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Health and Fitness, Stanford News

Raining? Snowing? Too cold? Tips to stay fit during winter

Raining? Snowing? Too cold? Tips to stay fit during winter

My husband still teases me about the time he spotted me completely drenched, trying to jog during a downpour when we were dating. What kind of a oddball is she, he wondered. Now, I’m a bit less daring and, as a recent BeWell@Stanford feature reminds us, you don’t have to get wet, or cold, to stay fit during the winter.

As outlined in the piece, indoor options abound, and it’s possible to modify favorite outdoor pursuits such as:

Running: You can use a hallway, garage, kitchen, living room, or local gym for alternative running exercises such as butt kickers, side-to-side shuffle, backward/forward running, jumping jacks and high knees. You can also try interval training on the treadmill to keep indoor running interesting.

Walking: Walk indoors on the treadmill, at a mall, or anywhere you feel comfortable. You can do step-ups at the bottom of a staircase, or even purchase an old school step platform for less than $100.

Strength Training: Bodyweight exercises are a great way to get a strength workout without using any equipment. An exercise band, hand weights, a Swiss ball, and/or TRX/suspension trainers can all be purchased and used at home, as well. You can also find credible workout videos (DVD/online) that are safe and evidence-based. Another option: Incorporate exercise while doing chores, such as calf raises while washing dishes or doing planks while watching TV (during commercials).

Biking: Purchasing a bike trainer is an option for people who want to ride indoors, but would rather not be in the gym. Trainers can cost anywhere between $100-400 and can be set up in your garage or inside your house. Additional equipment such as a mat, fan, towel, etc. also may be useful. Cycling classes can also be a fun and worthwhile way to stay in biking shape during the winter.

Of course, it can be tough to stay motivated – with dark days and blustery conditions making exercise daunting. The BeWell@Stanford team recommends working out with friends or co-workers, signing up for an activity, which requires a commitment, and keeping the many good reasons for exercising at the top of your mind.

And if you do venture outdoors, make sure you dress in layers (and include lights/reflectors if it’s dark) and cover up those exposed extremities.

Previously: Why I never walked to school: the impact of the built environment on health, Injured? Tips on maintaining your physical and mental fitness and “Nudges” in health: Lessons from a fitness tracker on how to motivate patients
Photo by bertvthul

Imaging, Public Safety

MRI use flushes gadolinium into San Francisco Bay

MRI use flushes gadolinium into San Francisco Bay

22951789105_b548e1e5d6_o_Flickr_ScienceActivismThe levels of gadolinium in the San Francisco Bay have been steadily increasing over the past two decades, according to a study recently published in Environmental Science & Technology. Gadolinium is a rare-earth metal and the potential long-term effects of its environmental exposure have not been studied in detail.

Russell Flegal, PhD, and his research team at UC Santa Cruz collected and analyzed water samples throughout the San Francisco Bay from 1993 to 2013, as part of the San Francisco Bay Regional Monitoring Program.

They found the gadolinium levels to be much higher in the southern end of the Bay, which is home to about 5 million people and densely populated with medical and industrial facilities, than in the central and northern regions. They also observed a sevenfold rise in gadolinium concentration in the South Bay over that time period.

The study attributes the rising level of gadolinium contamination largely to the growing number of magnetic resonance imaging (MRI) scans performed with a gadolinium contrast agent. A gadolinium contrast agent is used for about 30 percent of MRI scans to improve the clarity of the images. It is injected into the patient and then excreted out of the body in urine within 24 hours.

Lewis Shin, MD, assistant professor of radiology and a MRI radiologist, explained to me the importance of using intravenous gadolinium contrast agents:

Gadolinium contrast agents allow us to detect abnormalities that would otherwise be hidden from view and to improve our characterization of the abnormalities that we do find. Gadolinium is not always used; for example, if a physician is just concerned about identifying a herniated disk in the spine, an MRI without contrast agent is sufficient.

However, gadolinium is routinely administered to detect and characterize lesions if there is a clinical concern of cancer. Also, if a patient was previously treated for cancer, gadolinium administration is often extremely helpful to detect early recurrences. MRI with a gadolinium contrast agent greatly improves our ability to make an accurate diagnosis not only for cancer but for many other disease processes as well.

According to the UCSC researchers, gadolinium is not removed by standard wastewater treatment technologies, so it is discharged by wastewater treatment plants into surface waters that reach the Bay.

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In the News, Parenting, Pregnancy, Public Health, Public Safety, Women's Health

Exploring new recommendations to diagnose prenatal and postpartum depression

Exploring new recommendations to diagnose prenatal and postpartum depression

Although having a child is usually considered a happy event, an estimated 10 to 15 percent of women living in the U.S. develop some form of maternal depression. In response to new research and increased awareness about the problem, the U.S. Preventive Services Task Force revised their 2009 recommendations for screening procedures to diagnose and treat prenatal and postpartum depression.

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The guidelines, published last week in the Journal of the American Medical Association, now recommend screening for depression in the general adult population and they highlight the potential benefits of screening for pregnant and postpartum women.

Earlier this week, KQED Forum delved into the basis and potential implications of these new recommendations by exploring the topic with a panel of experts including Katherine Williams, MD, director  of Stanford’s Women’s Wellness Clinic.

Williams (who begins speaking at the 10:25 mark) stated that one of the most important aspects of the revised recommendations is its discussion of psychotherapy and how it can and, as Williams says, should be used as the first form of treatment for pregnant or nursing moms who are suffering from depression. The entire hour-long discussion is worth a listen.

Previously: A telephone lifeline for moms with postpartum depression“2020 Mom Project” promotes awareness of perinatal mood disordersAh…OM: Study shows prenatal yoga may relieve anxiety in pregnant women and Helping moms emerge from the darkness of postpartum depression
Photo by Sarah Zucca

Pediatrics, Sports, Stanford News

A Super Bowl surprise at Packard Children’s

A Super Bowl surprise at Packard Children’s

Just in time for the Super Bowl: A sweet story out of Lucile Packard Children’s Hospital about a special visit for 18-year old patient/football fan Alex Walter. As writer Samantha Dorman describes on the hospital’s Healthier, Happier Lives Blog:

Last week, as Super Bowl 50 excitement grew, we learned that Alex’s dream was to meet his beloved Denver Broncos, who would be practicing just down the street at Stanford University. On Monday, we posted this to our Facebook page. The goal was to catch the Broncos’ eye. Thousands of fans liked and shared the post, tagging Peyton Manning, the Broncos, local reporters, and anyone else to help spread the word.

By the next morning we made contact with Vernon Davis, former 49er and now Super Bowl-contending Broncos tight-end. The photo also caught the attention of Bay Area news outlets, including KTVU’s (Fox 2) Rob Roth and NBC Bay Area, who called the hospital wanting to talk to Alex. Staff and the hospital school devised a plan to surprise Alex, telling him that two TV stations were going to interview him about wanting to meet a Bronco. And during the interview Vernon Davis would walk in and give Alex the surprise of a lifetime!

It all worked according to plan. Check out our behind-the-scenes video of the surprise.

As outlined in the post, Walters received a heart transplant at Packard Children’s when he was 11 and is now being treated for rhabdomyosarcoma, a soft tissue cancer. The treatments leave him with little energy, but he is, according to his mom, “relentlessly positive.”

Big data, Genetics, Precision health, Research

Individuals’ medical histories predicted by non-coding DNA in Stanford study

Individuals' medical histories predicted by non-coding DNA in Stanford study

image.img.320.highAs whole-genome sequencing gains ground, researchers and clinicians are struggling with how best to interpret the results to improve patient care. After all, three billion base pairs are a lot to sift through, even with powerful computers. Now genomicist Gill Bejerano, PhD, and research associate Harendra Guturu, PhD, have published in PLoS Computational Biology the results of a study showing that computer algorithms and tools previously developed in the Bejerano lab (including one I’ve previously written about here called GREAT) can help researchers home in on important regulatory regions and predict which are likely to contribute to disease.

When they tried their technique on five people who agreed to publicly share their genome sequences and medical histories, they found it to be surprisingly prescient. From our release:

Using this approach to study the genomes of the five individuals, Guturu, Bejerano and their colleagues found that one of the individuals who had a family history of sudden cardiac death had a surprising accumulation of variants associated with “abnormal cardiac output”; another with hypertension had variants likely to affect genes involved in circulating sodium levels; and another with narcolepsy had variants affecting parasympathetic nervous system development. In all five cases, GREAT reported results that jibed with what was known about that individual’s self-reported medical history, and that were rarely seen in the more than 1,000 other genomes used as controls.

Bejerano and Guturu focused on a subset of regulatory regions that control gene expression. As I explained:

The researchers focused their analyses on a relatively small proportion of each person’s genome — the sequences of regulatory regions that have been faithfully conserved among many species over millions of years of evolution. Proteins called transcription factors bind to regulatory regions to control when, where and how genes are expressed. Some regulatory regions have evolved to generate species-specific differences — for example, mutating in a way that changes the expression of a gene involved in foot anatomy in humans — while other regions have stayed mostly the same for millennia. […]

All of us have some natural variation in our genome, accumulated through botched DNA replication, chemical mutation and simple errors that arise when each cell tries to successfully copy 3 billion nucleotides prior to each cell division. When these errors occur in our sperm or egg cells, they are passed to our children and perhaps grandchildren. These variations, called polymorphisms, are usually, but not always, harmless.

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Biomed Bites, Genetics, Research, Videos

RNA editing: Many mysteries remain

RNA editing: Many mysteries remain

Welcome to Biomed Bites, a weekly feature that introduces readers to some of Stanford’s most innovative biomedical researchers.  

DNA, RNA, protein, end of story, right? Well, no. Sometimes, RNA is edited after it is created. These new revised copies can perform different functions or contribute to the development of disease.

But for decades, no one had a great way to examine post-transcriptional changes to RNA, much less understand what role they play in cellular processes. Thanks to advances in technology, that is changing.

In the video above, Jin Billy Li, PhD, assistant professor of genetics, explains how his lab is working to unravel RNA’s remaining secrets. “In the future, we hope to associate this interesting phenomenon with human neurological conditions such as autism, epilepsy, depression and ALS,” he says.

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: Tissue-specific gene expression focus of Stanford research, grant, “Housekeeping” RNAs have important, and unsuspected, role in cancer prevention, study shows and Make it or break it — or both: New research reveals RNA’s dual role

Medicine and Literature, Podcasts, Stanford News

Into the Magic Shop: Stanford neurosurgeon Jim Doty’s captivating memoir

Into the Magic Shop: Stanford neurosurgeon Jim Doty's captivating memoir

Doty and Dalai LamaWhen he was 12 years old, Stanford neurosurgeon Jim Doty, MD, met an unusual woman named Ruth in a magic shop in Lancaster, Calif., the town where he grew up. When she enters his life, she seems ethereal or perhaps even a dream. She arrives at the exact moment she’s needed, a young boy from a fractured home spinning without direction or parental love. Well before mindfulness became commonplace, Ruth taught him a series of mental exercises to ease his angst and focus on a world of possibilities not problems. Most significantly, Ruth offered hope to a somewhat hopeless life.

Doty has written an unusual memoir – Into the Magic Shop – detailing his life’s journey. In this 1:2:1 podcast I spoke with him about this most uncommon life –  one of potholes and promise, detours and dreams, redemption and revisions, and, yes, contentment and even possibly peace.

Stanford physician and noted author Abraham Verghese, MD, gave advance praise to the book:

Into the Magic Shop is pure magic! That a child from humble beginnings could become a professor of neurosurgery and the founder of a center that studies compassion and altruism at a major university, as well as an entrepreneur and philanthropist is extraordinary enough. But it is Doty’s ability to describe his journey so lyrically, and then his willingness to share his methods that make this book a gem.

Outside of the OR, Doty spends much of his time studying the neuroscience of compassion and altruism. He serves as director of the Center for Compassion and Altruism Research and Education at the School of Medicine, of which the Dalai Lama is a founding benefactor.

Into the Magic Shop may not be like anything else you read. But it will take you places where you might never have been.

Previously: What the world needs now: altruism/A conversation with Buddhist monk-author Matthieu RicardFrom suffering to compassion: Meditation teacher-author Sharon Salzberg shares her story and How being compassionate can influence your health
Photo of Doty and the Dalai Lama, from a 2010 Stanford event, by Linda Cicero

Applied Biotechnology, Ask Stanford Med, Clinical Trials, Research, Stanford News

SPARKing a global movement

SPARKing a global movement

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Many academic researchers are tenacious, spending years in the lab studying the processes that lead to human diseases in hopes of developing treatments. But they often underestimate how difficult it is to translate their successful discovery into a drug that will be used in the clinic.

That’s why Daria Mochly-Rosen, PhD, founded SPARK, a hands-on training program that helps scientists move their discoveries from bench to bedside. SPARK depends on a unique partnership between university and industry experts and executives to provide the necessary education and mentorship to researchers in academia.

In recent years, Stanford’s program has sparked identical programs throughout the world; at TEDMED 2015, Mochly-Rosen described this globalization. I recently spoke with her about the SPARK Global program, which she co-directs with Kevin Grimes, MD, MBA.

How has SPARK inspired similar programs throughout the world?

We’ve found our solution for translational research to be particularly powerful. Of the 73 completed projects at Stanford, 60 percent entered clinical trials and/or were licensed by a company. That’s a very high accumulative success rate. So I think it has showed other groups that we have a formula that really works – a true partnership with academia and industry. It’s the combination of industry people coming every week to advise us and share lessons learned and our out-of-the-box, risk-taking academic ideas that makes SPARK so successful.

We feel that what we’ve learned is applicable to others. Kevin and I also feel very strongly that universities need to take responsibility to make sure inventions are benefitting patients. So we’re trying to do our part.

How do you and Dr. Grimes help develop the global programs?

When a university asks about our program, we invite them to come visit us for a couple of days so they can talk to SPARKees (SPARK participants), meet SPARK advisors and watch our weekly meeting. Sometimes they also ask Kevin and I to come to their country to help set up a big event or assist in other ways. If they begin a translational research program at their institution, we offer for them to be affiliated with SPARK Global. Everyone is invited.

There are now SPARK programs throughout the world, including the United States, Taiwan, Japan, Singapore, South Korea, Australia, Germany and Brazil. We are also working with other countries, including Norway, Israel, Netherlands, Poland and Finland, to help them start a program.

Do researchers in other countries face the same challenges as those in the U.S. when developing new drugs?

There are many common challenges. And there are also some advantages and challenges that are different in other places. So it’s a mix, both within and outside the U.S.

There are several key components to the success of translation research. It’s important to have a good idea. It’s even more important to have good advisors from industry to help develop the idea. And it’s very important that the people involved are open-minded and not inhibited by hierarchical structures. In some places, there is a big problem with hierarchy – particularly in parts of Europe and East Asia. In some cultures, it’s also difficult to get experts to volunteer and academics can’t afford to pay multiple advisors. Also, some universities don’t have a good office of technology to help with patent licensing, which can be a major challenge.

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Cardiovascular Medicine, Patient Care, Pediatrics, Pregnancy, Stanford News

World-first treatment for rare heart defect saves baby born at Packard Children’s

World-first treatment for rare heart defect saves baby born at Packard Children's

Group shot Liam and doctorsLinda Luna was five months pregnant with her first child when she got the bad news: Ultrasound scans showed a deadly defect in her baby boy’s heart. He had a 90 percent chance of dying before or just after birth. But thanks to a groundbreaking treatment at Lucile Packard Children’s Hospital Stanford, two-month-old baby Liam, who just went home to San Jose last week, is beating those odds.

He is the first baby in the world successfully treated with prenatal maternal hyper-oxygenation for his rare heart defect: congenital Ebstein’s anomaly. This week, several local news outlets report on the success of Liam’s case.

The problem at diagnosis? Due to severe leaks in two heart valves, blood flowed backward through the right half of Liam’s heart. His heart became dangerously enlarged. Too little blood reached his lungs and the rest of his body. Left untreated, the defect would cause irreparable heart and lung damage.

“Once you see type of leakage Liam had, it’s usually a progressive process,” said Theresa Tacy, MD, the fetal cardiology specialist who treated Liam in concert with his mom’s high-risk obstetrician, Katherine Bianco, MD, and a team of other specialists from across the hospital. “It just gets worse,” Tacy said. “The fetus eventually develops heart failure and dies.”

The team gave expectant mom Luna 12 hours per day of oxygen therapy for the last three weeks of her pregnancy. The idea was to relax Liam’s lung blood vessels with the extra oxygen he’d get from his mom. This would make it easier for his heart to pump blood forward into his lungs and, the doctors hoped, let him survive until birth and surgery.

Ebsteins vs normal by Tacy“We were trying to offer Liam’s parents hope but also remain realistic that their baby had a very high chance of not making it,” said cardiologist David Axelrod, MD, who cared for Liam in the cardiovascular intensive care unit after he was born. “We knew that even if he made it through pregnancy, his risk of dying during his first few days of life was very high.”

Immediately after his Nov. 22 birth, the doctors put Liam on an ECMO machine that delivered oxygen to his blood. Cardiothoracic surgeon Frank Hanley, MD, also closed a blood vessel near the heart to help Liam’s blood to flow forward. Finally, 11 days later, Liam was strong enough for a Dec. 3 surgery in which Hanley fully repaired his heart.

“It was a huge operation for a tiny baby fighting for his life,” Luna said. “The seven-hour wait during surgery was the longest wait of my life, but when they finally wheeled him out, he was a different baby. We were so thankful.”

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Medical Schools, Patient Care, Stanford Medicine Unplugged

What happens when you can’t communicate with your patient?

What happens when you can’t communicate with your patient?

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

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Over the past eight months, I’ve rotated at the Palo Alto VA, Santa Clara Kaiser, Stanford outpatient family medicine and pediatrics clinics, and most recently, at Santa Clara Valley. At the VA and Kaiser, all my patients spoke English. Occasionally, at Stanford’s outpatient sites, our patients spoke a language other than English; however, this never felt like a barrier to care because Stanford had phone interpreters available, as well as iPads on wheels that you could use to videoconference in an interpreter. These resources made it feel as though the interpreter was right there in the room with us. And indeed, they could not only hear the patient’s words but also see their expressions, adding an extra dimension to the interpreting services they generously provided.

Valley, however, felt like a different world. As a county hospital, Valley doesn’t often have the luxury of flashy resources. I spent this past month there, on my general surgery/trauma rotation. On morning rounds each day, we would check on each one of our patients, asking whether their pain was under control, if they were able to eat post-surgery, if they had walked around the ward to get back to their baseline activity level, and more. These rounds would take place as early as 6:15 a.m., and they were efficient, since operating room cases would begin at 7:30 a.m.

At various point in the month, our Valley team had patients who spoke only Spanish, only Korean, only Cantonese, and only Vietnamese. Sometimes, we got lucky, and a member of the nursing staff spoke one of these languages. But at other times, we worked through hand gestures and simple words to try and ascertain patient pain, symptoms, etc. Phone interpreters were an option, but the early timing and rapid pace of rounds made it cumbersome to call an interpreter. We usually circled back in the afternoon with a phone interpreter – and if we happened to have multiple traumas that came into the hospital that day, it would be later rather than earlier that we returned to the patient’s bedside. Putting myself in patients’ shoes, I imagine how frustrating it must have been for them, to feel both dependent on the medical team for care as well as helpless to communicate how they felt and what they wanted.

I began to think about how this problem could be fixed, and my thoughts took me back to my middle and high-school years. In middle school, I was required to take at least one foreign language. I chose Spanish and continued taking Spanish throughout high school (then promptly forgot everything when I went to college, making me rather useless on surgery rounds). Wouldn’t it be useful to have a similar language requirement in medical school? I don’t mean a comprehensive foreign language course. Instead, I think it would be meaningful to know key words and phrases – Do you have pain? Are you able to eat? Where does it hurt? – in, let’s say, the ten most common languages spoken in the particular geographic region a medical school is located in.

I know, I know, medical school curricula are already teeming with courses and requirements, and adding a language requirement feels like just one extra thing. But, if it makes a valuable difference in patient care, isn’t it a worthwhile addition? It’s certainly something to ponder. As for me, I just downloaded Duolingo on my iPad, so if you catch me awkwardly practicing my Spanish out loud in any one of my favorite Palo Alto cafés, you’ll know why!

Hamsika Chandrasekar is a third-year student at Stanford’s medical school. She has an interest in medical education and pediatrics. 

Photo courtesy of Bill Pugin, The Sign Language Company

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