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H A R T F O R D H O S P I T A L’ S W E L L N E S S M A G A Z I N E
W I N T E R
R O U N D S2 0 0 5 2 0 0 6
Easing the pain...Palliative medicine comforts the body and soul
�
Hartford Hospital’s Wellness Magazine
Editor: LeeMonroe Director of Public RelationsDesigner: ClarePhilipsWriter: JaneBradleyPhotography: Pages3,4-5,8:JoyMillerCalendarCoordinator: LuisaMachado
ROUNDSisaquarterlypublicationofHartfordHospital.Itisnotintendedtoprovidemedicaladviceonindividualhealthmatters.Pleaseconsultyourphysicianforanyhealthconcerns.
Hartford Hospital80SeymourStreet
Hartford,CT06�0�-5037(860)545-5000
Health Referral Service(860) 545-1888 or (800) 545-7664
www.harthosp.orgRounds Medical Advisory Board:
AdrienneBentman,M.D.DavidCrombie,M.D.JosephKlimek,M.D.AndrewSalner,M.D.LindaTaylor,M.D.
R O U N D S
H E A L T H T I P S
Today tattoos are in style, but what happens when the trend ends? People often get a tattoo on a whim. Now that one in seven Americans sports at least one tattoo, laser surgery for tattoo removal is booming.
Removal takes repeated laser treatments at substantial cost. Laser surgery must be performed slowly over the course of a year to destroy pigment-containing cells without damaging underly-ing skin. Multicolor tattoos are particularly hard to remove, and people of color often have trouble because of their skin’s natural pigmentation. Black ink is actually the easiest to remove with laser light.
Treated skin turns white, then black and blue, and may scab or swell after laser surgery. No makeup can be worn for a week to hide the ugly discoloration because the skin is so fragile. Over the course of a couple of months, the pigmented lesions slowly fade and the process is repeated. Rarely, bleeding, scarring or infection can occur.
Avoid any tattoo parlor where tattoo artists re-use needles, don’t wear gloves or “double-dip” into a jar of ink used for more than one customer. Insist on sterile needles in unopened pack-ages. Select a reputable and licensed tattoo parlor to minimize the risk of hepatitis or infection from unsanitary needles. The American Society for Dermatologic Surgery warns that attempt-ing to give yourself a tattoo is extremely dangerous—infections can turn deadly.
Viral VengeanceLurkingsilentlyinthenerves,dormantfordecades,achild-hoodinfectionoftenmakesanunwelcomereappearanceaspeopleage.Shingles(herpes zoster)resultsfromapainfulreactivationofthesamevaricella-zostervirusthatcauseschickenpoxinkids.
Shingleseruptanywhere,usuallyononesideofthebody,sincethespreadofvirusislimitedtoskinsuppliedbyaparticularnerve.“Becausethevirusattacksnerves,shinglescancauselastingneurologicaldeficits,muscleweakness,facialparalysisorcornealscarringintheeye,”explainsStephenConway,M.D.,aHartfordHospitalneu-rologist.“Therashcangoaway,leavingpermanentresidualpaincalledpost-herpeticneuralgia.”
Althoughpainusuallysubsidesafteramonthorso,post-herpeticneuralgiaafflictsabout�0percentoftheestimatedonemillionAmericanswhodevelopshingleseachyear.Nervepainishardertotreatthanotherkindsofpain.Surprisingly,anti-seizuremedicationsworkbetterthannar-coticsfornervepain.“Aftershingles,somepeopleareleftwithburning,stabbing,shooting,electricshock-likepain,”saysRichardGannon,Pharm.D.,directorofthePharmacyPainManagementService.
NewtreatmentsapprovedbytheFoodandDrugAdmin-istrationforpost-herpeticneuralgiaincludetheLidoderm
patchcontainingthelocalanestheticlidocaine,whichblockssignalsfromdamagednerveendingswithoutbeingsignificantlyabsorbedintothebloodstream.FDA-approvedoralmedicationsincludetheanti-seizuremedicationsNeu-rontinandLyricaandtheantidepressantCymbalta.Inclini-caltrials,anewvaccinemarkedlyreducedtheincidenceofpost-herpeticneuralgiainolderadults.
Seeyourprimarycarephysicianpromptlyifyouexperi-encenumbness,tingling,itchingandpain,whichoftenpre-cedethetelltaleblisteringrash.Antiviralmedicationscanshortenthedurationofashinglesoutbreakandminimizelaterpainifgivenearly.
Easy to Get, Easier to Regret
3
PHYSICIAN PROFILE
Paincreatesfear,andfearintensifiespain.Manypeople
aremorefrightenedofpainthantheyareofdying.Theprocessofdevelopinglivingwillsandadvancedirectivesmayhelppa-tientscometotermswithdeathandpotentiallyalleviatesomeofthedepression,angerandanxietybyofferingthemsomemeasureofcontrolattheendoftheirlives.
Overtime,theword“hos-pice”hasbecomeassociatedwiththeterminalcareofcancerpatients,while“palliativecare”hasbroadenedtoincludesuchchronicillnessesasstroke,AIDS,
heartdiseaseandlungdisease.MorethanhalfofthepalliativecarepatientsatHartfordHospitalhaveadiagnosisotherthancancer.Todaypalliativecarehascometomean“comfortmeasures”designedtomanagesymptoms,relievepainandofferemotionalandspiritualsupportthroughwhatareoften,butnotalways,thepatient’slastdays.
AtHartfordHospital,aninterdisciplinarypalliativecareteamworkswithphysicians,careprovidersandfamiliestoassurequalityoflifeforpatientshospitalizedwithgraveillnesses.Theteamcomprisesphysicians,apsychiatrist,anurse,asocialworker,achap-lainandapharmacist,aswellasanesthesiologistsandotherspecialistsasneeded.“Ourgoalistorelievesuffering,”saysSharonDiamen,M.D.,associatedirectorofMedicineandaco-directorofthePalliativeMedicineConsultService.“Youcan’ttreatpaininisolation.Whatisthetotalburdenofsuffering?Painmeansdifferentthingstodifferentpeople.Sufferingincludesphysical,emotional,socialorspiritualpain.”
Atsomepointinaterminalillness,heroicmedicalinterventionslosetheirpowertohealthebody.Althoughpalliativecaredoesn’truleoutlife-prolongingtherapies,pa-tientsmaychoosetospendtheirfinaldayswiththeirfamilies,secureintheknowledgethattheircaregiversaredoingeverythingintheirpowertokeepthemcomfortable.Fordyingpatients,abandoninganendlessroundoftestsandtreatmentsmaybringrelief.
Forpatientsinseverepain,medicationscanbeprescribedtocontrolpainandrelievesymptoms.“Ourapproachtotreatingacutepost-surgicalortraumapaindiffersfromthewaywetreatchronicpain,”saysRichardGannon,Pharm.D.,amemberofthepalliativecareservice.“Severepaindoesn’tnecessarilyrequireaddictivenarcotics,butpatientswithcertainchronicdiseasesneedpainmedicationsjustlikeadiabeticneedsinsulin.”
Manycancerpatientsworryneedlesslyaboutbecomingaddictedtopainmedications.“Addictionisobsession,craving,psychologicaldependencythat’soutofcontrol,”saysGannon.“Forcancerpatientsreceivingpalliativecare,methadoneisagreatanalgesicthathasfewersideeffectsandisfarlessexpensivethanoxycontinorothernarcotics.Whilewecan’talwaysmakepatientscompletelypain-free,wecankeepthemcomfortable.”
Recently,thepalliativecareteamwascalledtothebedsideofapatientwhotoldhisnursehewantedtodie.“Hewasextremelyanxious,”recallsDr.Diamen.“Hewassuffer-ingfromshortnessofbreath,alongwithseverebackandchestpain.WhenIspokewithhim,Irealizedthathedidn’treallywanttodie,hejustwantedrelief.”
“Wewantpatientstofeelsupportedandnotafraid,”addsColleenMulkerin,MSW,LCSW,aco-directoroftheservice.“Wecareforthemsimplybylisteningtowhattheysay.Wegivecontrolbacktopatientsbyhelpingthemhaverealisticexpectationsaboutthecourseandoutcomeoftheirdisease.”
Sharon A. Diamen, M.D.Sharon A. Diamen, M.D., is associate director of Hartford Hospital’s Depart-ment of Medicine, medical director of Ambulatory Services and co-director of the Palliative Medicine Consult Service.
A graduate of the University of Connecticut School of Medicine, Dr. Diamen joined Hartford Hospital in 1985 as assistant direc-tor of the Department of Medicine. Board-certified in internal medicine and pulmonary disease, she did her residency in internal medicine at Yale-New Haven Hospital, followed by specialty training in pulmonary disease at Yale University.
In July, she was named co-director of the Palliative Medicine Consult Service, a collaborative team of rep-resentatives from pastoral services, pharmacy pain management, psychiatry, nursing, social work and surgical critical care. When she’s not spending long days visiting patients and talking with families in the hospital, she enjoys garden-ing, kayaking, birding, hik-ing and caring for a virtual menagerie of pets.
Pain and Palliation
4
WHAT’S GOING AROUND…News & Breakthroughs
P I 0 N E E R I N G
Fibroidtumorsoftheuterusafflictabout40percentofwomenoverage40andaccountforathirdofthe
600,000hysterectomiesperformedeachyearintheUnitedStates.Morethanaquarterofthoseofchildbearingage—andasmanyashalfofallAfricanAmericanwomen—sufferfromthesebenignbutoftentroublesomeuterinegrowths.Especiallyafterage40,fibroidscancauseheavymenstrualbleeding,backandpelvicpain,urinaryfrequencyorpressureonthebladder.
“Itellpatientsthattheyshouldn’tundergoanyproce-dureunlesstheirfibroidsarecausingproblems,”explainsJohnGreene,M.D.,assistantdirectorofHartfordHospital’sDepartmentofObstetricsandGynecology.“Duringpreg-nancy,fibroidscantripleinsize,causingprematurelabororothercomplications.Symptomslikeheavyorirregularbleedingmayworsenasawomannearsmenopause.”
Nowanewnon-surgicalapproachcalleduterine artery embolizationstarvesthefibroidofbloodsupplyandshrivelsthetumorawayovertime.“Fibroidsarevasculartumorsthatneedarichbloodsupply,”explainsHartfordHospital’sheadofinterventionalradiology,DomenicA.Zambuto,M.D.
“Deprivedofblood,thetumorsshrinkanddie.”Interventionalradiologistsuseminimallyinvasivetech-
niquesandhigh-resolutionimagingtechnologiestoguideinstrumentsthroughthevesselstothefarthestreachesofthebody.Withthepatientconsciousunderintravenoussedation,theinterventionalradiologistmakesasmallinci-sioninthegroinandthreadsanarrowtube,orcatheter,upthroughthefemoralarteryintofirstoneandthentheotherofthetwouterinearteries.Tinyplasticparticlesareinjectedintoeacharterytoplugthebloodvesselsleadingtothefibroids.Onceitsbloodsupplyiscutoff,thetumorbreaksdownandisre-absorbedbythebody.
Theoutpatientprocedureoffersamuchshorterrecoverytimethansurgicalremovalofthefibroidsorhysterectomy(removaloftheuterus).“Sincepatientshavesignificantpainandcrampingaftertheprocedure,weadministera‘cocktail’ofpainmedications,antibioticsandanalgesics,”explainsDr.Greene.“Insteadofthetypicalsix-weekpost-surgicalrecoveryafterahysterectomy,womenwhoundergoembolizationareusuallybackatworkinaweek.”
Two-thirdsofwomenwithheavybleedingreportsignificantimprovementaftertheprocedure,althoughabout�0percentexperience“post-embolizationsyndrome,”characterizedbyfever,pelvicpain,malaiseandmuscleaches.“Theprocedurecanberepeatediffibroidsrecur,”addsDr.Zambuto.“Manywomenwithsymptomaticfibroidssuffersilentlybecausetheydon’tknownewtreatmentoptionsexist.”
Fishy FactsEatingfishweeklylowerstheriskofdementia,prob-ablyduetobrain-boostingfattyacidsinomega-3fishoilsthathavealsobeenshowntocutstrokerisk,accordingtoasix-yearstudyatRushUniver-sityMedicalCenter.TheresearchersconfirmedtheresultsofEuropeanstudiesthatshowedeatingfishorseafoodappearstopro-tecttheagingbrainfromdementia.
Breathing LessonsThe New England Journal of Medicinereportsthatbreathlessness(dyspnea)isamorereliablepredictorofdeathfromheartproblemsthanchestpaincausedbycoronaryarterydisease.ResearchersatCalifornia’sCedars-SinaiMedicalCenterfoundthatpeoplewithdyspneabutnohistoryofcoronarydiseasewerefourtimesmorelikelythanthosewithoutbreathingproblemstodiefromheartdisease.
Race for the CureSpecificmutationsonthegenesBRCA�andBRCA�havelongbeenknowntoraisebreastcancerriskamongwhites,especiallyAshkenaziJews.Afterfind-ingdifferentmutationsonthesamegenesinAfricanAmericanswithastrongfamilyhistoryofthedis-ease,UniversityofChicagoMedicalCenterresearchersarecallingforwiderge-netictestingamongethnicgroups.
Scleroderma HopeThecancerdrugpaclitaxel(Taxol)mayslowskinthick-eningandsmallbloodvesseldestructioninsclerodermasufferers,saysaDukeUni-versityMedicalCenterstudythatoffersnewinsightsintothedebilitatingdis-ease.Scleroderma,achronic,life-threateningdegenera-tivedisease,causestissuedamage,hardeningoftheskin,shrinkingofmusclesanddamagetoorgansandbloodvessels.
Minimally Invasive Alternative to Hysterectomy for Fibroids
See Drs. Zambuto (lleft) and Greene, along with interventional radiologist Michael Hallisey, M.D., perform the procedure in a webcast archived on the hospital’s website, www.harthosp.org.
5
T H E N E W M E D I C I N E
Burden of Care Caregiversforafamilymemberwithcanceroftenneglecttheirownmentalhealth.TheJournal of Clini-cal Oncologyreportsthat�6percentofcaregiversmetthediagnosticcriteriaforpanicdisorder,majordepressivedisorder,post-traumaticstressdisorderorgeneralizedanxietydisorder.Fewerthanhalfhadsoughtprofessionalhelpfortheirmentalhealthafteralovedone’sdiagnosis.
Wake A Walker?Shouldyourouseasleep-walker?Mythsaboundaboutcausingaheartattackbysuddenlywakingsome-onewho’swanderinginadaze.ExpertsattheSleepDisordersCenteratNewYorkUniversityrecommendguidingthesleepwalkerbacktobedbythearmorelbow.Sleepwalking,whichoftenrunsinfamilies,maybelinkedtosleepapneaorrestlesslegssyndrome.
Stemming the DamageParalyzedmicebeganwalkingagainafterinjec-tionsofhumanstemcellsrepaireddamagecausedbyspinalcordinjury.Surpris-ingly,thestemcellsnotonlyformednewnervecells,butalsomyelin,thebiologi-calinsulationthatshieldsnervefibers.Thestemcellsseemtoformconnec-tionsthathelpbridgetheinjuredspinalcord,sayresearchersattheUniver-sityofCalifornia,Irvine.
Bird Flu Test Takes OffAnewtestpinpointsinflu-enzastrains,includingtheH5N�avianflu,inhoursratherthandays,sayre-searchersattheUniversityofColoradowhohopetode-velopthediagnostic“chip”intoanon-the-spottestforflu.Strainanalysisnowtakesaboutthreetofourdays,toolongifahighlyvirulenthuman-adaptedformofbirdflubecomesapandemic.
Asobesityratesclimb,alarmingnumbersofAmericansaretippingthescalesat300poundsormore.More
thanninemillionpeopleintheUnitedStatessufferfromclinicallysevereormorbidobesity,achronicdiseasedefinedasanexcessweightof�00poundsormoreoveridealbodyweight.
Withnoshortageofdietandexerciseplans,whydosomepeopleseemunabletoloseweight?Obesityamongadultshasdoubledsince�980,whilethenumberofover-weightadolescentshastripled.TheNationalInstitutesofHealthfoundthatmedicallysupervisedweightlossprogramsfailedupto98percentofthetimeoverafive-yearperiod.Sedentarylifestyles,slapdasheatinghabitsandhereditycontributetomorbidobesityinsusceptibleindividuals,butevena�0percentgainoveridealbodyweightraisestheriskofdiabetes,hypertension,highcholesterol,jointproblems,cancerandcoronaryarterydisease.
HartfordHospitalisnowofferinganinnovative,safeandeffectivesur-gicalinterventionformorbidlyobeseindividualswhohaverepeatedlyfailedmoreconservativeweightreductionalternativessuchassuperviseddiet,exerciseandbehavior-modificationprograms.“TheLAP-BANDsystemislessinvasivethangastricbypassbutstillrequiresthesamehighlevelofpatientcommitment,”saysDar-renTishler,M.D.,directorofbariatric(weightloss)surgeryatHartfordHospital.“TheadjustableLAP-BAND
LAP-BAND® Is a Cinch for the Stomachrequiresnocuttingofthestomachorintestineanddoesnotalterthenormalanatomy.”
Usingminimallyinvasivelaparoscopictechniques,Dr.Tishlerbucklesaninflatablesiliconebandjustbelowthejunctionbetweentheesophagusandstomach.Theadjustablebandisconnectedbytubingtoareservoirun-dertheskin.Aftertheoperation,Dr.Tishlerperiodicallyadjuststhebandthroughaportundertheskin.Thesmallpouchcreatedbythebandlimitstheamountoffoodthatcanbeeatenatanyonetime,whichallowspatientstofeelfullandsatisfiedaftereatingonlyasmallmeal.Thebandisdesignedtostayinplaceindefinitely,butcanbesurgicallyremovedifnecessary.
Althoughsurgeryforweightreductioncanhelppatientsloseweight,itisn’tamiraclecure.Thisnewsurgicaloptionissimplyanothertoolinthesurgicalweightlossprogram’smultidisciplinarymenuofnutritionclasses,exerciseandsupportgroups.
“Worldwide,theLAP-BANDisthemostcommonlyperformedobesitysurgerywithmorethan�00,000patientstreatedtodate,”addsDr.Tishler.“Nutritionalandsurgicalrisksaresignificantlylowerthanwithgastricbypassandmortalityis�0timeslower.”Aswithanymedi-caltreatment,patientsshouldcare-fullyweightherisksandbenefitsoftheprocedure.Forweightlosstobelasting,patientsmustmakeacommitmenttopermanentlifelongchangesinhabitsofeatingandexercise.
Dr. Darren Tishler holds a LAP-BAND for minimally invasive weight loss surgery.
6
|intheDOCTOR’S OFFICE |
Nearly four out of five people in the United States suffer from back pain at some time in their lives. Sciatica sends shooting pains down the nerves radiating from the lower back into the legs. Arthritis or other chronic joint pain afflicts nearly 70 million Americans, while low back pain is often caused by exertion and muscle strain. Low back pain is the leading cause of job-related disability in individuals under age 50.
“Strengthening the abdominal and back muscles helps prevent low back pain,” says Gerald J. Becker, M.D., an orthopedic and spinal
surgeon. “To minimize stress on your spine, make a concerted ef-fort to sit up straight, pull in your belly muscles and use the arms to get up from a chair. Pilates exercise or physical therapy can strengthen torso muscles.”
As people age, disks degenerate and supporting muscles shrink, thanks to a combination of a sedentary lifestyle, lack of exercise, cigarette smoking and obesity. Before surgery, patients should lose weight and quit smoking for a couple of months. “Smokers don’t heal bone properly,” says Dr. Becker. “And minimally invasive techniques don’t work as well in heavy people.”
Back pain may come from damage to an intervertebral disk, a fluid-filled shock-absorbing ring of cartilage between each of the backbones that serves as a cushion for the spinal column. When the ring of cartilage tears and fluid leaks out, the extremely pain-ful “herniated” disk presses on the nerves around the backbone and may require surgery.
Last year, sufferers underwent approximately 150,000 opera-tions to “fuse” their unstable spines in the hope of relieving pain. In a lower-lumbar spinal fusion, surgeons remove one or more degenerated disks and mechanically brace the spine with metal rods and bone grafts.
Dr. Becker warns people with severe or chronic back pain to avoid taking narcotic painkillers like codeine, Oxycontin, Perco-cet and morphine if they think they may need an operation. “How will patients cope with pain after surgery?” asks Dr. Becker. “The ideal patient is someone who has never taken a narcotic before.”
Common causes of back pain
ARTHRITIS(Spondylosis)
STRAINSANDSPRAINSLow Back(LUMBAR)
SCIATICA
SYMPTOMS CAUSES TREATMENTS
Shootingpaininthesciaticnervethatrunsfromthebackdownintothelegorfeet,usuallyononeside;burningortinglingpainradiatingfromthelowerbackthroughthebackofthethightothefrontoftheshin.
Osteoarthritis;jointsaffect-edbydegenerativechanges;localizedpaininfacetjointsofthespine;stiffness
Pain,musclespasm,relatedtoactivityandrestrictedtothelowbackandupperbuttocks
Pressureonthesciaticnerve,herniateddisk(alsocalledruptured disk, pinchednerve, slipped disk)
Injury,occupation,excessweightandgenetics;worncartilage;bonyspurs
Lowbackmuscleinjury;faultylifting;poorphysicalcondition;strain(musclefibersstretchedortorn);sprain(ligamentstorn)
Physicaltherapy;quitsmoking;loseweight;NSAIDs(aspirin,naproxenandibuprofen),topicalanalgesics,spinalfusion
Exercise,stretching,physicaltherapy,NSAIDs(aspirin,naproxenandibuprofen),tricyclicanti-depressants,anticonvulsantdrugs,epiduralsteroidinjections,surgery
Physicaltherapy,backstrengtheningexercises;epiduralsteroidinjections;R-I-C-E(rest,ice,compres-sionandelevation)
Back Talk
7
Psychosisseemstostrikeinyoungadulthood,bringingdelusions,hal-lucinationsanddisorderedthinkingatatimeoflifewhenpeopleoften
feelvulnerableandconfused.Thefirstplungeintoapsychoticepisodesometimessignalsthebeginningofalongdescentintoalifetimeofmentalillness.
Psychosisafflictsanestimatedthreeinevery�00youngadults.Withtreatment,somerecoverfromapsychoticepisode,whileothersbeginarelentlessjourneytowardchronicdisability.NowapilotprojectisunderwayattheInstituteofLiving(IOL)tostudyhowwellpeopleofcollegeagewithpsychoticsymptomsrespondtoearlyinterventionandtreatmentwithanti-psychoticmedications,groupandindividualtherapy,andfamilysupport.
TheIOLteamaimstoidentifythoseage�8to�5whoareshowingthefirstsymptomsofaclinicaldiagnosislikeschizophrenia,bipolardisorder,orpsychoticdepression.Alcoholordrugusemayalsobeafactor.“Ourgoalistotreatpsychosisinyoungadultsasearlyaspossibleinanintensivesix-monthprogram,”explainsStevenH.Madonick,M.D.,theIOLpsychiatristwhoisleadingthepilotprojectalongwithDirectoroftheFamilyResourceCenterLawrenceHaber,Ph.D.,andDavidVaughan,LCSW.“Intermsofre-coveryandremission,age�8worksbetterthanage35.Inthepast,byage��peoplewouldoftenbeinthepublicsystemandonthewaytofull-blownpsychoticillness.”
Althoughthepilotprojecthassofarenrolledonlyafewpatients,Dr.Madonickbelievessomedayearlytreatmentwillbeanestablishedpartofclinicalpractice.“We’relookingforpeoplenotyetcaughtinthedownwardspiralofanillness,”saysDr.Madonick.“Youngadultsoftenstillhavefamilysupportandtheresourcesthataccompanyit.Mosthaven’tbeenhospital-izedmorethanonceortwice.Atthebeginningofanillness,theytendtorespondtolowerdosesofmedicationsandhavelesscollateraldamagetotheirpsychosocialdevelopment.”
Oneofthefirstpatientswasacollegestudentwhobecamesodisturbedthathewalkedoutontotheledgeofahigh-risebuilding.“Hisparanoiawassoextremewhenhewasfirsthospitalizedthathethoughtthenursesweretryingtopoisonhim,”recallsDr.Madonick.“Nowhe’sbeingtreatedwithantipsychoticmedication,backincollegeanddoingwell.”
Dr.Madonickalsostressesthevalueoffamilyeducation.“Parentsoftensufferfromdenial,”heexplains.“Unlikeatumor,mentalillnessisintangible.Noonewantstoseethatachildisfallingapart.Parentsgetangrybecausetheirsonwreckedthecar,hisroomisuninhabitableorhehasn’tbathedindays.Expressionofgreatangerorotherintenseemotionputsincrediblepressureonsomeonewhosethoughtsarealreadydisorganized.”
Familyeducationsessions,alongwithindividualandgrouptherapy,keepdesperateparentsfrombecomingcontrollingoroverprotective.“Researchshowsthattheparents’expressedemotions,oftentheresultoffearoranger,canbeasimportanttotheirchildren’srecoveryasmedicationcompliance,”hesays.“Eventhemostfunctionalfamilyischallenged.”
“BythetimeIbecamepsychoticmylifehaddeterioratedandIwasdelusional,”recallsSarah(notherrealname),whobecamepsychoticat�9andisnowdoingwellonrelativelylow-dosemedications.“Myparentsdidn’trealizetheextentofmyproblemsandhowourfamilydynamics—specificallymyfather’sdrinking—wereaffectingmenegatively.Therewereplentyofredflagsthatmighthavepromptedaquickerintervention.Iurgeparentstobewillingtoaddressfamilyproblems.Don’tloseheartifyourchildbecomespsychotic.Ifmyparentshadrealizedsoonerthatthewholefamilyneededhelp,thingsmighthavebeendifferent.”
For more information about participating in the pilot project, call 860-545-7665.
Pilot Project
for Psychotic
Young Adults
NonProfitOrganizationU.S.Postage
PAIDHartford,CT
PermitNo.436�
80 Seymour Street
Hartford, Ct 06102-5037
Preheatovento450°.Wrapgarliclooselyinfoil.Putgarlicclovesandeggplantsonabakingsheetwitharim.Roastuntileggplantsandgarlicare
softandeggplantskinsbegintoblisterandblacken,about45minutes.Removegarlicfromoven;setaside.
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Heatoilinasmallnonstickskilletovermedium-lowheatuntilhotbutnotsmoking.Addslicedonion.Cook,stirringoccasionally,untilsoftandgolden(about8minutes).Setaside.
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Festive Eggplant Dip5garliccloves(unpeeled)3lbs.eggplant(�to3medium)�tbs.oliveoil�mediumonion,cutinhalflengthwise (Sliceonehalfinto¼-inch-thick pieces;finelychoptheotherhalf)½cupnonfatyogurt¾tsp.freshlemonjuice�tsp.coarsesaltfreshlygroundpepper�tsp.choppedfreshcilantro(ordriedcilantrototaste)
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(servingsize:3pitasand3tbs.dip)Calories:44;Protein:�g;Carbohydrate:4g;Fiber:.65g;TotalFat:�.9g(73%monounsaturated);Sodium:��7mgRecipe analyzed by Brunella Ibarrola, MS, RD, CD-N.
A cup of plain lowfat or nonfat
yogurt has 60 percent more
protein, one and a half times
the calcium and as much
magnesium, riboflavin and
vitamins B6 and B12 as a cup
of lowfat milk. Beyond its bone-
building benefits, the “active
cultures” in yogurt help digest
the naturally occurring milk
sugar that causes bloating
and diarrhea in lactose-in-
tolerant individuals. The only
snag—unlike milk, yogurt is
only rarely fortified with vita-
min D, necessary for calcium
absorption in the body.
Recommended