Thursday, March 23, 2017

6 ways to use your mind to control pain

Bublished: April, 2015

Relaxation, meditation, positive thinking, and other mind-body techniques can help reduce your need for pain medication.

Drugs are very good at getting rid of pain, but they often have unpleasant, and even serious, side effects when used for a long time. If you have backache, fibromyalgia, arthritis, or other chronic pain that interferes with your daily life, you may be looking for a way to relieve discomfort that doesn't involve drugs. Some age-old techniques—including meditation and yoga—as well as newer variations may help reduce your need for pain medication.
Research suggests that because pain involves both the mind and the body, mind-body therapies may have the capacity to alleviate pain by changing the way you perceive it. How you feel pain is influenced by your genetic makeup, emotions, personality, and lifestyle. It's also influenced by past experience. If you've been in pain for a while, your brain may have rewired itself to perceive pain signals even after the signals aren't being sent anymore.
The Benson-Henry Institute for Mind-Body Medicine at Harvard-affiliated Massachusetts General Hospital specializes in helping people learn techniques to alleviate stress, anxiety, and pain. Dr. Ellen Slawsby, an assistant clinical professor of psychiatry at Harvard Medical School who works with patients at the Benson-Henry Institute, suggests learning several techniques so that you can settle on the ones that work best for you. "I tend to think of these techniques as similar to flavors in an ice cream store. Depending on your mood,you might want a different flavor of ice cream—or a different technique," Dr. Slawsby says. "Practicing a combination of mind-body skills increases the effectiveness of pain relief."
The following techniques can help you take your mind off the pain and may help to override established pain signals.
1. Deep breathing. It's central to all the techniques, so deep breathing is the one to learn first. Inhale deeply, hold for a few seconds, and exhale. To help you focus, you can use a word or phrase to guide you. For example, you may want to breathe in "peace" and breathe out "tension." There are also several apps for smartphones and tablets that use sound and images to help you maintain breathing rhythms.
2. Eliciting the relaxation response. An antidote to the stress response, which pumps up heart rate and puts the body's systems on high alert, the relaxation response turns down your body's reactions. After closing your eyes and relaxing all your muscles, concentrate on deep breathing. When thoughts break through, say "refresh," and return to the breathing repetition. Continue doing this for 10 to 20 minutes. Afterward, sit quietly for a minute or two while your thoughts return. Then open your eyes and sit quietly for another minute.
3. Meditation with guided imagery. Begin deep breathing, paying attention to each breath. Then listen to calming music or imagine being in a restful environment. If you find your mind wandering, say "refresh," and call the image back into focus.
4. Mindfulness. Pick any activity you enjoy—reading poetry, walking in nature, gardening, or cooking—and become fully immersed in it. Notice every detail of what you are doing and how your senses and emotions are responding. Practice bringing mindfulness to all aspects of your life.
5. Yoga and tai chi. These mind-body exercises incorporate breath control, meditation, and movements to stretch and strengthen muscles. Videos and apps can help you get started. If you enroll in a yoga or tai chi class at a gym or health club, your health insurance may subsidize the cost.

6. Positive thinking. "When we're ill, we often tend to become fixated on what we aren't able to do. Retraining your focus on what you can do instead of what you can't will give you a more accurate view of yourself and the world at large," says Dr. Slawsby. She advises keeping a journal in which you list all the things you are thankful for each day. "We may have limitations, but that doesn't mean we aren't still whole human beings."

Wednesday, March 22, 2017

Is ADHD overdiagnosed and overtreated?

POSTED MARCH 16, 2017, 10:00 AM , UPDATED MARCH 18, 2017, 7:58 AM

Updates in Slow Medicine, Contributing Editors

Pieter Cohen, M.D., Michael Hochman, M.D., M.P.H., Rachael Bedard, M.D.
Follow us on Twitter @slowmedupdates

Gretchen LeFever Watson, then a clinical psychologist at Eastern Virginia Medical School, wanted to understand how many children had been diagnosed with attention deficit hyperactivity disorder (ADHD) at elementary schools in Virginia communities. Her findings among the 30,000 children she studied in the 1990s foreshadowed a national pattern: rates of ADHD varied widely among districts, and the rates in some communities were much higher than predicted. In some school districts, by the fifth grade 28% of boys had been diagnosed with ADHD. In other communities, being young for one’s grade increased the chances of being prescribed stimulants 20-fold. Her findings garnered national attention and additional research funding, including a major grant from the Centers for Disease Control and Prevention.
LeFever Watson’s success, unfortunately, was abruptly cut short after her medical school received an anonymous letter accusing her of academic fraud. She was placed on administrative leave, and her computers were confiscated. After a university investigation found no evidence of fraud, she was vindicated, but the effects were devastating. Dr. Watson describes the impact of the accusation as contributing “to the suppression of a large and unique dataset of risk and protective factors associated with ADHD diagnosis and treatment [and] to the total dismantling of a school health coalition… that showed promise for improving ADHD care.”
The relationship between ADHD, academic experts, and the pharmaceutical companies who promote stimulants for ADHD is at the core of Alan Schwarz’ new book, ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic. As a journalist for the New York Times, Schwarz has spent years investigating the link between the pharmaceutical industry and the diagnosis and treatment of ADHD. His articles have vividly described some of the devastating psychological dangers of stimulants. His book summarizes these concerns and puts new focus on the ADHD experts who have shaped the current environment.
Many of the book’s themes will be well known to readers. For one, ADHD is overdiagnosed. Experts estimate that 5% is a realistic upper limit of children with the disorder, but in many areas of the country, as Watson found in Virginia, up to 33% of white boys are diagnosed with ADHD. By 2011 several states reported rates greater than 13% among both boys and girls. Schwarz explores how this came to pass. He investigates pharmaceutical companies’ collaboration with leading academic experts and celebrities (including Adam Levine) combined with aggressive direct-to-consumer advertising campaigns to boost recognition of and pharmacotherapy for the condition. Unlike Watson, many scientists that Schwartz profiles permit their research and expertise to be coopted by companies keen on maximizing profit.
Schwarz acknowledges that many children are appropriately diagnosed with ADHD and that a subset of these children will benefit from stimulants. What he helps us understand is the forces that have led clinicians to misdiagnose millions of children with the disease and, far too often, to prescribe stimulants that expose children to more harm than good.

Sunday, February 5, 2017

For a healthy brain, treat high blood pressure

Blood pressure medications might lower your risk for Alzheimer's and other types of dementia.
Fighting high blood pressure also fights dementia—and studies hint that successful hypertension treatment may lower a person's risk of memory loss, thinking problems, and even Alzheimer's disease.
"There seems to be a synergistic process in which a person's risk factors for cardiovascular disease work together to decrease cognitive function in general," suggests Dr. Robert Green, associate professor at Harvard Medical School and Brigham and Women's Hospital. Dr. Green studies the genetics of Alzheimer's disease and other neurological conditions.
What the evidence shows
New studies recently published online in the journal Neurology offer intriguing evidence that drug treatments for high blood pressure may go beyond just stroke prevention to include lowering dementia risk across the board. For example:
  • A study of 2,197 over-70 men in the Honolulu-Asia Aging Study suggested that after six years, those taking beta blockers (a class of blood pressure drugs) may have had a 31% lower risk of mild cognitive impairment than men not taking beta blockers, even if they were on other blood pressure drugs. No protection was seen in men whose blood pressure remained high despite beta blocker treatment.
  • A study of nearly 2,000 normal adults over age 75 in the Ginkgo Evaluation in Memory Study found no protection from ginkgo supplements—but found that those taking any of several classes of blood pressure–lowering drugs had a 42% to 59% lower risk of Alzheimer's disease.
High blood pressure is "not just the No. 1, but also the No. 2 and No. 3 most important risk factor for stroke," notes Dr. Sudha Seshadri, professor of neurology at Boston University School of Medicine. "Stroke, because it takes out part of the brain, doubles the risk of having dementia."
Blood pressure drugs are safe and widely used, so it makes sense to look at them as possible modifiers of dementia progression, Dr. Seshadri says. She is quick to add that these studies do not prove blood pressure drugs have an anti-Alzheimer's effect, and that they don't explain why being on blood pressure medication might prevent or delay dementia.
High BP makes brain vulnerable
The new studies aren't the first to link blood pressure–lowering drugs to decreased dementia risk. Over all, the evidence is contradictory. Some earlier studies found effects for one class of drugs, others found effects for other classes, and some found little or no effect. A recent analysis of these studies was unable to find that any particular medication was better than others at dementia prevention.
"High blood pressure does mean poorer performance in some cognitive domains, but the link to dementia is less clear," Dr. Seshadri says. "Is it that hypertension is bad for your brain, or that being on anti-hypertensive medication is good for your brain? It is hard to separate the two."
Over the course of a lifetime, many people may accumulate small injuries to the blood vessels of the brain that impair brain function. "So you want to minimize all the potential for further injury," he says. "In that context high blood pressure is another risk factor, both at the macro level of stroke and at the micro level of the mental slowness and sluggishness we may experience as we get older."
Dr. Seshadri agrees that there are many factors and many pathways that eventually lead to the breakdown of brain function we call dementia. High blood pressure likely plays a role in this decline.
Overall heart health best
At this point, no one is advising people with normal blood pressure to take antihypertensive drugs to prevent dementia. But the research offers another good reason to make lifestyle changes to reduce or control blood pressure.
"The feeling among neurologists is that hypertension does increase risk of dementia," Dr. Seshadri says. "This is probably true for people who develop high blood pressure in their 30s and 40s, but might also be true for high blood pressure starting later in life, when people are at most risk of dementia."
Hypertension isn't the only heart disease risk factor that contributes to dementia risk.

"Heart health takes a multifactorial approach—lowering cholesterol, watching your blood pressure, eating healthy foods, staying active—and so does brain health," Dr. Seshadri says. "If you can get everything up to speed and fix what is vulnerable, you may keep both your heart and your brain running better."?

Friday, February 3, 2017

How to tame stubbornly high blood pressure

How to tame stubbornly high blood pressure

How to tame stubbornly high blood pressure

Resistant hypertension poses a serious threat to your heart's health.
About one in three American adults has high blood pressure, defined as a top (systolic) blood pressure reading of 140 or higher or a bottom (diastolic) reading of 90 or higher. Also known as hypertension, this often-symptomless condition is a leading cause of stroke and heart attack. The good news is that more people have their blood pressure under control than in years past. The bad news? Nearly 10 percent of people who've been prescribed multiple medications to treat their hypertension still have dangerously elevated blood pressure readings.

Defining resistant HTN

"When people have high blood pressure despite being on three different medications, including a thiazide diuretic, they have what's known as resistant hypertension," says Dr. Joshua Beckman, a cardiologist at Harvard-affiliated Brigham and Women's Hospital. (Thiazide diuretics are often the first drugs doctors prescribe for high blood pressure.)
Resistant hypertension is especially worrisome because the risk of death from heart attack and stroke rises in tandem with blood pressure. But pinpointing the underlying cause can be tricky. For instance, some people who appear to have resistant hypertension may have "white-coat hypertension," which refers to an abnormally high blood pressure reading in a medical setting. The problem is thought to result from stress or anxiety, which raises blood pressure. To rule this out, your doctor may recommend using a home blood pressure monitor, or send you home with a device that automatically takes your blood pressure every 15 to 30 minutes over a 24-hour period.
Some people with apparent resistant hypertension simply may not be taking their medicines. Dr. Beckman suspects this may be the reason for many cases of resistant hypertension, a conclusion he bases on his involvement in a major clinical trial to address the problem. In a group of people thought to have resistant hypertension, researchers compared an experimental catheter-based procedure with the standard drug therapy—in this case, a regimen of at least three blood pressure medications. "But once we got them in the study and following a closely tracked drug regimen, some of them no longer had resistant hypertension," says Dr. Beckman.

Blood pressure drugs: Many options and combinations

There are more than 200 different drugs to treat high blood pressure. They fall into several classes:
  • diuretics
  • ACE inhibitors and angiotensin-receptor blockers
  • calcium-channel blockers
  • beta blockers
  • aldosterone blockers.
Exactly which classes of blood pressure medications your doctor prescribes may depend on other medical conditions you have, such as angina or atrial fibrillation. Side effects can also limit which classes of medications are used. Many commonly prescribed drugs are available as generics. Combination medications pack two different classes into one pill, such as a diuretic with a beta blocker or an ACE inhibitor with a calcium-channel blocker.

Wednesday, February 1, 2017

Avoiding ADHD’s Wide Net: One Parent, One Child at a Time

Alternatives to consider before accepting an ADHD diagnosis (and drugs).

Posted Sep 09, 2015

ustin is eight years old and his parents and grandparents think he has ADHD. At home he is irritable and difficult to manage. He doesn’t socialize well with friends at school and his academic performance doesn’t match his ability. 
After spending a few days with his grandparents, Justin’s behavior does a flip-flop—he is calmer, less combative and impulsive. His grandparents are concerned that once diagnosed with ADHD, a clear possibility, Justin will be prescribed Adderall or Ritalin. Given the current trend of putting young children on stimulant or similar medications, Justin’s grandparents are probably correct.
The number of children diagnosed with ADHD is staggering. Some 11 million young children and high school students in this country are labeled ADHD and two-thirds of them take stimulant drugs. These are stunning numbers, frightening if you have a young child diagnosed with ADHD who may wind up taking one of these drugs, often for life.  They can have some very unpleasant side effects and are addictive.
Have We Been Misled?

Source: Avery/Penguin Group
In less than 30 years, the ADHD “disorder” that applied to 3 percent of US children in 1987 skyrocketed to 11 percent and growing. Not so in other countries, making it a uniquely American epidemic. In her book, A Disease Called Childhood: Why ADHD Became an American Epidemic, Marilyn Wedge, PhD, a family therapist, explains the explosion in detail and offers sensible and, in many cases, must-try alternatives when parents are urged to use drugs to alter what might be an emotional or behavioral problem and not a “biological disorder.”
A confluence of factors created the rise of ADHD to its current and widespread proportions. In an engaging and well-documented manner, Wedge explains how the Diagnostic and Statistical Manual of Mental disorders (DSM), a reference manual written by the American Psychiatric Association, broadened its definition of ADHD sweeping in more children under the ADD/ADHD umbrella. For example, the 1968 edition defined ADD as “short attention span, restlessness, distractibility and over activity, especially in young children,” noting that such behavior “usually diminishes in adolescence.”
By 1980 the definition expanded to include children who were disorganized, procrastinated, and acted impulsively, and in 1987 ADD (attention deficit disorder) became ADHD, or ADD with hyperactivity, in the DSM version III.
Throughout the 1990s the distinction between what might be a central nervous system disorders and factors like abuse, problems at school or issues in the home became blurred. In later editions many of the DSM markers to make an ADHD diagnosis were widened to cover: difficulty waiting for his turn, fidgets, makes careless mistakes or is impulsive, to name a few qualities that are, for many children, just part of childhood.
Over the years, while the various editions of the DSM stretched the definition of ADHD, academics from prestigious universities jumped on the drug bandwagon, some being paid by the pharmaceutical companies. The movement to “tame” our children with drugs became ubiquitous.
Avoiding ADHD’s Wide Net
As Wedge points out, one can’t help but think that “society has moved the goalposts of normal childhood.” Wedge urges parents to consider what might be causing the troubling behaviors and make adjustments within the family or at school before popping pills into their child’s mouth. 
Did all of these children need to be drugged in the first place? Wedge thinks not. Her case is solid and should make physicians, psychiatrists, teachers, and most of all, parents carefully evaluate what is going on in their child’s life that may be causing inattention, hyperactivity, anxiety or other behaviors so quickly given an ADHD diagnosis followed by a prescription.
Before you accept an ADHD diagnosis, as a parent it is your responsibility to consider what might be causing your child’s difficult behaviors: Are you and your spouse arguing? Might your child fear a divorce? Is your child being bullied at school? Is something amiss between siblings that you may be unaware of and that your child sees as upsetting or threatening? How much food dye is in the foods the child eats? What TV programs does he watch—might they be too fast-paced or violent and are they having a negative effect on your son or daughter’s ability to concentrate?
One Parent, One Child at a Time
Most parents today are attempting to raise “star” children. Might your child feel pressured to perform and succeed? It is true that stimulant drugs improve focus and attention—just ask college students, some 35 percent use them whether or not they have an ADHD diagnosis. Wedge puts it this way, “Our expectations have changed and parents seek medication for their kids primarily to drive them to raise their grades.”
Before you agree to Ritalin, Adderall and similar drugs for your child or teen who isn’t acting and/or achieving exactly as you hoped he or she would, bear in mind that according to the Drug Enforcement Administration, these drugs are “as addictive and subject to abuse as cocaine and morphine.”
The pharmaceutical industry has lots to lose when parents reject drugs designed to get troublesome children to do well in school and to behave at home and  look for the root cause of a child’s behavioral or emotional problem and decide to fix it without resorting to the drugs of the day. With one parent and one child at a time, we can stop the ADHD epidemic by not being so quick to diagnose ADHD and medicate as if it were a panacea in every case.
Postscript: The central issues causing Justin’s behavior were not biological, but rather stemmed from the friction and animosity between his parents. As they worked on their problems and showed a more unified front with regard to Justin, the boy’s behavior gradually improved. No Adderall or Ritalin needed. Justin’s parents and grandparents credit A Disease Called Childhood for inspiring them to look into alternatives to stimulant drugs to help Justin.

Sunday, January 29, 2017

Should you plan your leisure time, or does that take the fun out of it?

Should you plan your leisure time, or does that take the fun out of it?

MARCH 30, 2016

n the common narrative, we are all scheduled to the hilt. Our work lives are dictated by 15-minute slots on Outlook. So should you treat your leisure time the same way, scheduling in that workout and drinks with a friend?
No! Say researchers at Washington University. According to a series of studies (written up in Time -- originally in Health -- see link here), people who schedule their leisure time enjoy it less. It feels too much like work.
Longtime readers know I am quite a planner, and so I have to admit, I have been puzzling over this contribution to the marketplace of ideas since alert reader ARC sent me that link. I feel this conclusion is lacking some nuance, much like people used to think that fat makes you fat, and now we know it is not so simple. Other research has found that anticipation accounts for a major chunk of human happiness. It is hard to anticipate something you haven’t planned.
There are likely some other things going on too. Some people hate to plan and some people love to plan. If a study (and maybe the population at large) had more “Ps” than “Js” in the old Myers-Briggs taxonomy, you might decide that planning was problematic, when in reality it is problematic for some people and not for others. I also think it is quite possible that the researchers hit upon the phenomenon that we never feel perfect bliss in the moment. You can be unhappy at a party you have looked forward to for months because your feet hurt. (I would point out -- if you planned to go, and enjoyed the anticipation, however, you still reaped real enjoyment! Just not during. But does it have to be during to count?).
But anyway, let us say this conclusion is true: planning our leisure means we enjoy it less. So what? The problem with accepting the logical conclusion -- stop planning your leisure time! -- is that in order to enjoy leisure time at all it has to happen. And if you have a busy life with moving parts -- for instance, if you are a working parent of small children -- you have to plan or there will be no leisure in your life beyond watching TV. That is the easiest thing to do, and it does not require any planning to do during the downtime that presents itself after the kids go to bed or are occupied with other things.
Now I grant that watching TV with a glass of wine can certainly be fun. I will even grant that if you have a dinner reservation at a hot restaurant with your two best friends -- which required coordinating with their schedules, and calling the restaurant, and booking a sitter if you are the sole adult in charge -- you may, while sitting on the couch watching TV, feel like it is a bit of trouble to roust yourself, get dressed, give the sitter instructions, and so forth. If a researcher talked with you at that moment, you might express your displeasure. However, in the grand scheme of things, you will probably still be happy you went. The evening will be a source of more happy memories than sitting on the couch with the wine would be.
I think this gets at the distinction between effortless fun, and effortful fun. Because effortful fun involves, well, effort, and effort can be unpleasant, it is always easier to under-invest in this side of life. But if we refuse to engage in effortful fun because of that unpleasantness, this would basically mean a life of no parties, no performances that could not be decided on as you were walking past the venue at the last possible second, no getting together with friends who have busy schedules, no book clubs, no volunteer gigs, etc. I find it hard to believe that such a life would be more enjoyable than one that was better planned.
In other news: The New York Times ran a very nice profile of my brother-in-law and his work in health care.
In other, other news: I am writing a piece about how to become an "intellectual middleman/woman." A lot of innovation is about combining ideas from disparate fields. So how do you expose yourself to different ideas? Some suggestions so far: following different thought leaders on Twitter, buying new magazines to fill the white space of airport wait time, etc.

Thursday, January 26, 2017


10 Homework & Study Tips for Students with ADHD/ADD

Jan 02, 2017

Every child will likely have trouble with homework at some point. But for children with ADD and ADHD, the problem can go beyond a few assignments. Among other things, children with ADD and ADHD face challenges with focusing, patience, and organizing. These challenges can make it hard for students to perform to the best of their potential in, and out of, the classroom.
Children with ADD and ADHD can be hasty, rushing through their homework and making mistakes. They may lose homework, struggle to organize thoughts and tasks, and fail to plan ahead.
The challenges your child faces can be overcome with practiced habits and proper study skills for ADD/ADHD students. With these 10 ADD/ADHD homework tips, your child can learn how to focus on homework with ADD/ADHD and achieve success in the classroom.


Children with ADD and ADHD can be easily distracted by their surroundings. Find a comfortable place where your child can work with few distractions. Use this as a quiet study space away from noise and movement where your child can clear his or her mind and focus.

It is important for kids with ADD/ADHD to have a consistent routine. This will help your child start his or her homework and focus. Set a time each day for your child to sit down and complete his or her work.
ADD and ADHD can make it hard to focus, so breaks are a must. Studying in short spurts can help. Give your child regular breaks from homework for a snack or a walk, and let the mind refresh and reset! This will give your child a chance to burn off extra energy and improve concentration when he or she returns.
It’s hard to always know what is happening with your child at school. Talking to his or her teacher can help make sure you’re informed. Ask the teacher about sending regular reports on your child and updates on homework assignments. If possible, meet with them every few weeks and for progress reports. Knowing what is going on in the classroom can help you and your child’s teacher make changes to make sure your child is learning effectively.
Organize school supplies and make checklists and schedules for homework and assignments. Help your child get his or her bag ready for school the next morning and make sure all homework is complete. You can make organization fun for your child with coloured folders, special pencils, stickers and cool labels.
Encourage your child to always try his or her best. Although your child should be completing his or her work independently, it is okay to help when asked. Help your child look at challenges in a positive light to keep him or her motivated. This will show that you are willing to always help him or her do better.
Whether it is auditory, kinesthetic or visual, knowing how your child learns is important. Change studying habits to fit his or her learning style with graphs, visuals, music, walking, or talking out loud. Every child learns differently. Studying in a way that works for him or her can help improve understanding and retention.
Read our Complete Study Guide For Every Type Of Learner for more study tips!
Children with ADD/ADHD can become easily frustrated and overwhelmed. Encourage your child to keep going as long as he or she can, but don’t push your child too much. If he or she has hit his or her limit, stop for the night. If homework hasn’t been completed for the following school day, send the teacher a note to explain.
Congratulate your child after he or she finishes his or her homework. You can also do something special, like a small treat or trip to the park. Even if your child was not able to finish his or her work, praise his or her efforts and strive for a new goal the next day.
Sitting for long periods of time can be challenging for students with ADD/ADHD. Letting your child get up to move around can help him or her maintain focus. Try making studying into a physical activity, where your child counts out steps when practicing math problems like addition and subtraction. Having something he or she can fidget with while doing work can also help. Stress balls are a great item your child can take with him or her wherever he or she goes.


Children with ADD and ADHD feel at times they cannot control their own actions. They can become easily distracted, which can lead to poor grades, frustration, and disappointment. These ADD/ADHD study tips will help your child conquer these academic challenges, with improved concentration, time management and organizational skills. Most importantly, they will also help boost self esteem and confidence.
Remember, these changes won’t happen overnight. It will take time for your child to adjust to new routines and habits. Once you, and your child, understand how to study and do homework with ADD/ADHD, your child will be on the way to more effective learning.