Published by
Stanford Medicine

Category

Stanford News

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.

Continue Reading »

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

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

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

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

Cancer, Events, Pediatrics, Stanford News, Videos

Pediatric nephrologist Mary Leonard discusses bone health in children with chronic diseases at Childx

Pediatric nephrologist Mary Leonard discusses bone health in children with chronic diseases at Childx

The inaugural Childx conference was held here last month video interviews featuring keynote speakers, panelists and moderators are now on the Stanford YouTube channel. To continue the discussion of driving innovation in maternal and child health, we’ll be featuring a selection of the videos this month on Scope.

Stanford pediatric nephrologist Mary Leonard, MD, initially began her career as a physician-scientist by investigating the bone complications of pediatric kidney disease. One of her earlier findings was that a number of the risk factors for poor bone development were also associated with many other childhood diseases, such as inflammatory bowel disease and cancer.

In the above video, Leonard explains how advances in treating pediatric kidney failure, cancer and other diseases is creating a growing population of survivors who are entering adulthood facing other health risks, including poor bone health, insulin resistance and cardiovascular disease. Watch the full interview to understand the magnitude of the problem and learn about efforts to develop prevention methods.

Previously: Childx speaker Matthew Gillman discusses obesity prevention, Pediatric health expert Alan Guttmacher outlines key issues facing children’s health today, “It’s not just science fiction anymore”: Childx speakers talk stem cell and gene therapy and Global health and precision medicine: Highlights from day two of Stanford’s Childx conference

Cardiovascular Medicine, Chronic Disease, Patient Care, Stanford News

Monitoring heart failure from home

Monitoring heart failure from home

blood pressure readingSometimes, the best way to prevent a visit to the hospital is to become your own care provider. That’s the theory behind a new Stanford-led project that monitors heart-failure patients at home.

From an Inside Stanford Medicine story on the pilot program:

“There is abundant evidence in the literature that suggests home monitoring can improve patient outcomes,” said Rita Ghatak, PhD, director of Stanford’s Aging Adult Services, one of the sponsors of the program. “It can improve survival, days out of the hospital, quality of life and it provides an extra measure of psychosocial support.”

Project leaders teach heart-failure patients, such as 74-old-year Earl Shook, who is featured in the story, how to measure their blood pressure and oxygen saturation at home. Patients also receive visits from specially trained nurses. A nurse caught when Shook’s blood pressure was climbing too high and helped get him in to the cardiologist the next day.

Shook said it was hard to leave the hospital, but he was reassured by the home-monitoring program. “It let me know there was somebody still caring for me.”

Previously: Exercise may boost heart failure patients’ mental and physical health, Failing at prescribing the best heart-failure treatments and Home health-care treatments for lymphedema patients cut costs and improve care 
Photo by sriram bala

Big data, Events, Stanford News, Videos

Stanford bioengineer discusses mining social media and smartphone data for biomedical research

Stanford bioengineer discusses mining social media and smartphone data for biomedical research

During the 2014 Big Data in Biomedicine conference, Stanford bioengineer and geneticist Russ Altman, MD, PhD, spoke about the possibility of collecting data directly from patients, via social media or smartphones, and using it to compliment traditional methods of gathering medical information to give clinicians an unprecedented capability to assess individuals’ state of health.

“One of the most exciting things is the ability to combine data at multiple levels,” he says in the video above. “We have an amazing ability to collect molecular data, cellular data, organism data from electronic medical records and population data about what’s happening at the population and global scale. The beauty of informatics is we don’t have to be tied to one of those levels.”

At the upcoming Big Data in Biomedicine conference, Altman will moderate a discussion with Kathy Hudson, PhD, deputy director for Science, Outreach, and Policy at the National Institutes of Health. Hudson leads the science policy, legislation, and communications efforts of the NIH and serves as a senior advisor to the NIH Director Francis Collins, MD, PhD. She is responsible for creating major new strategic and scientific initiatives and was a key architect of the National Center for Advancing Translational Sciences and the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative.

Registration for the conference, which will be held May 20-22 at Stanford, is currently open. More details about the program can be found on its website.

Previously: Big data used to help identify patients at risk of deadly high-cholesterol disorder, Examining the potential of big data to transform health care and Registration for Big Data in Biomedicine conference now open

Stanford Medicine Resources: