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Sunday, October 19, 2014

In the Spotlight: Pica

6:18 AM Posted by Tiffany Taft ,
This month for our Rare Disease of the Month blog we're discussing Pica, which is a condition that often appears in conjunction with other conditions.  The word Pica is from the latin for Magpie, which is a bird associated with odd eating habits.  It was first documented in medicine in 1563. Pica has the potential to be dangerous, even fatal, depending on the substances the person is eating.

Snapshot:  Pica is when a person repeatedly eats substances with no nutritional value such as dirt, ice, paint, stones, or even glass.  Eating these substances must occur for at least 1 month and at an age where it's developmentally appropriate to not engage in this behavior (aka a 3 month old eating a piece of dirt is not Pica). The most common substance eaten is ice, which may seem benign, and can lead to cracked teeth, slowed digestion, and weight gain.  There are several subtypes of Pica, depending on the preferred substance to eat. Complications may occur. For example, lead poisoning may result from the ingestion of paint or paint-soaked plaster, hairballs may cause intestinal obstruction, and infections may follow ingestion of feces or dirt. Pica can also be a cultural practice not associated with a deficiency or disorder.

How Common is It?
Pica is more common in women (often during pregnancy), small children, and people living with developmental disabilities such as Autism.  Pica often occurs when the person has some type of vitamin or mineral deficiency, most commonly iron or zinc, which can drive cravings. Pica cravings are most commonly seen in children and occur in approximately 25-30% of all children.

What About Diagnosis and Treatment?
There is no single test that confirms pica. However, because pica can occur in people who have lower than normal nutrient levels and poor nutrition, blood levels of iron and zinc should be tested.   Anemia should also be ruled out. Pica may also be a behavioral response to stress. People living with certain chronic illnesses are more susceptible to developing pica including celiac disease and sickle cell anemia, as well as people who have undergone gastric bypass surgery.

Treatment should first address any missing nutrients or other medical problems, such as lead poisoning. Treating pica involves behaviors, the environment, and family education. One form of treatment associates the pica behavior with negative consequences or punishment (mild aversion therapy). Then the person gets positive reinforcement for eating normal foods. Medications may help reduce the abnormal eating behavior if pica is part of a developmental disorder such as intellectual disability. There is some evidence that a simple multivitamin supplement could be an effective treatment in some cases.  In many cases, the disorder lasts several months, then disappears on its own.

What About the Social and Emotional Impact?
There are few research studies on the social and emotional impact of pica.  A major issue can be stigma. We teach children not to eat dirt even before they can talk; conversely, telling someone to eat dirt is a powerful expression of contempt, a way of demoting them from human to animal.  Pica even has its own reality TV show - "My Strange Addiction" where, unfortunately, they are often the subject of ridicule and being thought of as "weird" or "crazy."  The stress from pica-related stigma can add fuel to the stress-pica cycle, making the urge to engage in pica-behavior stronger and more frequent.  Social withdrawal, feelings of isolation, depression, and anxiety can result.

Helpful Resources:

Yahoo! Pica Support Group
Medscape Information About Pica

Saturday, October 18, 2014

How To Fail at Awareness

7:11 AM Posted by Tiffany Taft , ,
I don't need to make anyone aware that October is Breast Cancer Awareness month.  Our annual descent into all things pink to remind the populace that women (and men, although this is usually lost in the messages) get breast cancer.  And we should get our mammograms, do our monthly breast exams, and support women who have been diagnosed with this awful disease.

It's a great idea, and whoever thought it up gets a major high five.  Unfortunately, we've turned this idea on its head and the message is often upsetting, distasteful, and demeaning to women living with breast cancer, or who are survivors.

I don't claim to speak for anyone who lives with this diagnosis, but I have listened to several of them who actually hate October, the color pink, and most of the "awareness" campaigns.  I use quotes around that word because the aim to truly raise awareness of what breast cancer is has been lost in a sea of pink merchandise and marketing gimmicks.  Take the pink drill bit:

I completely understand that these ad campaigns produce revenue for various breast cancer organizations, like Susan G Komen, who, in turn, invest millions of dollars in breast cancer research and patient support programs.  But how does this help people understand what living with breast cancer is really like?  I guess the pain that is often endured may be something like being drilled by a device designed to cut through layers of limestone?

We've sugar coated breast cancer in a layer of pink bullshit, I mean icing:

The fact of the matter is breast cancer isn't cute, or sweet, or, for the love of all things holy, sexual.

Breast cancer is painful, and messy, and can be really depressing.  Up to a third of women living with breast cancer develop anxiety or depression.  It's devastating for spouses, family, and friends when a loved one is diagnosed.

It's a really uncomfortable topic if you get into the weeds.  Which is what all of these "awareness" campaigns try to buffer the general population from.  The message is "Look I totally want to support breast cancer awareness...but I really don't want to know the details.  So let's keep it light, okay?"

I'm not saying that we need to plaster images of cancerous breasts, people vomiting into buckets from chemotherapy, or radiation burns at the 50 yard line.  But we shouldn't shy away from these realities, either.  The message to those going through the diagnosis, treatments, and prognoses is a lack of respect.  Not everyone survives with their breasts in tact, so having a 30 foot bra in the middle of Daley Plaza in Chicago is a lovely reminder for those who've had mastectomies that they've somehow failed, or are less of a woman:

Not everyone survives, either.  Yet discussions about metastatic breast cancer are non-existent for the most part.

So what can we do to truly be more aware of what breast cancer is?  If you know someone who has breast cancer, talk to them and listen to their stories.  Even the uncomfortable stuff, if they're willing to share it with you.  If you don't have this relationship, read blogs of people who live with it.  Follow them on Twitter (@annmarieg4@AdamsLisa, and @ReneeCancerLand are good ones).

Do a Google image search of breast cancer; mixed among the pink ribbons are real images of what breast cancer does.

Update your Facebook status with a breast cancer statistic, a link to self-exams, or a blog entry that really hits home rather than the color of your underwear or whatever the hell this year's offensive campaign is.  Donate money to the American Cancer Society, Avon Walk, or Gilda's Club.

Get outside of the comfort zone of the pink crap.  People living with breast cancer will thank you for it.

Thursday, October 9, 2014

How to have an allergy-free Halloween

1:11 PM Posted by Stephanie Horgan ,
Happy autumn, everyone! The air is crisp, the leaves are turning, and pumpkins abound. Many families celebrate Halloween and I wanted to dedicate this blog entry to our patients who have food allergies or restrictions. A few years ago, Dr. Taft and I traveled to Cincinnati, Ohio, to speak at the Cured Foundation conference. There we met with families who have children with with Eosinophilic esophagitis (EoE) or Eosinophilic Gastrointestinal Disorders (EGIDs), and saw some of the most severe food allergies we have ever seen. Although you may not know children with as severe of food allergies as those diagnoses, there are currently 15 million Americans dealing with food allergies. Our friends over at Food Allergy Research and Education (FARE) have a wonderful idea for families who celebrate Halloween that I wanted to share.

What it is:
Their project is called the Teal Pumpkin Project. The basic idea of this initiative is to have houses provide non-edible treats for those trick-or-treaters who may have illnesses such as food allergies, diabetes. Houses who choose to do this are encouraged to put out a Teal Pumpkin sign or paint a pumpkin teal, in order to show they are doing this. While most families hand out treats that contain peanuts, tree nuts, coconut, milk ingredients, and gluten, a teal pumpkin is a symbol to show that there are alternatives available that are non-edible.

What could I hand out instead of candy?
 FARE suggests glow bracelets or necklaces, pencils, markers, boxes of crayons, erasers, bubbles, mini Slinkies, whistles or noisemakers, bouncy balls, coins, spider rings, vampire teeth, mini notepads, playing cards, bookmarks, stickers, play-dough, and stencils. You can purchase these items inexpensively at dollar stores, or online at Amazon and Oriental Trading. The best part is that they’ll easily keep until next Halloween if you have extras, so there’s no waste — unlike those mini candy bars that go stale.

FARE is also offering a free printable poster that you can stick in your window — or right on your front door — to make sure trick-or-treaters and their parents understand you have non-food treats available. Some people may feel comfortable offering both edible and non-edible treats, which is fine, as long as they are kept seperate so that there isn't contamination. Let us know what you end up getting and how it goes!

Thursday, October 2, 2014

National Mental Illness Awareness Week (Oct 5-11, 2014)

12:18 PM Posted by Stephanie Horgan ,

Next week begins the 24th anniversary of having Congress recognize and establish a National Mental Illness Awareness Week. It starts Monday October 5th and continues until October 11th. As a therapist, I have the opportunity to meet many different types of clients, some with physical illness, some with mental illness, and often these two overlap. There is still such a long ways to go with decreasing the stigma around mental illness. There are wonderful organizations doing great work to empower those who suffer to share their stories, in order for others to truly understand what mental illness is about. If you haven’t already, check out these three: National Alliance on Mental Illness, Bring Change to Mind, and StrengthofUs. 
One of the best ways to decrease the stigma around mental illness is to know the facts and educate yourself and others. I was shocked to know that 1 in 4 American adults have a mental illness as well as 1 in 5 American kids. That number is astounding, and yet how many people actually talk about their experience openly? I am truly lucky to get to walk along so many of those managing their illness, and I encourage anyone reading this who is struggling to reach out for help. You are not alone. And now I’ll let the statistics speak for themselves: (courtesy of NAMI)

One in four adults−approximately 61.5 million Americans−experiences mental illness in a given year.
Approximately 20 percent of youth ages 13 to 18 experience severe mental disorders in a given year. For ages 8 to 15, the estimate is 13 percent.
Approximately 6.7 percent of American adults−about 14.8 million people−live with major depression.
Approximately 18.1 percent of American adults−about 42 million people−live with anxiety disorders, such as panic disorder, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), generalized anxiety disorder and phobias.
About 9.2 million adults have co-occurring mental health and addiction disorders.
Approximately 26 percent of homeless adults staying in shelters live with serious mental illness and an estimated 46 percent live with severe mental illness and/or substance use disorders.
Approximately 60 percent of adults12, and almost one-half of youth ages 8 to 15 with a mental illness received no mental health services in the previous year.
African American and Hispanic Americans used mental health services at about one-half the rate of whites in the past year and Asian Americans at about one-third the rate.
Individuals living with serious mental illness face an increased risk of having chronic medical conditions.
Adults living with serious mental illness die on average 25 years earlier than other Americans, largely due to treatable medical conditions.
Suicide is the tenth leading cause of death in the U.S. (more common than homicide) and the third leading cause of death for ages 15 to 24 years.
Although military members comprise less than 1 percent of the U.S. population, veterans represent 20 percent of suicides nationally. Each day, about 22 veterans die from suicide.