds or by administration of injected growth hormone.
Sinus infections are treated by prolonged courses of antibiotics. The development of nasal polyps or other chronic changes within the nasal passages may severely limit airflow through the nose, and over time reduce the person’s sense of smell. Sinus surgery is often used to alleviate nasal obstruction and to limit further infections. Nasal steroids such as fluticasone are used to decrease nasal inflammation.
Female infertility may be overcome by assisted reproduction technology, particularly embryo transfer techniques. Male infertility caused by absence of the vas deferens may be overcome with testicular sperm extraction (TESE), collecting sperm cells directly from the testicles. If the collected sample contains too few sperm cells to likely have a spontaneous fertilization, intracytoplasmic sperm injection can be performed.Third party reproduction is also a possibility for women with CF. It is unclear if taking antioxidants affects outcomes.
The prognosis for cystic fibrosis has improved due to earlier diagnosis through screening, better treatment and access to health care. In 1959, the median age of survival of children with cystic fibrosis in the United States was six months. In 2010, survival is estimated to be 37 years for women and 40 for men. In Canada, median survival increased from 24 years in 1982 to 47.7 in 2007.
Of those with cystic fibrosis who are more than 18 years old as of 2009, 92% had graduated from high school, 67% had at least some college education, 15% were disabled and 9% were unemployed, 56% were single and 39% were married or living with a partner.
Chronic illnesses can be very difficult to manage. Cystic fibrosis (CF) is a chronic illness that affects the “digestive and respiratory tracts resulting in generalized malnutrition and chronic respiratory infections”. The thick secretions clog the airways in the lungs, which often cause inflammation and severe lung infections. If it is compromised, it affects the quality of life of someone with CF and their ability to complete such tasks as everyday chores. It is important for CF patients to understand the detrimental relationship that chronic illnesses place on the quality of life. According to Schmitz and Goldbeck (2006), the fact that cystic fibrosis significantly increases emotional stress on both the individual and the family, “and the necessary time-consuming daily treatment routine may have further negative effects on quality of life (QOL)”. However, Havermans and colleagues (2006) have shown that young outpatients with CF who have participated in the CFQ-R (Cystic Fibrosis Questionnaire-Revised) “rated some QOL domains higher than did their parents”. Consequently, outpatients with CF have a more positive outlook for themselves. Furthermore, there are many ways to improve the QOL in CF patients. Exercise is promoted to increase lung function. Integrating an exercise regimen into the CF patients daily routine can significantly improve the quality of life. There is no definitive cure for cystic fibrosis. However, there are diverse medications used, such as mucolytics, bronchodilators, steroids, and antibiotics, that have the purpose of loosening mucus, expanding airways, decreasing inflammation, and fighting lung infections.
Cystic fibrosis is the most common life-limiting autosomal recessive disease among people of European heritage. In the United States, approximately 30,000 individuals have CF; most are diagnosed by six months of age. In Canada, there are approximately 4,000 people with CF. Approximately 1 in 25 people of European descent, and one in 30 of Caucasian Americans, is a carrier of a cystic fibrosis mutation. Although CF is less common in these groups, approximately 1 in 46 Hispanics, 1 in 65 Africans and 1 in 90 Asians carry at least one abnormal CFTR gene. Ireland has the world’s highest prevalence of cystic fibrosis, at 1:1353.
Although technically a rare disease, cystic fibrosis is ranked as one of the most widespread life-shortening genetic diseases. It is most common among nations in the Western world. An exception is Finland, where only one in 80 people carry a CF mutation. The World Health Organization states that “In the European Union, 1 in 20003000 newborns is found to be affected by CF”. In the United States, 1 in 3,500 children are born with CF. In 1997, about 1 in 3,300 caucasian children in the United States was born with cystic fibrosis. In contrast, only 1 in 15,000 African American children suffered from cystic fibrosis, and in Asian Americans the rate was even lower at 1 in 32,000.
Cystic fibrosis is diagnosed in males and females equally. For reasons that remain unclear, data has shown that males tend to have a longer life expectancy than females, however recent studies suggest this gender gap may no longer exist perhaps due to improvements in health care facilities, while a recent study from Ireland identified a link between the female hormone estrogen and worse outcomes in CF.
The distribution of CF alleles varies among populations. The frequency of F508 carriers has been estimated at 1:200 in northern Sweden, 1:143 in Lithuanians, and 1:38 in Denmark. No F508 carriers were found among 171 Finns and 151 Saami people. F508 does occur in Finland, but it is a minority allele there. Cystic fibrosis is known to occur in only 20 families (pedigrees) in Finland.
The F508 mutation is estimated to be up to 52,000 years old. Numerous hypotheses have been advanced as to why such a lethal mutation has persisted and spread in the human population. Other common autosomal recessive diseases such as sickle-cell anemia have been found to protect carriers from other diseases, a concept known as heterozygote advantage. Resistance to the following have all been proposed as possible sources of heterozygote advantage:
It is supposed that CF appeared about 3,000 BC because of migration of peoples, gene mutations, and new conditions in nourishment. Although the entire clinical spectrum of CF was not recognized until the 1930s, certain aspects of CF were identified much earlier. Indeed, literature from Germany and Switzerland in the 18th century warned “Wehe dem Kind, das beim Ku auf die Stirn salzig schmekt, er ist verhext und muss bald sterbe” or “Woe to the child who tastes salty from a kiss on the brow, for he is cursed and soon must die,” recognizing the association between the salt loss in CF and illness.
In the 19th century, Carl von Rokitansky described a case of fetal death with meconium peritonitis, a complication of meconium ileus associated with cystic fibrosis. Meconium ileus was first described in 1905 by Karl Landsteiner. In 1936, Guido Fanconi published a paper describing a connection between celiac disease, cystic fibrosis of the pancreas, and bronchiectasis.
In 1938 Dorothy Hansine Andersen published an article, “Cystic Fibrosis of the Pancreas and Its Relation to Celiac Disease: a Clinical and Pathological Study,” in the American Journal of Diseases of Children. She was the first to describe the characteristic cystic fibrosis of the pancreas and to correlate it with the lung and intestinal disease prominent in CF. She also first hypothesized that CF was a recessive disease and first used pancreatic enzyme replacement to treat affected children. In 1952 Paul di SantAgnese discovered abnormalities in sweat electrolytes; a sweat test was developed and improved over the next decade.
The first linkage between CF and another marker (Paroxonase) was found in 1985 by Hans Eiberg, indicating that only one locus exists for CF. In 1988 the first mutation for CF, F508 was discovered by Francis Collins, Lap-Chee Tsui and John R. Riordan on the seventh chromosome. Subsequent research has found over 1,000 different mutations that cause CF.
Because mutations in the CFTR gene are typically small, classical genetics techniques had been unable to accurately pinpoint the mutated gene. Using protein markers, gene-linkage studies were able to map the mutation to chromosome 7. Chromosome-walking and -jumping techniques were then used to identify and sequence the gene. In 1989 Lap-Chee Tsui led a team of researchers at the Hospital for Sick Children in Toronto that discovered the gene responsible for CF. Cystic fibrosis represents a classic example of how a human genetic disorder was elucidated strictly by the process of forward genetics.
Gene therapy has been explored as a potential cure for cystic fibrosis. Results from trials have shown limited success as of 2013. A small study published in 2015 found a small benefit.
The focus of much cystic fibrosis gene therapy research is aimed at trying to place a normal copy of the CFTR gene into affected cells. Transferring the normal CFTR gene into the affected epithelium cells would result in the production of functional CFTR in all target cells, without adverse reactions or an inflammation response. Studies have shown that to prevent the lung manifestations of cystic fibrosis, only 510% the normal amount of CFTR gene expression is needed. Multiple approaches have been tested for gene transfer, such as liposomes and viral vectors in animal models and clinical trials. However, both methods were found to be relatively inefficient treatment options. The main reason is that very few cells take up the vector and express the gene, so the treatment has little effect. Additionally, problems have been noted in cDNA recombination, such that the gene introduced by the treatment is rendered unusable. There has been a functional repair in culture of CFTR by CRISPR/Cas9 in intestinal stem cell organoids of cystic fibrosis patients.
A number of small molecules that aim at compensating various mutations of the CFTR gene are under development. One approach is to develop drugs that get the ribosome to overcome the stop codon and synthesize a full-length CFTR protein. About 10% of CF result from a premature stop codon in the DNA, leading to early termination of protein synthesis and truncated proteins. These drugs target nonsense mutations such as G542X, which consists of the amino acid glycine in position 542 being replaced by a stop codon. Aminoglycoside antibiotics interfere with protein synthesis and error-correction. In some cases, they can cause the cell to overcome a premature stop codon by inserting a random amino acid, thereby allowing expression of a full-length protein. The aminoglycoside gentamicin has been used to treat lung cells from CF patients in the laboratory to induce the cells to grow full-length proteins. Another drug targeting nonsense mutations is ataluren, which is undergoing Phase III clinical trials as of October 2011[update].
It is unclear as of 2014 if ursodeoxycholic acid is useful for those with cystic fibrosis-related liver disease.
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Posted: March 26, 2016 at 3:45 am
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Journal of Bioethical Inquiry(vol. 12, no. 4, 2015) is available online by subscription only. Articles include: Vaccine Refusal and Trust: The Trouble with Coercion and Education and Suggestions for a Cure by Johan Christiaan Bester Intellectual Property in Genetic Material Read More
December 29, 2015
(The Washington Post) But the discussion reflects a broader truth: We live in an age in which machine intelligence has become a part of daily life. Computers fly planes and soon will drive cars. Computer algorithms anticipate our needs Read More
Posted: March 16, 2015 at 4:41 pm
Politics By Amanda Andrade-Rhoades, Mon, March 16, 2015
Thanks to the Affordable Care Act, also known as Obamacare, more than 16 million Americans now have health insurance.
According to The Huffington Post, Health and Human Services issued a report that found the uninsured rate has fallen from 20.3 percent in October 2013, when enrollment in Obamacare was opened, to 12.3 percent this year. Health and Human Services partnered with the polling company Gallup to determine the number of people who now have health insurance.
Since the passage of the Affordable Care Act almost five years ago, about 16.4 million uninsured people have gained health coverage — the largest reduction in the uninsured in four decades,” Health and Human Services Secretary Sylvia Mathews wrote in a statement.
In addition to enrollment in the Affordable Care Act, another 14.1 million people acquired health insurance by joining a private plan or Medicaid.
The government plans to push for more sign-ups and will spend $1.2 trillion over the next decade expanding health coverage. That estimate is lower than what the Congressional Budget Office projected in January.
The fate of Obamacare still hangs in the balance. The Supreme Court is considering the case of King v. Burwell, which could result in 9.6 million people becoming uninsured if the court rules in favor of David King, jacking up the price of healthcare.
Source: The Huffington Post Image via Healthcare Costs/Flickr
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16.4 Million People Now Have Health Insurance Due To Obamacare
Posted: March 10, 2015 at 3:44 am
2015 1st Annual UCLA HBA Healthcare Conference: Lunch Keynote – Peter Diamandis
Peter H. Diamandis, M.D. X PRIZE Foundation, Chairman CEO Human Longevity Inc. (HLI), Co-Founder Vice-Chairman.
By: UCLA Anderson HBA
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2015 1st Annual UCLA HBA Healthcare Conference: Lunch Keynote – Peter Diamandis – Video
Posted: at 3:44 am
Adults with the common chronic skin condition eczema had higher out-of-pocket health care costs, more lost workdays, poorer overall health, more health care utilization and impaired access to care compared to adults without eczema, according to an article published online by JAMA Dermatology.
The prevalence of adult eczema (or atopic dermatitis, AD) is estimated to be about 10.2 percent in U.S. adults and similarly about 10.7 percent in U.S. children. However, little is known about the direct and indirect costs of adult eczema and recent cost estimates for the disease are lacking, according to the study background.
Jonathan I. Silverberg, M.D., Ph.D, M.P.H., of the Northwestern University Feinberg School of Medicine, Chicago, examined those costs by analyzing data from two population-based studies between 2010 and 2012 that surveyed 27,157 and 34,613 adults, respectively.
The study results show that adults with eczema paid more than $37.7 billion and $29.3 billion in out-of-pocket health care costs in 2010 and 2012, respectively (an average of $371 and $489 per person-year). Adults with eczema also were more likely to have six or more lost workdays due to any cause than those adults without eczema, and having eczema was associated with increased odds of physician visits, urgent care or emergency department visits, and hospitalizations. There also were differences in access to care, including adults with eczema being unable to afford prescription medications and having higher odds of delayed care because they cannot get a medical appointment soon enough, reach a physician’s office or having to wait too long to see a physician. Adults with eczema also were more likely to have delayed care or no care because of worry about the related costs, according to the results.
“This study demonstrates that adults with eczema have a major health burden with significantly increased health care utilization and costs. Future studies are needed to identify the determinants of health care utilization and access in adults with eczema,” the study concludes.
(JAMA Dermatology. Published online march 4, 2015. doi:10.1001/jamadermatol.2014.5432. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor’s Note: This study was made possible with support from the Agency for Healthcare Research and Quality. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Media Advisory: To contact author Jonathan I. Silverberg, M.D., Ph.D., M.P.H., call Marla Paul at 312-503-8928 or email firstname.lastname@example.org.
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