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Behavioral Science, Events, Mental Health, Stanford News

From suffering to compassion: Meditation teacher-author Sharon Salzberg shares her story

From suffering to compassion: Meditation teacher-author Sharon Salzberg shares her story

20150416-CCARE-Sharon Salzberg-0434Mediatation master and author Sharon Salzberg showed her recent Stanford audience that she could field even the toughest questions about the nature of compassion.

“What about the beheadings in the Middle East?” one audience member called out. Is it really possible to feel compassion for the perpetrators?

“It’s not easy,” Salzberg admitted. “But I also think it’s possible and important… Hatred will never cease with hatred.”

For models and proof it can be done, there are examples of great leaders who have suffered deeply such as Aung San Suu Kyi, Nelson Mandela, Desmond Tutu and the Dalai Lama, Salzberg and James Doty, MD, pointed out.

Salzberg joined Doty, the director of the Stanford Center for Compassion and Altruism Research and Education, at a Conversation on Compassion last week on campus.

She had a tough start in life; her parents separated when she was 4 years old and her mother died soon after. Yet it was through suffering that she gained the motivation, and experience, to pursue the study of meditation, she said.

After taking an Asian philosophy course — on a whim — at the State University of New York at Buffalo, Salzberg traveled to India in 1970 to experience Buddhism firsthand. “The course completely changed my life,” she told the audience. She said she was attracted by the Buddha’s acknowledgment of the existence of suffering.

“Like many people, mine was a family system where this was never spoken about,” Salzberg said. “Buddha’s saying right out loud, ‘Suffering is a part of life,’ you don’t have to feel isolated or abhorrent.”

Salzberg went on to co-found one of the first meditation centers in the United States, the Insight Meditation Society in Massachusetts.

Her conversation at Stanford was informal: Doty confessed he had spilled coffee on the business shirt he planned to wear, and the pair fielded questions from the audience throughout the talk.

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Aging, Medicine and Society, Pain, Palliative Care, Patient Care, Stanford News, Videos

“Everybody dies – just discuss it and agree on what you want”

"Everybody dies - just discuss it and agree on what you want"

Earlier this week, my colleague pointed to a New York Times essay penned by VJ Periyakoil, MD. In it, Periyakoil calls for a role-reversal in talking about end-of-life issues and encourages patients to take the lead in starting such conversations with their doctors. “Without these conversations, doctors don’t know what the patients’ goals are for living their last days,” she writes. “What are their hopes, wants, needs and fears? Do they want to die at the hospital connected to a machine? Do they want to die at home? The current default is for doctors to give patients every possible treatment for their condition, regardless of its impact on the patient’s quality of life, the cost or the patient’s goals.”

Periyakoil goes on to describe a letter that she and her colleagues created to help facilitate these patient-doctor conversations. The video above expands upon the Stanford Letter Project, which helps patients map out what matters most to them at the end of life, and includes the candid thoughts of numerous older adults.

“If I’m brain-dead, unplug me,” one woman says matter-of-factly. “And I want to die painless. No pain – just put me to sleep and don’t let me wake up.”

In the doctor’s office, one man shares his reason for writing a letter and expressing his wishes: “One of the worst things in the world that you can have happen [is you’re on] your deathbed and you’re putting the burden of life-altering decisions on a family member that has no clue of what you really want or don’t want.”

Advises another older man: “Don’t be ashamed of it – everybody dies. Just discuss it and agree on what you want.”

Previously: How would you like to die? Tell your doctor in a letter, In honor of National Healthcare Decisions Day: A reminder for patients to address end-of-life issues, Study: Doctors would choose less aggressive end-of-life care for themselves, On a mission to transform end-of-life care and The importance of patient/doctor end-of-life discussions

Events, Medicine and Literature, Palliative Care, Patient Care, Stanford News

Physician-author Abraham Verghese encourages journalists to tell the powerful stories of medicine

Physician-author Abraham Verghese encourages journalists to tell the powerful stories of medicine

Verghese,_Abraham,_blurred_2Stanford’s Abraham Verghese, MD, greeted hundreds of journalists at the Association of Health Care Journalists 2015 conference last evening with a talk centered on the power of stories and of medicine.

The conference, held this year in Santa Clara, Calif., and co-hosted by Stanford Medicine, brings together journalists from a variety of outlets to solidify their scientific knowledge, enhance their journalism skills and network with colleagues. (As a reminder, we’ll be live tweeting from the conference today and tomorrow; you can follow us at @StanfordMed.)

Verghese is a physician and educator, born in Ethiopia to Indian parents. But he’s also an established writer, author of numerous essays and several books, including Cutting for Stone and My Own Country. In that way, he is “really one of us,” said Karl Stark, president of the AHCJ.

Like journalists, Verghese has an abiding interest in storytelling. But his stories stray from the researchers-made-this-discovery narratives that often occupy health-care journalists. Verghese’s stories are tales of lost loves and the act of toasting death with a glass of champagne. They’re the stories of people, of patients, and of the importance of listening and being present.

There are many types of stories that need to be told, Verghese encouraged his audience. Tell about the company that dominates medical-record keeping, of families who can’t allow their loved ones to pass away peacefully, of young physicians and students who are determined to place patients first, despite the dominance of technology.

And perhaps most importantly, writers should tell the story of medicine itself: of what it can and cannot do, of where it has been and where it is going.

In that vein, Verghese shared a story with his rapt audience. As a physician in rural Tennessee in the 1980s, he cared for many patients with HIV/AIDS. At the time, doctors had no drugs, nothing that could thwart the disease’s progress. Yet when one patient’s mother called the clinic one day, saying her son was too sick to come in, Verghese said he felt compelled to visit the family in their rural trailer home. He wasn’t ready for the patient to die without seeing him again. “My visit had a profound effect on him and the family. It helped them come to terms and that I wouldn’t abandon them,” Verghese said.

This was a revelation, he admitted. This is what doctors did before antibiotics and sterile operating rooms and medical devices galore. “They were able to heal, even when they could not cure.” And that is a power that today’s doctors should never forget that attests to the power of the patient-physician relationship, he said.

Medicine has other stories to share as well. In the past, metaphors abounded in medicine: the strawberry tongue of scarlet fever, the apple-core lesion of tuberculosis, the saber shin of the tibia, Verghese said. Yet now, despite the abundance of new conditions, metaphors are achingly absent, signifying a growing gap between the doctor as data scientist and the patient.

And then there’s the story of the body itself, one that future physicians may not know how to read, Verghese said. He said he jokes that if a patient came in with a missing limb, doctors wouldn’t be able to confirm the diagnosis without a variety of tests. “We really have stopped looking at the patient,” he said.

And that is one reason why journalists, as storytellers, are important. “Stories are the units of life; they’re how we extract meaning,” he said.

Previously: Live tweeting from Association of Health Care Journalists conference, A “grand romp through medicine and metaphor” with Abraham Verghese, Abraham Verghese: “A saintliness in so many of my patients”, Abraham Verghese discusses stealing metaphors and the language of medicine at TEDMED, Abraham Verghese urges Stanford grads to always remember the heritage and rituals of medicine and Stanford’s Abraham Verghese honored as both author and healer
Photo by Wikimedia

Behavioral Science, Mental Health, Research

Type of verbal therapy could reduce PTSD risk among trauma victims

Type of verbal therapy could reduce PTSD risk among trauma victims

217849066_f011b26437_zTurning on the bedroom light can knock the teeth out of all kinds of terrors. This same concept – seeing things as they are, not as we fear them to be – also forms the basis for many therapies used to treat the estimated 5.2 million people living in the U.S. with post-traumatic stress disorder (PTSD). Now, research shows that treating a victim of trauma with a certain type of therapy within six hours of the event – when most memories are formed – can reduce his or her risk of developing PTSD.

In the study, researchers from King’s College London and the University of Oxford investigated the effect of two treatments: “updating” therapy, where the patient talks about traumatic memories to update them with more factual information, and “exposure” therapy where the patient revisits the source of fear to decrease its emotional effect. These two techniques were applied to 115 participants after they watched six film clips containing real-life footage of humans and animals in distress.

The researchers found giving the participants “information about the fate of the films’ protagonists” (i.e., using the updating technique) significantly reduced the occurrence of fearful feelings, and it reduced these intrusive thoughts better than the exposure treatment and no treatment at all.

As psychologist and lead author Victoria Pile, PhD, explains in a press release, this study is important because there are currently no established therapies to help victims of trauma fend off PTSD. And, she said, “this research implies that finding out what actually happened as soon as possible after the trauma might change the way the memory is stored and so limit the devastating effects of PTSD.”

The researchers note that these findings could be especially helpful for people who are routinely exposed to traumatic situations, such as emergency service workers, military personnel and people working in conflict zones.

Previously: Study shows benefits of breathing meditation among veterans with PTSDExamining the scientific evidence behind experimental treatments for PTSDUsing mindfulness therapies to treat veterans’ PTSD and In animal study, sleep deprivation after traumatic events lowers risk of PTSD symptoms
Image by Capture Queen

Events, Health Disparities, Medical Education, Medicine and Society, Public Health

An ounce of action is worth a ton of theory: Med student encourages community engagement

An ounce of action is worth a ton of theory: Med student encourages community engagement

IMG_0775Right after graduating from Stanford, Steve (Suk) Ko moved to East Palo Alto with some friends who were also recent graduates. They put all their effort into becoming engaged in their new community, starting and running a tutoring program out of their apartment – which could get really crowded, judging by the pictures he showed last week while speaking to undergraduates interested in public health.

Soon after making East Palo Alto his new home, Ko started medical school at Stanford and continued his service work throughout. “We at Stanford are good at thinking and debating, but less good at action,” Ko said during this talk. “I felt some guilt about indulging in socioeconomic affluence when there was this community right next door.”

Ko’s talk was part of the Primary Care, Public Health, and Health Disparities Lecture Series sponsored by Stanford’s Center of Excellence in Diversity in Medical Education, which aims to produce leaders who can eliminate national-health inequities. Ko shared his personal experience and offered three points of advice:

1). Never lose what makes you special. 

If you’re thinking about how to improve public or global health, “don’t fake it – do what you’re passionate about.” This will lead you in the right direction. As for medical school applications, there are all kinds of ways to have a “research background,” he said.

For Ko, a Korean ethic of hard work and his Christian faith enabled his interest, experiences, and goals in public health. During an undergraduate service learning trip to Oaxaca, Mexico, he shadowed an OB/GYN at a public hospital and was moved both by the beauty of birth and the limited opportunities these newborns faced. Born resource poor and in a society with high gender inequality, “this baby girl had not made a single choice, but 99 percent of her life was already decided,” Ko said. He wanted to think about health in a broader context.

2). An ounce of action is worth a ton of theory.

Last summer, Ko implemented a 5-week summer meal program in East Palo Alto that served kids and their families. The suggestion to focus on food insecurity came from Stanford pediatrician Lisa Chamberlain, MD, Ko’s mentor. The YMCA, Stanford Medicine, and Revolution Foods supported the project, which served 270-370 kids and 4-30 adults every day, and provided a total of 2,525 take-home meals. Ko said it’s “like pulling teeth” to get kids to eat healthy food, but shaping tastes early is key to forming long-term habits. The team ran both quantitative and qualitative analyses of the program, gathering insights like that families are hungrier in bad weather because those who work outdoors or in construction cannot earn money, and that libraries could be great food distribution points.

One of Ko’s most rewarding recent memories was when several of the high-school students he works with made a documentary film about East Palo Alto. They wanted to challenge its unfair portrayal in the news media – although it had the highest homicide rate in the country in 1992, gentrification is now starting to be a bigger problem than crime. “The 90’s were a long time ago,” the students pointed out.

3). Community engagement is difficult, and therefore a privilege.

It was very hard for Ko to gain the trust of his adult neighbors (he says kids are easy: just smile at them). After living there for years, he felt gratified last week when he was ill and a neighbor brought him soup. Trust comes slowly; you have to prove you’re there for the long haul. Even so, circumstances are just hard – what do you do when a student tells you a family member just died from gang violence? Ko coped with the emotional and physical difficulty through his faith and by finding joy in the process, not the outcomes.

One of the audience members asked a question about “white knight syndrome” – the problematic idea that someone from a different community is able (and welcome) to storm in and fix everything. Ko agreed that good intentions can hurt vulnerable people. Temporary involvement doesn’t require accountability and invites the community to be jaded and skeptical, focusing on the impact of the last person/organization. For this reason, it can be much better to join an existing project than to start a new one, he said. But above all, Ko favors humility and a sense of wonder, not just going in and”fixing it”.

Previously: A quiz on the social determinants of health, Stanford researchers use yoga to help underserved youth manage stress and gain focus, Med students awarded Schweitzer Fellowships lead health-care programs for underserved youth, Nutrition and fitness programs help East Palo Alto turn the tide on childhood obesity and Doctors tackling child hunger during the summer
Photo, of Steve Ko (right) and Marcella Anthony of Stanford Medicine’s Community Outreach, by Andrea Ford

 

Events, Research, Science, Stanford News

Live tweeting from Association of Health Care Journalists conference

Live tweeting from Association of Health Care Journalists conference

10948923353_90e2273cdc_zStarting tomorrow morning, we’ll be live tweeting from the Association of Health Care Journalists 2015 conference, which is being held in Santa Clara, Calif. and is co-hosted by Stanford Medicine.

The conference brings together hundreds of the top journalists who cover health care and, thanks to its proximity to our campus, also includes numerous top Stanford medical experts.

We’ll start our tweeting efforts on Friday morning at 9 a.m. Pacific time with “Ebola and Ebolanoia: Covering outbreaks responsibly,” a panel discussion that includes Michele Barry, MD, director of the Stanford Center for Innovation in Global Health. At 10:40 a.m., Henry Lee, MD, assistant professor of pediatrics, and Amen Ness, MD, associate professor of obstetrics and gynecology, will participate in a discussion on “High-risk obstetrics: Challenges of very preterm births.”And later in the day, at 4:20 p.m., we’ll be there as Michael Snyder, PhD, chair of the Department of Genetics, discusses “How big data might revolutionize medical research and treatment.”

Early Saturday, we’ll dive into the brain with Amit Etkin, MD, PhD, and Michael Greicius, MD, MPH. Their session, “Inside the living brain: What have we learned, and what’s next?”, begins at 9 a.m. Next, at 10:40 a.m., George Sledge, Jr., MD, will discuss “Cancer as a chronic condition.” Finally, at 3 p.m., Dean Lloyd Minor, MD, will join a panel discussion on “The shifting demands in health provider education.”

We’ll be using the hashtag #AHCJ15 and tweeting from @StanfordMed. And we’ll be featuring blog posts on the conference – including one on a kickoff talk by physician-author Abraham Verghese, MD, – here on Scope.

Photo by Esther Vargas

Cancer, Neuroscience, Pediatrics, Research, Stanford News, Videos

Brain tumor growth driven by neuronal activity, Stanford-led study finds

Brain tumor growth driven by neuronal activity, Stanford-led study finds

Nerve activity in the cerebral cortex can drive the growth of deadly brain tumors called high-grade gliomas, new research has found. The finding, from a study of mice with human brain tumors, provides a surprising example of an organ’s function driving the growth of tumors within it, according to Michelle Monje, MD, PhD, the Stanford neuroscientist who led the work. The work appears online today in Cell.

High-grade gliomas include tumors that affect children, teens and adults. They are the most lethal of all brain tumors, and their survival rates have scarcely improved in 30 years. Monje’s team and others around the world are trying to learn how the tumors arise and grow, with the hope that this understanding will enable development of new drugs that specifically attack the tumors’ vulnerabilities.

From our press release about the research:

Monje’s team identified a specific protein, called neuroligin-3, which is largely responsible for the increase in tumor growth associated with neuronal activity in the cerebral cortex. Neuroligin-3 had similar effects across the different types of high-grade gliomas, in spite of the fact that the four cancers have different molecular and genetic characteristics.

“To see a microenvironmental factor that affects all of these very distinct classes of high-grade gliomas was a big surprise,” Monje said.

The identity of the factor was also unexpected. In healthy tissue, neuroligin-3 helps to direct the formation and activity of synapses, playing an important role in the brain’s ability to remodel itself. The new study showed that a secreted form of neuroligin-3 promotes tumor growth.

“This group of tumors hijacks a basic mechanism of neuroplasticity,” Monje said.

Blocking the tumor-stimulating effects of neuroligin-3 might be an effective treatment for high-grade gliomas, Monje added.

In the video above, Monje describes some of the earlier work that led her team to ask whether nerve activity could drive tumor growth. In the healthy brain, it’s important for neuronal activity to be able to modify how the brain grows and develops, she explains – this is how experience changes our brains. But: “The growth-inducing effects of neuronal activity are very robust and it made me wonder if a similar physiology was being hijacked by glioma cells,” she says in the video.

Previously: Emmy nod for film about Stanford brain tumor research — and the little boy who made it possible, Big advance against a vicious pediatric brain tumor and New Stanford trial targets rare brain tumor

Biomed Bites, Imaging, Neuroscience, Research, Science, Videos

Vrrrooom, vrrrooom vesicles: A Stanford researcher’s work on neurotransmission

Vrrrooom, vrrrooom vesicles: A Stanford researcher's work on neurotransmission

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

When one neuron wants to communicate with another neuron, it doesn’t talk, make gestures, or perform an interpretive dance. Instead, it ejects a vesicle filled with chemical information. That vesicle travels like an interstellar ship to the next neuron, which sucks it up, receiving the message.

And this isn’t a slow, hmm, maybe-I-should-send-this-out-sometime-today kind of message.

“The process of effusion of synaptic vesicles is very fast,” says Axel Brunger, PhD, in the video above. “It occurs on the order of a millisecond. It’s one of the fastest known biological processes, so we’re trying to understand this process at a molecular level and how it actually works is a big mystery at the moment.”

Brunger, the chair of the Department of Molecular and Cellular Physiology, and his team use a variety of optical imaging methods and high-resolution structural methods to examine the transmission of synaptic vesicles:

We’re now using our [in vitro] system to study the effect of a number of factors, including factors involved in a number of diseases.

What we are hoping from these studies is to obtain a better understanding of how these factors and then secondly and importantly, to develop new strategies or therapeutics to combat these diseases.

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

Previously: New insights into how the brain stays bright, Revealed: The likely role of Parkinson’s protein in the healthy brain and Examining the potential of creating new synapses in old or damaged brains 

Big data, Chronic Disease, Public Health, Research

Finding asthma outbreaks using Twitter: How social media can improve disease detection

Finding asthma outbreaks using Twitter: How social media can improve disease detection

Asthma_inhaler_useWant to know if bad air has sparked an asthma epidemic in your neighborhood? Well, you’ll have to wait several weeks using traditional epidemiologic methods, a time lag that makes prompt response efforts quite tricky.

Or, perhaps you can just check out your Twitter feed.

A team led by Sudha Ram, PhD, at the University of Arizona found that a model that aggregates Twitter data, Google searches, air quality data and asthma-related emergency room visits can predict outbreaks with 70 percent precision. It’s big data in action.

As Ram comments in a press release:

The CDC gets reports of emergency department visits several weeks after the fact, and then they put out surveillance maps. With our new model, we can now do this in almost real time, so that’s an important public health surveillance implication.

With that information, hospitals could beef up their staff and health care workers could reach out to at-risk populations.

In the future, Ram said she plans to examine diseases with greater geographic and temporal variability such as chronic obstructive pulmonary disease (COPD) and diabetes. Her research was published in a special issue of the Institute of Electrical and Electronics Engineers Journal of Biomedical and Health Informatics.

Previously: Advice for young doctors: Embrace Twitter, Mining Twitter to identify cases of foodborne illness and Text messages about asthma could help children breathe easier 
Via MedCity News
Photo by Wikimedia

Patient Care, Pediatrics, Stanford News

A high-school student reflects on bringing joy to pediatric intensive care unit

A high-school student reflects on bringing joy to pediatric intensive care unit

heart-balloonThe pediatric intensive care unit can feel like an alternate reality, one in which the challenges of treating severe illness push being a kid into the background. That’s why it was lovely to read an essay (subscription required) in this week’s issue of the Journal of the American Medical Association that reflects on a moment of childhood fun within the confines of the PICU at Lucile Packard Children’s Hospital Stanford.

The essay, written by high-school freshman Julie Cornfield, describes how her father, pediatric pulmonologist David Cornfield, MD, enlisted her help in bringing joy to one of his young patients. Here is Julie’s description of how she met that patient, whom she later describes as “vivacious, strong, unbelievably kind, and outgoing, despite, or maybe because of, [her] sickness:”

Soon we found ourselves in the Pediatric Intensive Care Unit, where critically ill children are treated for all sorts of sicknesses, and where my dad spends most of his time. As I trailed behind my father down a long hall, we passed quizzical-looking nurses and young doctors. Everywhere I looked, there was a child with a life-threatening issue, and the air was thick with anxiety. After having me sanitize my hands,my Dad led me into a door at the very end of the hall.

That was when I caught my first glance of Adrianna, a frail 8-year-old girl with severe arthritis that had led to lung issues. My father introduced me to Addie and her mother, and then we unveiled our fluffy guest. Adrianna’s eyes grew to the size of saucers and she squeaked with joy. Her face lit up and it looked like, for a second, she forgot her pain.

The rest of the essay, including the moving story of a balloon the young patient gave to Julie’s dad, is well worth a read.

Photo by Pedro Moura Pinheiro

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