Published by
Stanford Medicine



Aging, In the News, Public Health, Sleep

Nothing to snort over: Why snoring should be taken seriously

Nothing to snort over: Why snoring should be taken seriously

6258904896_ec4a6f155a_zIt’s the middle of the night—or maybe the middle of the day—and all seems well. Then, you hear it: a low, rumbling, animalistic sound. It could be a snort or a growl or even a snarl. But it’s not an animal at all. It’s a person who is snoring far too loudly for your liking, and the sound only seems to be getting worse.

It’s safe to say we all know someone who snores – or we may even do it ourselves. A Huffington Post article puts a spotlight on snoring and features Stanford’s Rafael Pelayo, MD, who explains why it occurs, why it becomes increasingly worse with age, and, most importantly, why it could signal a potentially serious health problem.

“Think of fire and a fire alarm,” Pelayo says. “The snoring is the alarm. If there’s a fire and the fire alarm goes off and I disconnect the alarm, it doesn’t mean I put out the fire. The fire could still be burning.”

Snoring could be a symptom of sleep apnea, a disorder in which a person’s breathing repeatedly stops and starts during sleep. Apnea is a legitimate medical issue that can be harmful if gone unchecked, and Pelayo encourages anyone who snores to get tested for it.

Alex Giacomini is an English literature major at UC Berkeley and a writing and social media intern in the medical school’s Office of Communication and Public Affairs.

Previously: New recommendation: Adults need at least 7 hours of sleep each night, Why untreated sleep apnea may cause more harm to your health than feeling fatigued and How insufficient sleep can lead to weight gain 
Photo by Marc Lewis

Aging, BigDataMed15, Videos

A look at aging and longevity in this “unprecedented” time in history

A look at aging and longevity in this "unprecedented" time in history

Keynote talks and presentations from the 2015 Big Data in Biomedicine conference at Stanford are now available on the Stanford YouTube channel. To continue the discussion of how big data can be harnessed to improve the practice of medicine and enhance human health, we’re featuring a selection of the videos on Scope.

Life expectancy dramatically increased in the 20th century and has reached an all-time high in the United States. At this year’s Big Data in Biomedicine conference, Laura Carstensen, PhD, director of the Stanford Center on Longevity, called this point in history “unprecedented” in terms of longevity. She told attendees, “Our ancestors in the 20th century added more years to life expectancy than all years added across all prior millennia of human evolution combined.” She also noted that for the first time in the history of our species, “the vast majority of babies born in the developing world have the opportunity to grow old.”

In the above talk, she explains the changes that led to this “stunning achievement” and presents data to explore what aging now looks like – and what it might look like in the future.

Previously: Parents turn to data after son is diagnosed with ultra-rare disease, Nobel Laureate Michael Levitt explains why “biology is information rich” at Big Data in Biomedicine, At Big Data in Biomedicine, Stanford’s Lloyd Minor focuses on precision health, Experts at Big Data in Biomedicine: Bigger, better datasets and technology will benefit patients and On the move: Big Data in Biomedicine goes mobile with discussion on mHealth

Aging, Cancer, Dermatology, Genetics, Research, Stanford News

Genetic secrets of youthful skin

Genetic secrets of youthful skin

new hatEvery year, upwards of $140 billion a year gets spent on cosmetics. In the United States alone, says an authoritative report, a recent year saw upwards of 5.6 million Botox procedures, 1.1 million chemical peels, almost a half-million laser skin procedures, 196,286 eyelid surgeries and a whole bunch of face lifts.

If you’ve got the courage to compare your present-tense face with the one you were wearing 20 or even 10 years ago, you’ll see why. As I wrote in a just-published Stanford Medicine article, “Wither youth?”:

The terrain of aging skin grows all too familiar with the passing years: bags under the eyes, crow’s feet, jowls, tiny tangles of blood vessels, ever more pronounced pores and pits and pigmentation irregularities. Then there are wrinkles — long, deep “frown lines” radiating upward from the inside edges of the eyebrows and “laugh lines” that trace a furrow from our nostrils to the edges of our lips in our 40s, and finer lines that start crisscrossing our faces in our 50s. Sagging skin gets more prominent in our later years as we lose bone and fat.

“And,” I added wistfully, “it’s all right there on the very outside of us, where everyone else can see it.”

Stanford dermatologist Anne Chang, MD, who sees a whole lot of skin, got to wondering: Why does skin grow old? Armed with a sophisticated understanding of genetics, she went beyond lamenting lost youth and resolved to address the question scientifically, asking: “Can you turn back time? Can aging effects be reversed? Can you rejuvenate skin, make it young again?”

The answers she’s come up with so far – from hereditary factors to a possible underlying genetic basis for how some treatments now in common commercial cosmetic use (such as broadband light therapy) could potentially slow or even reverse the aging of skin – are described in my magazine article.

Previously: This summer’s Stanford Medicine magazine shows some skinResearchers identify genetic basis for rosacea, New study: Genes may affect skin youthfulness and Aging research comes of age
Photo by thepeachpeddler

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

Aging, Pain, Palliative Care, Research, Stanford News

How would you like to die? Tell your doctor in a letter

How would you like to die? Tell your doctor in a letter

writing a letterAsking patients how they would like to die is not a question that comes easy to most doctors. Not surprisingly, most of us – doctors and patients alike – prefer to avoid the topic completely. That’s not good, says VJ Periyakoil, MD, director of palliative care education and training at Stanford.

As I wrote in an Inside Stanford Medicine article on Periyakoil’s new study on end-of-life conversations:

End-of-life conversations help clarify for doctors what matters most to patients in their waning days of life… “What are their hopes, wants, needs and fears? Do they want to die at the hospital on a machine? Do they want to die at home? We can’t know unless we have a conversation,” she said.

Her study, published today in PLOS One, surveyed more than 1,000 medical residents and found that most balk at talking with seriously ill patients about what’s important to them in their final days, especially if the patient’s ethnicity is different than their own. Of those surveyed, 99.99 percent reported barriers, with 86 percent rating them as very challenging.

The upshot for Periyakoil, as she explains in a New York Times column published today, is that if we want to have a say in how we die, we should start that conversation ourselves.

To get these conversations started far and wide, she has launched the Stanford Letter Project – a campaign to empower all adults to take the initiative to talk to their doctor about what matters most to them at life’s end. The project’s website hosts templates for a letter about this to your doctor to get the conversation rolling. The templates are in Mandarin, Spanish and Tagalog as well as English – and Periyakoil says translations in additional languages will be available soon.

Previously: 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 themselvesAsking the hardest questions: Talking with doctors while terminally ill, On a mission to transform end-of-life care and The importance of patient/doctor end-of-life discussions
Photo by Gioia De Antoniis

Aging, Medicine and Society, Videos

In honor of National Healthcare Decisions Day: A reminder for patients to address end-of-life issues

In honor of National Healthcare Decisions Day: A reminder for patients to address end-of-life issues

When San Jose, Calif. residents Shirley and Eddie Jones wanted to discuss their end-of-life wishes, they encountered resistance from an unexpected source. As detailed in the video above, their beloved children refused to participate in the conversation.

As with the Jones, the people who love you the most may not be willing to help you because they care too much – and your doctors may be largely silent as they’re uncomfortable broaching this sensitive topic for fear of offending you. So, when it comes to end-of-life planning, you’re largely on your own. And it’s important that you take the first step and break this wall of silence.

Even as you’re reading this, you may be thinking that the topic of end-of-life decision making is not relevant to you right now – that it’s too early. Or it may be that you’re uncomfortable thinking about death. You may even be waiting for your doctor to broach this subject with you and lead the way. After all, as long as you do what the doctor tells you to do, you can get pretty good results with your health care. But, this ‘wait-for-your-doctor’ strategy isn’t going to serve you well when it comes to end-of-life decision making and planning.

Don’t believe me? Then just take a moment to review the evidence (link to .pdf): Eighty percent of people say that it’s important to have end-of-life wishes in writing, but only 23 percent say they have have done so. Eighty percent wish to have end-of-life conversations with their doctor but only 7 percent get to do this. Research also shows that most doctors have neither the training nor the time to skillfully conduct end-of-life conversations with their patients.

Continue Reading »

Aging, Immunology, Infectious Disease, Research, Stanford News

Frenemies: Chronic cytomegalovirus infection boosts flu vaccination efficacy (IF you’re young)

Frenemies: Chronic cytomegalovirus infection boosts flu vaccination efficacy (IF you're young)

cheapo boost“The enemy of my enemy is my friend.” This phrase, or at least the thinking it embodies, is at least 2,400 years old. So, there must be something to it, right?

Of course, it’s arguably a vast oversimplification. The more nuanced and much newer term “frenemy,” dating back merely to the early 1950s, is more apt in the case of infection by the microbe known as cytomegalovirus (CMV, for short). If the name is unfamiliar, brace yourself: You’ve probably already been introduced. It’s ubiquitous.

“Between 50 percent and 80 percent of adults in the United States have had a CMV infection by age 40,” states a page on the National Institutes of Health’s website. (Worldwide, the proportion of people infection exceeds 90 percent.) Once CMV is in a person’s body, it stays there for life,” the page soberly adds.

For the most part in healthy people, CMV pretty much sits there inside of cells (particularly in the salivary glands), pretty much biding its time and getting slapped down by the immune system if it tries to act up.

On the other hand, the virus can cause serious trouble if you’re immune-compromised: say, getting a bunch of immune-suppressing drugs pending or after a transplantation operation, or carrying another virus, the infamous immune-deficiency-causing HIV (which as far as we know is nothing but an enemy, plain and simple.)

But in a new study published in Science Translational Medicine, Stanford immunology expert Mark Davis, PhD, and his colleagues show that carriers of CMV mount a more robust immune response to seasonal influenza vaccinations, increasing the chances that the annual vaccine will be more effective in those people.

That’s the good news. The not-so-great news is that this only holds for young people (20-30 years old), not the older ones (age 60 and up) who could really use a boost: The older you get, it’s well known, the less effective the standard seasonal flu vaccine is in helping you fight off an influenza infection.

Experimenting with mice, Davis and his associates went a step farther. They actually infected the animals with influenza itself. Sure enough, young mice who were carrying CMV fought off the bug better than the non-infected mice did.

That’s the good news. The not-so-great news is that the old mice didn’t.

And although the study didn’t say so, one wonders whether in young people whose immune systems are going strong, that extra rocket fuel CMV seems to provide may have a dark side, for example a tendency to autoimmunity. Women’s immune systems tend to be more robust than those of men (very possibly due to the effects of testosterone, as Davis and his crew found a little over a year ago. And they have several times the rate of many autoimmune diseases that men do.

Previously: In human defenses against disease, environment beats heredity, study of twins shows, Why do flu shots work in some but not others? Stanford researchers are trying to find out, In men, a high testosterone count can mean a low immune response and Mice to men: Immunological research vaults into the 21st century
Photo by Joe Lillibridge

Aging, Global Health, Medical Education, Patient Care, Stanford Medicine Unplugged

After the rain: Experiencing illness as a medical student and granddaughter

After the rain: Experiencing illness as a medical student and granddaughter

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

rainy groundIn India, when the first heavy droplets of rain meet dry earth it releases a particular kind of smell: a dampness arising from sizzling soil that in Bengal we call shnoda gondho. It is raining on the second day we go to visit my grandfather in the hospital.

He has been readmitted to the hospital, after spending a week recovering at home from a hospitalization for rib fractures and bleeding into his lungs. The irony of his hospitalization is not lost on his family: that a renowned doctor, one of the first cancer surgeons in the city of Kolkata and one who spearheaded oncological care in this region, is now gowned and sitting in a hospital bed. This happens frequently, of course, for doctors are not immune to being patients, even if we would like to think so. The problem is that we are little prepared for the unstructured, unscripted nature of experiencing illness rather than treating it.

Certainly for my grandfather, a man who even recently traveled to multiple hospitals each day to supervise surgeries and see patients in clinic, being confined to bed for respiratory treatments and being unable to walk without support feels equivalent to being bound up, tied down, and chained to the hospital. This is the way illness imprisons. For his family, used to seeking his wise medical advice on various things from pesky coughs to unremitting cancers, we are unprepared to now help make decisions for him.

We never stop being medical students, and later we never stop being doctors, whether in relationships with family members, friends, acquaintances, or strangers in emergency situations

Perhaps this reflection is too personal for a forum created for sharing medical school experiences. But I suppose my realization is that medical school is not a place but rather a privilege we hold. We never stop being medical students, and later we never stop being doctors, whether in relationships with family members, friends, acquaintances while traveling, or strangers in emergency situations.

But, as I spend these three weeks with my grandfather and my family in Kolkata, I find that it is important to play both roles: that of medical student, the one who can help translate the staccato of medical jargon into fluid lines, and that of loved one, the one who listens not via an earpiece through the taut drum of a stethoscope but through bare ears and naked eyes, the one who listens for and is moved by the cries of pain, or suffering, or confusion, or desperation, of the ones they love.

In many ways the loved one is the harder role to play, for it is the role with no lines. No chest x-rays to evaluate in the morning. No medications to re-dose for a rising creatinine. No growing charts of oxygen saturation, or heart rate, or urine output. As someone who has recently grown used to doing these things on the medicine wards of Stanford Hospital, I now acculturate to a more improvisational kind of care. Placing a soothing hand on an aching back. Sitting at someone’s bedside while he nods in and out of sleep. Holding down an arm so that it doesn’t tremble like the string on a harp. In Indian hospitals, the family must often arrange to bring the medications that the doctors have prescribed and may often visit the hospital multiple times a day to bring food. We mix rice with soft, curried vegetables or boiled eggs and offer them to our loved ones, hoping to find through these labors some connection, some solace.

As family members we grasp for metaphors. In India, these metaphors of illness are often built around ideas of hot or cold, of water or wind. Perhaps that is why I find it so poignant that it rained today, the dense, gray clouds releasing their water just as the water from the pleural effusion in my dadu’s lungs was drained.

I hope that one day soon, when this rain had cleared, my grandfather will write his own words as he has planned to do. And then he can tell you his story, not I.

Amrapali Maitra is a fifth-year MD/PhD student working towards a PhD in Anthropology. She is interested in the illness experience, the cultural and social basis of health, and practices of care.   Amrapali grew up in New Zealand and Texas, and she studied history and literature as an undergraduate at Harvard. She is a 2013 Paul and Daisy Soros Fellow.  

Photo by Jason Devaun

Aging, Chronic Disease, Events, Health Policy, Neuroscience, Public Health, Women's Health

Alzheimer’s forum with Rep. Jackie Speier spurs conversation, activism

Alzheimer's forum with Rep. Jackie Speier spurs conversation, activism

10776927963_3dd8d244da_zWhat happens when you bring together a woman with Alzheimer’s, a congresswoman, a policy expert and two doctors? No, this isn’t a joke – but an intro to an informative and wide-ranging discussion on Alzheimer’s disease and its effects on women.

“I was pretty ignorant until fairly recently,” said Rep. Jackie Speier (D-CA), who organized the forum Alzheimer’s: A women’s health issue held in San Mateo, Calif. yesterday. She also penned an opinion piece published recently in the San Francisco Chronicle. “I had no idea that two out of three people diagnosed with Alzheimer’s are women.”

Although it’s the fifth leading cause of death in California, Alzheimer’s receives much less federal money than many other major diseases, she said.

To spur conversation and provide information, Speier invited Cynthia Ortiz Guzman, a former nurse who suffers from Alzheimer’s; Ruth Gay, director of public policy and advocacy for the Alzheimer’s Association; Elizabeth Landsverk, MD, medical director of ElderConsult, and Stanford’s Michael Greicius, MD, MPH, an associate professor of neurology and neurology and medical director of the Stanford Center for Memory Disorders. Greicius has done research on women’s risk of the disease.

Nearly all of the 150-plus people who attended the forum had a loved one who suffered from Alzheimer’s. “We still have a good life, but there is so much that needs to be done,” Guzman told them.

Greicius and Landsverk fielded questions about how to diagnose and treat Alzheimer’s as well as promising directions of research.

At Stanford, Greicius said a person with memory impairment would meet with a neurologist, take a several hour neuropsychological exam, have bloods tests and a brain scan, and meet with social workers and nurses. He emphasized that this is far above the level of care available in more community medical centers. Sometimes physicians are able to find biomarkers that signal Alzheimer’s presence more than a decade before symptoms appear he said.

Greicius urged attendees to find out if they’re eligible for a neurological research trial at Stanford and to consider donating their brains and the brains of their loved ones to use for research. He also thanked Speier for focusing attention on Alzheimer’s.

“We’ve got to get the attention of policymakers to address this issue,” Speier said, adding that she might try to secure federal funds as part of the defense budget.

Gay, who recently traveled to Washington, D.C. to advocate for the disease, agreed. “We know that today we need a game changer – we need people to step forward and speak out about this disease,” she said.

Previously: Science Friday explores women’s heightened risk for Alzheimer’s, The state of Alzheimer’s research: A conversation with Stanford neurologist Michael Greicius and The toll of Alzheimer’s on caretakers 
Photo by Marjan Lazarevski

Aging, Genetics, Research, Science, Stanford News

“Are we there yet?” Exploring the promise, and the hype, of longevity research

"Are we there yet?" Exploring the promise, and the hype, of longevity research

Brunet photoThe days are getting longer, and it’s no longer dark outside when I drop my teenager at school for her early-bird class. I appreciate the light, of course, and there’s something soothing about the rhythmic change of seasons.

If only we could extend our lifespan in a similar gentle, reliable manner.

The idea of living longer, and healthier, is the theme of my story for the new issue of Stanford Medicine magazine. It’s my favorite kind of article – a dash of juicy science history, a panoply of dedicated scientists and a brand-new animal model (and my newest crush) that may open all kinds of research doors. Best of all, there’s a sense of real progress in the field. From my article:

“Ways of prolonging human life span are now within the realm of possibility,” says professor of genetics and newbie fish keeper Anne Brunet, PhD. Brunet, who is an associate director of Stanford’s Paul F. Glenn Center for the Biology of Aging, focuses her research on genes that control the aging process in animals such as the minnowlike African killifish I’d watched fiercely guarding his territory.

The killifish is especially important to researchers like Brunet because it has an extremely variable, albeit short, life span. One strain from eastern Zimbabwe completes its entire life cycle — birth, maturity, reproduction and death — within about three to four months. Another strain can live up to nine months.

It’s also a vertebrate, meaning it belongs to the same branch of the evolutionary tree as humans. This gives it a backbone up over more squishy models of aging like fruit flies or roundworms — translucent, 1-millimeter-long earth dwellers you could probably find in your compost pile if you felt like digging.

I hope you’ll read the rest of my piece to learn more.

Previously: My funny Valentine – or, how a tiny fish will change the world of aging research, Stanford Medicine magazine reports on time’s intersection with health and Living loooooooonger: A conversation on longevity
Photo of Anne Brunet by Gregg Segal

Stanford Medicine Resources: