Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

---

Katherine Boutin speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

---

Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

---

Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

---

This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.

Read More..

Well: Getting the Right Addiction Treatment

“Treatment is not a prerequisite to surviving addiction.” This bold statement opens the treatment chapter in a helpful new book, “Now What? An Insider’s Guide to Addiction and Recovery,” by William Cope Moyers, a man who nonetheless needed “four intense treatment experiences over five years” before he broke free of alcohol and drugs.

As the son of Judith and Bill Moyers, successful parents who watched helplessly during a 15-year pursuit of oblivion through alcohol and drugs, William Moyers said his near-fatal battle with addiction demonstrates that this “illness of the mind, body and spirit” has no respect for status or opportunity.

“My parents raised me to become anything I wanted, but when it came to this chronic incurable illness, I couldn’t get on top of it by myself,” he said in an interview.

He finally emerged from his drug-induced nadir when he gave up “trying to do it my way” and instead listened to professional therapists and assumed responsibility for his behavior. For the last “18 years and four months, one day at a time,” he said, he has lived drug-free.

“Treatment is not the end, it’s the beginning,” he said. “My problem was not drinking or drugs. My problem was learning how to live life without drinking or drugs.”

Mr. Moyers acknowledges that treatment is not a magic bullet. Even after a monthlong stay at a highly reputable treatment center like Hazelden in Center City, Minn., where Mr. Moyers is a vice president of public affairs and community relations, the probability of remaining sober and clean a year later is only about 55 percent.

“Be wary of any program that claims a 100 percent success rate,” Mr. Moyers warned. “There is no such thing.”

“Treatment works to make recovery possible. But recovery is also possible without treatment,” Mr. Moyers said. “There’s no one-size-fits-all approach. What I needed and what worked for me isn’t necessarily what you or your loved one require.”

As with many smokers who must make multiple attempts to quit before finally overcoming an addiction to nicotine, people hooked on alcohol or drugs often must try and try again.

Nor does treatment have as good a chance at succeeding if it is forced upon a person who is not ready to recover. “Treatment does work, but only if the person wants it to,” Mr. Moyers said.

Routes to Success

For those who need a structured program, Mr. Moyers described what to consider to maximize the chances of overcoming addiction to alcohol or drugs.

Most important is to get a thorough assessment before deciding where to go for help. Do you or your loved one meet the criteria for substance dependence? Are there “co-occurring mental illnesses, traumatic or physical disabilities, socioeconomic influences, cultural issues, or family dynamics” that may be complicating the addiction and that can sabotage treatment success?

While most reputable treatment centers do a full assessment before admitting someone, it is important to know if the center or clinic provides the services of professionals who can address any underlying issues revealed by the assessment. For example, if needed, is a psychiatrist or other medical doctor available who could provide therapy and prescribe medication?

Is there a social worker on staff to address challenging family, occupational or other living problems? If a recovering addict goes home to the same problems that precipitated the dependence on alcohol or drugs, the chances of remaining sober or drug-free are greatly reduced.

Is there a program for family members who can participate with the addict in learning the essentials of recovery and how to prepare for the return home once treatment ends?

Finally, does the program offer aftercare and follow-up services? Addiction is now recognized to be a chronic illness that lurks indefinitely within an addict in recovery. As with other chronic ailments, like diabetes or hypertension, lasting control requires hard work and diligence. One slip need not result in a return to abuse, and a good program will help addicts who have completed treatment cope effectively with future challenges to their recovery.

How Families Can Help

“Addiction is a family illness,” Mr. Moyers wrote. Families suffer when someone they love descends into the purgatory of addiction. But contrary to the belief that families should cut off contact with addicts and allow them to reach “rock-bottom” before they can begin recovery, Mr. Moyers said that the bottom is sometimes death.

“It is a dangerous, though popular, misconception that a sick addict can only quit using and start to get well when he ‘hits bottom,’ that is, reaches a point at which he is desperate enough to willingly accept help,” Mr. Moyers wrote.

Rather, he urged families to remain engaged, to keep open the lines of communication and regularly remind the addict of their love and willingness to help if and when help is wanted. But, he added, families must also set firm boundaries — no money, no car, nothing that can be quickly converted into the substance of abuse.

Whether or not the addict ever gets well, Mr. Moyers said, “families have to take care of themselves. They can’t let the addict walk over their lives.”

Sometimes families or friends of an addict decide to do an intervention, confronting the addict with what they see happening and urging the person to seek help, often providing possible therapeutic contacts.

“An intervention can be the key that interrupts the process and enables the addict to recognize the extent of their illness and the need to take responsibility for their behavior,”Mr. Moyers said.

But for an intervention to work, Mr. Moyers said, “the sick person should not be belittled or demeaned.” He also cautioned families to “avoid threats.” He noted that the mind of “the desperate, fearful addict” is subsumed by drugs and alcohol that strip it of logic, empathy and understanding. It “can’t process your threat any better than it can a tearful, emotional plea.”

Resource Network

Mr. Moyer’s book lists nearly two dozen sources of help for addicts and their families. Among them:

Alcoholics Anonymous World Services www.aa.org;

Narcotics Anonymous World Services www.na.org;

Substance Abuse and Mental Health Services Administration treatment finder www.samhsa.gov/treatment/;

Al-Anon Family Groups www.Al-anon.alateen.org;

Nar-Anon Family Groups www.nar-anon.org;

Co-Dependents Anonymous World Fellowship www.coda.org.

---

This is the second of two articles on addiction treatment. The first can be found here.

Read More..

For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness

When a life starts to unravel, where do you turn for help?

Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.

In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.

“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”

That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”

Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.

One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.

“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”

On a recent afternoon, she described in her Midtown office the range of her practice.

“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”

Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”

Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.

One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.

“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”

Her son cut her off. “Are you comparing me to the guy that shot those people?”

“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”

“Did you really just compare me to that guy?”

“No, I didn’t compare you.”

“Then what did you say?”

Read More..

In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

Read More..

The New Old Age: The Executor's Assistant

I’m serving as executor for my father’s estate, a role few of us are prepared for until we’re playing it, so I was grateful when the mail brought “The American Bar Association Guide to Wills and Estates” — the fourth edition of a handbook the A.B.A. began publishing in 1995.

This is a legal universe, I’m learning, in which every step — even with a small, simple estate that owes no taxes and includes no real estate or trusts — turns out to be at least 30 percent more complicated than expected.

If my dad had been wealthy or owned a business, or if we faced a challenge to his will, I would have turned the whole matter over to an estate lawyer by now. But even then, it would be helpful to know what the lawyer was talking about. The A.B.A. guide would help.

Written with surprising clarity (hey, they’re lawyers), it maps out all kinds of questions and decisions to consider and explains the many ways to leave property to one’s heirs. Updated from the third edition in 2009, the guide not only talks taxes and trusts, but also offers counsel for same-sex couples and unconventional families.

If you want to permit your second husband to live in the family home until he dies, but then guarantee that the house reverts to the children of your first marriage, the guide tells you how a “life estate” works. It explains what is taxable and what isn’t, and discusses how to choose executors and trustees. It lists lots of resources and concludes with an estate-planning checklist.

In general, the A.B.A. intends its guide for the person trying to put his or her affairs in order, more than for family members trying to figure out how to proceed after someone has died. But many of us will play both these parts at some point (and if you are already an executor, or have been, please tell us how that has gone, and mention your state). We’ll need this information.

---

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..

Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His brown eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

---

Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Correction: The patient’s eyes were brown, not blue.

Read More..

Ipswich Journal: Paul Mason Is One-Third the Man He Used to Be

Paul Nixon Photography

Paul Mason in 2012, two years after gastric bypass surgery stripped him of the unofficial title of “the world’s fattest man.”

IPSWICH, England — Who knows what the worst moment was for Paul Mason — there were so many awful milestones, as he grew fatter and fatter — but a good bet might be when he became too vast to leave his room. To get him to the hospital for a hernia operation, the local fire department had to knock down a wall and extricate him with a forklift.

That was nearly a decade ago, when Mr. Mason weighed about 980 pounds, and the spectacle made him the object of fascinated horror, a freak-show exhibit. The British news media, which like a superlative, appointed him “the world’s fattest man.”

Now the narrative has shifted to one of redemption and second chances. Since a gastric bypass operation in 2010, Mr. Mason, 52 years old and 6 foot 4, has lost nearly two-thirds of his body weight, putting him at about 336 pounds — still obese, but within the realm of plausibility. He is talking about starting a jewelry business.

“My meals are a lot different now than they used to be,” Mr. Mason said during a recent interview in his one-story apartment in a cheerful public housing complex here. For one thing, he no longer eats around the clock. “Food is a necessity, but now I don’t let it control my life anymore,” he said.

But the road to a new life is uphill and paved with sharp objects. When he answered the door, Mr. Mason did not walk; he glided in an electric wheelchair.

And though Mr. Mason looks perfectly normal from the chest up, horrible vestiges of his past stick to him, literally, in the form of a huge mass of loose skin choking him like a straitjacket. Folds and folds of it encircle his torso and sit on his lap, like an unwanted package someone has set there; more folds encase his legs. All told, he reckons, the excess weighs more than 100 pounds.

As he waits to see if anyone will agree to perform the complex operation to remove the skin, Mr. Mason has plenty of time to ponder how he got to where he is. He was born in Ipswich and had a childhood marked by two things, he says: the verbal and physical abuse of his father, a military policeman turned security guard; and three years of sexual abuse, starting when he was 6, by a relative in her 20s who lived in the house and shared his bed. He told no one until decades later.

After he left school, Mr. Mason took a job as a postal worker and became engaged to a woman more than 20 years older than him. “I thought it would be for life, but she just turned around one day and said, ‘No, I don’t want to see you anymore — goodbye,’ ” he said.

His father died, and he returned home to care for his arthritic mother, who was in a wheelchair. “I still had all these things going around in my head from my childhood,” he said. “Food replaced the love I didn’t get from my parents.” When he left the Royal Mail in 1986, he said, he weighed 364 pounds.

Then things spun out of control. Mr. Mason tried to eat himself into oblivion. He spent every available penny of his and his mother’s social security checks on food. He stopped paying the mortgage. The bank repossessed their house, and the council found them a smaller place to live. All the while, he ate the way a locust eats — indiscriminately, voraciously, ingesting perhaps 20,000 calories a day. First he could no longer manage the stairs; then he could no longer get out of his room. He stayed in bed, on and off, for most of the last decade.

Social service workers did everything for him, including changing his incontinence pads. A network of local convenience stores and fast-food restaurants kept the food coming nonstop — burgers, french fries, fish and chips, even about $22 worth of chocolate bars a day.

“They didn’t deliver bags of crisps,” he said of potato chips. “They delivered cartons.”

His life became a cycle: eat, doze, eat, eat, eat. “You didn’t sleep a normal sleep,” he said. “You’d be awake most of the night eating and snacking. You totally forgot about everything else. You lose all your dignity, all your self-respect. It all goes, and all you focus on is getting your next fix.”

He added, “It was quite a lonely time, really.”

He frequently got infections and was transported to the hospital — first in a laundry van, then on the back of a truck and finally on the forklift. For 18 months after a hernia operation in 2003, he lived in the hospital and in an old people’s home — where he was not allowed to leave his room — while the local government found him a house that could accommodate all the special equipment he needed.

This article has been revised to reflect the following correction:

Correction: February 6, 2013

The headline on an earlier version of this article misstated Paul Mason’s current weight relative to what he weighed nearly a decade ago. He is now about one-third of the weight he was then, not two-thirds.

Read More..

Well: Gluten-Free for the Gluten Sensitive

Eat no wheat.

That is the core, draconian commandment of a gluten-free diet, a prohibition that excises wide swaths of American cuisine — cupcakes, pizza, bread and macaroni and cheese, to name a few things.

For the approximately one-in-a-hundred Americans who have a serious condition called celiac disease, that is an indisputably wise medical directive.

---

One woman’s story of going gluten-free.

---

Now medical experts largely agree that there is a condition related to gluten other than celiac. In 2011 a panel of celiac experts convened in Oslo and settled on a medical term for this malady: non-celiac gluten sensitivity.

What they still do not know: how many people have gluten sensitivity, what its long-term effects are, or even how to reliably identify it. Indeed, they do not really know what the illness is.

The definition is less a diagnosis than a description — someone who does not have celiac, but whose health improves on a gluten-free diet and worsens again if gluten is eaten. It could even be more than one illness.

“We have absolutely no clue at this point,” said Dr. Stefano Guandalini, medical director of the University of Chicago’s Celiac Disease Center.

Kristen Golden Testa could be one of the gluten-sensitive. Although she does not have celiac, she adopted a gluten-free diet last year. She says she has lost weight and her allergies have gone away. “It’s just so marked,” said Ms. Golden Testa, who is health program director in California for the Children’s Partnership, a national nonprofit advocacy group.

She did not consult a doctor before making the change, and she also does not know whether avoiding gluten has helped at all. “This is my speculation,” she said. She also gave up sugar at the same time and made an effort to eat more vegetables and nuts.

Many advocates of gluten-free diets warn that non-celiac gluten sensitivity is a wide, unseen epidemic undermining the health of millions of people. They believe that avoiding gluten — a composite of starch and proteins found in certain grassy grains like wheat, barley and rye — gives them added energy and alleviates chronic ills. Oats, while gluten-free, are also avoided, because they are often contaminated with gluten-containing grains.

Others see the popularity of gluten-free foods as just the latest fad, destined to fade like the Atkins diet and avoidance of carbohydrates a decade ago.

Indeed, Americans are buying billions of dollars of food labeled gluten-free each year. And celebrities like Miley Cyrus, the actress and singer, have urged fans to give up gluten. “The change in your skin, physical and mental health is amazing!” she posted on Twitter in April.

For celiac experts, the anti-gluten zeal is a dramatic turnaround; not many years ago, they were struggling to raise awareness among doctors that bread and pasta can make some people very sick. Now they are voicing caution, tamping down the wilder claims about gluten-free diets.

“It is not a healthier diet for those who don’t need it,” Dr. Guandalini said. These people “are following a fad, essentially.” He added, “And that’s my biased opinion.”

Nonetheless, Dr. Guandalini agrees that some people who do not have celiac receive a genuine health boost from a gluten-free diet. He just cannot say how many.

As with most nutrition controversies, most everyone agrees on the underlying facts. Wheat entered the human diet only about 10,000 years ago, with the advent of agriculture.

“For the previous 250,000 years, man had evolved without having this very strange protein in his gut,” Dr. Guandalini said. “And as a result, this is a really strange, different protein which the human intestine cannot fully digest. Many people did not adapt to these great environmental changes, so some adverse effects related to gluten ingestion developed around that time.”

The primary proteins in wheat gluten are glutenin and gliadin, and gliadin contains repeating patterns of amino acids that the human digestive system cannot break down. (Gluten is the only substance that contains these proteins.) People with celiac have one or two genetic mutations that somehow, when pieces of gliadin course through the gut, cause the immune system to attack the walls of the intestine in a case of mistaken identity. That, in turn, causes fingerlike structures called villi that absorb nutrients on the inside of the intestines to atrophy, and the intestines can become leaky, wreaking havoc. Symptoms, which vary widely among people with the disease, can include vomiting, chronic diarrhea or constipation and diminished growth rates in children.

The vast majority of people who have celiac do not know it. And not everyone who has the genetic mutations develops celiac.

What worries doctors is that the problem seems to be growing. After testing blood samples from a century ago, researchers discovered that the rate of celiac appears to be increasing. Why is another mystery. Some blame the wheat, as some varieties now grown contain higher levels of gluten, because gluten helps provide the springy inside and crusty outside desirable in bread. (Blame the artisanal bakers.)

There are also people who are allergic to wheat (not necessarily gluten), but until recently, most experts had thought that celiac and wheat allergy were the only problems caused by eating the grain.

For 99 out of 100 people who don’t have celiac — and those who don’t have a wheat allergy — the undigested gliadin fragments usually pass harmlessly through the gut, and the possible benefits of a gluten-free diet are nebulous, perhaps nonexistent for most. But not all.

Anecdotally, people like Ms. Golden Testa say that gluten-free diets have improved their health. Some people with diseases like irritable bowel syndrome and arthritis also report alleviation of their symptoms, and others are grasping at gluten as a source of a host of other conditions, though there is no scientific evidence to back most of the claims. Experts have been skeptical. It does not make obvious sense, for example, that someone would lose weight on a gluten-free diet. In fact, the opposite often happens for celiac patients as their malfunctioning intestines recover.

They also worried that people could end up eating less healthfully. A gluten-free muffin generally contains less fiber than a wheat-based one and still offers the same nutritional dangers — fat and sugar. Gluten-free foods are also less likely to be fortified with vitamins.

But those views have changed. Crucial in the evolving understanding of gluten were the findings, published in 2011, in The American Journal of Gastroenterology, of an experiment in Australia. In the double-blind study, people who suffered from irritable bowel syndrome, did not have celiac and were on a gluten-free diet were given bread and muffins to eat for up to six weeks. Some of them were given gluten-free baked goods; the others got muffins and bread with gluten. Thirty-four patients completed the study. Those who ate gluten reported they felt significantly worse.

That influenced many experts to acknowledge that the disease was not just in the heads of patients. “It’s not just a placebo effect,” said Dr. Marios Hadjivassiliou, a neurologist and celiac expert at the University of Sheffield in England.

Even though there was now convincing evidence that gluten sensitivity exists, that has not helped to establish what causes gluten sensitivity. The researchers of the Australian experiment noted, “No clues to the mechanism were elucidated.”

What is known is that gluten sensitivity does not correlate with the genetic mutations of celiac, so it appears to be something distinct from celiac.

How widespread gluten sensitivity may be is another point of controversy.

Dr. Thomas O’Bryan, a chiropractor turned anti-gluten crusader, said that when he tested his patients, 30 percent of them had antibodies targeting gliadin fragments in their blood. “If a person has a choice between eating wheat or not eating wheat,” he said, “then for most people, avoiding wheat would be ideal.”

Dr. O’Bryan has given himself a diagnosis of gluten sensitivity. “I had these blood sugar abnormalities and didn’t have a handle where they were coming from,” he said. He said a blood test showed gliadin antibodies, and he started avoiding gluten. “It took me a number of years to get completely gluten-free,” he said. “I’d still have a piece of pie once in a while. And I’d notice afterwards that I didn’t feel as good the next day or for two days. Subtle, nothing major, but I’d notice that.”

But Suzy Badaracco, president of Culinary Tides, Inc., a consulting firm, said fewer people these days were citing the benefits of gluten-free diets. She said a recent survey of people who bought gluten-free foods found that 35 percent said they thought gluten-free products were generally healthier, down from 46 percent in 2010. She predicted that the use of gluten-free products would decline.

Dr. Guandalini said finding out whether you are gluten sensitive is not as simple as Dr. O’Bryan’s antibody tests, because the tests only indicate the presence of the fragments in the blood, which can occur for a variety of reasons and do not necessarily indicate a chronic illness. For diagnosing gluten sensitivity, “There is no testing of the blood that can be helpful,” he said.

He also doubts that the occurrence of gluten sensitivity is nearly as high as Dr. O’Bryan asserts. “No more than 1 percent,” Dr. Guandalini said, although he agreed that at present all numbers were speculative.

He said his research group was working to identify biological tests that could determine gluten sensitivity. Some of the results are promising, he said, but they are too preliminary to discuss. Celiac experts urge people to not do what Ms. Golden Testa did — self-diagnose. Should they actually have celiac, tests to diagnose it become unreliable if one is not eating gluten. They also recommend visiting a doctor before starting on a gluten-free diet.

---

---

This post has been revised to reflect the following correction:

Correction: February 4, 2013

An earlier version of this article misspelled the surname of Thomas O'Bryan. It is O'Bryan, not O'Brien.

Read More..

The New Old Age Blog: Therapy Plateau No Longer Ends Coverage

Ellen Gorman, 72, a New York psychotherapist, can’t walk very far and gets around the city mainly by taxi, “which is really expensive,” she said. Twice since 2008 her physical therapy was discontinued because she wasn’t progressing. But after a knee replacement last year, she is getting physical therapy again, exercising with her therapist and building up her endurance by walking in the hallway of her Manhattan apartment building.

“Before this, I was getting weaker and weaker, and I just kept caving in,” she said.

Because of an action by Congress and a recent court settlement, Medicare probably won’t cut off Ms. Gorman’s physical therapy again should her progress level off — as long as her doctor says it is medically necessary.

Congress continued for another year a little-known process that allows exceptions to what Medicare pays for physical, occupational and speech therapy. The Medicare limits before the exceptions are $1,900 for physical and speech therapy this year, and $1,900 for occupational therapy.

In addition, the settlement of a class-action lawsuit last month now means that Medicare is prohibited from denying patients coverage for skilled nursing care, home health services or outpatient therapy because they had reached a “plateau,” and their conditions were not improving. That will allow people with Medicare who have chronic health problems and disabilities to get the therapy and other skilled care that they need for as long as they need it, if they meet other coverage criteria.

The settlement is expected to affect thousands, and possibly millions, of Medicare beneficiaries with chronic health problems like Parkinson’s or Alzheimer’s disease, stroke, multiple sclerosis and spinal cord injuries. It could also help families, as well as the overburdened Medicare budget, delay costly nursing home care by enabling seniors to live longer in their own homes.

“Under this settlement, Medicare policy will be clarified to ensure that claims from providers are reimbursed consistently and appropriately and not denied solely based on a rule-of-thumb determination that a beneficiary’s condition is not improving,” said Fabien Levy, a spokesman for the U. S. Department of Health and Human Services, which includes the Medicare program.

The lawsuit was filed by the Center for Medicare Advocacy and Vermont Legal Aid on behalf of four Medicare patients and five national organizations, including the National Multiple Sclerosis Society, Parkinson’s Action Network and the Alzheimer’s Association. A tentative settlement had been reached in October and on Jan. 24 a federal judge in Vermont approved the deal.

For seniors getting skilled services at home under a doctor’s order, the settlement means Medicare’s home health coverage has no time limit, Margaret Murphy told lawyers attending the annual meeting of the National Academy of Elder Law Attorneys in Washington, D. C., shortly after the then-tentative settlement was announced.

The coverage “can go on for years and years, if your doctor orders it,” said Ms. Murphy, the center’s associate director, who added that patients must be homebound (though not bedbound) and need intermittent care — every couple of days or weeks – that can only be provided by a physical therapist, nurse or other trained health care professional. When physical therapy is provided as part of Medicare’s home health benefit, the therapy dollar limits may not apply.

The settlement ensures that nursing home residents will also get coverage for skilled care regardless of improvement, but does not change the duration, which is still limited to up to 100 days per “benefit period.” That begins when a patient is admitted as an inpatient to a hospital or a nursing home for skilled care and ends after 60 days without skilled care. The agreement preserves the requirement that they must also have spent at least three days as inpatients in a hospital.

Federal officials say the settlement is not a change in Medicare coverage rules, but that statement may surprise many beneficiaries and providers.

“If someone isn’t making progress, I say, ‘Listen, I’m sorry but Medicare’s not going to cover this so you can come in for a few more sessions but then I have to let you go,’ ” said Greg Babiec, a physical therapist and one of the owners of Evolve, a private therapy practice with offices in Manhattan and Brooklyn. He had not heard about the settlement.

Beneficiaries also often lose Medicare coverage for outpatient therapy because they hit the payment limit. But under the exceptions process Congress continued for another year, the health care provider can put an additional code on the claim that indicates further treatment above the $1,900 limit is medically necessary. When treatment costs reach $3,700, the provider can submit medical documentation to support a request for another exception to cover 20 more sessions. (A Medicare fact sheet provides some additional details, but has not been updated for 2013.)

In 2011, nearly five million seniors received therapy services at a cost of $5.7 billion, and about one out of every four received an exception to the then-$1,870 limit, according to the Medicare Payment Advisory Commission, an independent government agency that advises Congress.

Just a few hours before the settlement was approved, Rachel DeGolia learned that her 87-year-old father in Chicago was going to have to stop therapy because he stopped showing improvement — again.

“Every time he stops going to physical therapy, he starts to backslide in terms of his balance, his strength and his mobility,” said Ms. DeGolia, executive director of the Universal Health Care Action Network, a national advocacy group in Cleveland. His physical therapist did not know Medicare will cover therapy to prevent her father’s condition from getting worse.

Under the settlement, Medicare officials have until next January to straighten things out by notifying health care providers. Beneficiaries are not among those to be contacted, and so far the federal officials have not issued a formal statement on the settlement.

But patients don’t have to wait for their provider to get the official word, said Judith Stein, the lead attorney for the plaintiffs and executive director of the Center for Medicare Advocacy. “This isn’t a clandestine settlement,” she said.

The center’s Web site offers free “self-help” packets explaining how to challenge a denial of coverage that is based on the lack of improvement. Ms. Stein also advises beneficiaries to show a copy of the settlement — also available from the Web site — to your health care provider at your next physical therapy appointment if you are concerned about losing Medicare coverage. (If you follow this advice, let us know what happens.)

The Web site also explains how beneficiaries can request a review of their case if they received skilled nursing or therapy services in a skilled nursing facility, at home or as outpatients and were denied Medicare coverage because of a lack of progress after Jan. 18, 2011, when the lawsuit was filed.

Dean Lerner relied on the settlement last month to ensure that his brother-in-law would continue to receive Medicare physical therapy coverage.

“My brother-in-law in St. Louis suffers from Parkinson’s disease, and has for many years, and my sister is having a devil of a time helping him as his disease progresses,” said Mr. Lerner, a retired lawyer and state health official in Des Moines, who is also a Medicaid consultant.

A physical therapist teaches his brother-in-law to stand, turn and use a walker and maintain what little strength he still has. But because his condition hasn’t improved, the therapist said Medicare would not pay for additional sessions.

“But for my being an attorney, the outcome may well have been very different, and that shouldn’t be,” he said. “Why should you have to fight?”

Read More..

Concerns About A.D.H.D. Practices and Amphetamine Addiction

Before his addiction, Richard Fee was a popular college class president and aspiring medical student. "You keep giving Adderall to my son, you're going to kill him," said Rick Fee, Richard's father, to one of his son's doctors.

VIRGINIA BEACH — Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

Matt Eich for The New York Times

MENTAL HEALTH CLINIC Dominion Psychiatric Associates in Virginia Beach, where Richard Fee was treated by Dr. Waldo M. Ellison. After observing Richard and hearing his complaints about concentration, Dr. Ellison diagnosed attention deficit hyperactivity disorder and prescribed the stimulant Adderall.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.

Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.

Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.

Very few people who misuse stimulants devolve into psychotic or suicidal addicts. But even one of Richard’s own physicians, Dr. Charles Parker, characterized his case as a virtual textbook for ways that A.D.H.D. practices can fail patients, particularly young adults. “We have a significant travesty being done in this country with how the diagnosis is being made and the meds are being administered,” said Dr. Parker, a psychiatrist in Virginia Beach. “I think it’s an abnegation of trust. The public needs to say this is totally unacceptable and walk out.”

Young adults are by far the fastest-growing segment of people taking A.D.H.D medications. Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company I.M.S. Health. While this rise is generally attributed to the maturing of adolescents who have A.D.H.D. into young adults — combined with a greater recognition of adult A.D.H.D. in general — many experts caution that savvy college graduates, freed of parental oversight, can legally and easily obtain stimulant prescriptions from obliging doctors.

“Any step along the way, someone could have helped him — they were just handing out drugs,” said Richard’s father. Emphasizing that he had no intention of bringing legal action against any of the doctors involved, Mr. Fee said: “People have to know that kids are out there getting these drugs and getting addicted to them. And doctors are helping them do it.”

“...when he was in elementary school he fidgeted, daydreamed and got A’s. he has been an A-B student until mid college when he became scattered and he wandered while reading He never had to study. Presently without medication, his mind thinks most of the time, he procrastinated, he multitasks not finishing in a timely manner.”

Dr. Waldo M. Ellison

Richard Fee initial evaluation

Feb. 5, 2010

Richard began acting strangely soon after moving back home in late 2009, his parents said. He stayed up for days at a time, went from gregarious to grumpy and back, and scrawled compulsively in notebooks. His father, while trying to add Richard to his health insurance policy, learned that he was taking Vyvanse for A.D.H.D.

Richard explained to him that he had been having trouble concentrating while studying for medical school entrance exams the previous year and that he had seen a doctor and received a diagnosis. His father reacted with surprise. Richard had never shown any A.D.H.D. symptoms his entire life, from nursery school through high school, when he was awarded a full academic scholarship to Greensboro College in North Carolina. Mr. Fee also expressed concerns about the safety of his son’s taking daily amphetamines for a condition he might not have.

“The doctor wouldn’t give me anything that’s bad for me,” Mr. Fee recalled his son saying that day. “I’m not buying it on the street corner.”

This article has been revised to reflect the following correction:

Correction: February 3, 2013

An earlier version of a quote appearing with the home page presentation of this article misspelled the name of a medication. It is Adderall, not Aderall.

Read More..

Ferrol Sams, Doctor Turned Novelist, Dies at 90

Ferrol Sams, a country doctor who started writing fiction in his late 50s and went on to win critical praise and a devoted readership for his humorous and perceptive novels and stories that drew on his medical practice and his rural Southern roots, died on Tuesday at his home in Lafayette, Ga. He was 90.

The cause, said his son Ferrol Sams III, also a doctor, was that he was “slap wore out.”

“He lived a full life,” his son said. “He didn’t leave anything in the tank.”

Dr. Sams grew up on a farm in the rural Piedmont area of Georgia, seven mud-road miles from the nearest town. He was a boy during the Depression; books meant escape and discovery. He read “Robinson Crusoe,” then Mark Twain and Charles Dickens. One of his English professors at Mercer University, in Macon, suggested he consider a career in writing, but he chose another route to examining the human condition: medical school.

When he was 58 — after he had served in World War II, started a medical practice with his wife, raised his four children and stopped devoting so much of his mornings to preparing lessons for Sunday school at the Methodist church — he began writing “Run With the Horsemen,” a novel based on his youth. It was published in 1982.

“In the beginning was the land,” the book begins. “Shortly thereafter was the father.”

In The New York Times Book Review, the novelist Robert Miner wrote, “Mr. Sams’s approach to his hero’s experiences is nicely signaled in these two opening sentences.”

He added: “I couldn’t help associating the gentility, good-humored common sense and pace of this novel with my image of a country doctor spinning yarns. The writing is elegant, reflective and amused. Mr. Sams is a storyteller sure of his audience, in no particular hurry, and gifted with perfect timing.”

Dr. Sams modeled the lead character in “Run With the Horsemen,” Porter Osborne Jr., on himself, and featured him in two more novels, “The Whisper of the River” and “When All the World Was Young,” which followed him into World War II.

Dr. Sams also wrote thinly disguised stories about his life as a physician. In “Epiphany,” he captures the friendship that develops between a literary-minded doctor frustrated by bureaucracy and a patient angry over past racism and injustice.

Ferrol Sams Jr. was born Sept. 26, 1922, in Woolsey, Ga. He received a bachelor’s degree from Mercer in 1942 and his medical degree from Emory University in 1949. In his addition to his namesake, survivors include his wife, Dr. Helen Fletcher Sams; his sons Jim and Fletcher; a daughter, Ellen Nichol; eight grandchildren; and nine great-grandchildren.

Some critics tired of what they called the “folksiness” in Dr. Sams’s books. But he did not write for the critics, he said. In an interview with the Georgia Writers Hall of Fame, Dr. Sams was asked what audience he wrote for. Himself, he said.

“If you lose your sense of awe, or if you lose your sense of the ridiculous, you’ve fallen into a terrible pit,” he added. “The only thing that’s worse is never to have had either.”

Read More..

The New Old Age Blog: Caregiving, Laced With Humor

“My grandmother, she’s not a normal person. She’s like a character when she speaks. Every day she’s playing like she’s an actress.”

These are words of love, and they come from Sacha Goldberger, a French photographer who has turned his grandmother, 93-year-old Frederika Goldberger, into a minor European celebrity.

In the photos, you can see the qualities grandson and grandmother have in common: a wicked sense of humor, an utter lack of pretension and a keen taste for theatricality and the absurd.

This isn’t an ordinary caregiving relationship, not by a long shot. But Sacha, 44 years old and unmarried, is deeply devoted to this spirited older relation who has played the role of Mamika (“my little grandmother,” translated from her native Hungarian) in two of his books and a photography exhibition currently underway in Paris.

As for Frederika, “I like everything that my grandson does,” she said in a recent Skype conversation from her apartment, which also serves as Sacha’s office. “I hate not to do anything. Here, with my grandson, I have the feeling I am doing something.”

Their unusual collaboration began after Frederika retired from her career as a textile consultant at age 80 and fell into a funk.

“I was very depressed because I lived for working,” she told me in our Skype conversation.

Sacha had long dreamed of creating what he calls a “Woody Allen-like Web site with a French Jewish humor” and he had an inspiration. What if he took one of the pillars of that type of humor, a French man’s relationship with his mother and grandmother, and asked Frederika to play along with some oddball ideas?

This Budapest-born baroness, whose family had owned the largest textile factory in Hungary before World War II, was a natural in front of the camera, assuming a straight-faced, imperturbable comic attitude whether donning a motorcycle helmet and goggles, polishing her fingernails with a gherkin, wearing giant flippers on the beach, lighting up a banana, or dressed up as a Christmas tree with a golden star on her head. (All these photos and more appear in “Mamika: My Mighty Little Grandmother,” published in the United States last year.)

“It was like a game for us, deciding what crazy thing we were going to do next, how we were going to keep people from being bored,” said Sacha, who traces his close relationship with his grandmother to age 14, when she taught him how to drive and often picked him up at school. “Making pictures was a very good excuse to spend time together.”

“He thought it was very funny to put a costume on me,” said Frederika. “And I liked it.”

People responded enthusiastically, and before long Sacha had cooked up what ended up becoming the most popular character role for Frederika: Super Mamika, outfitted in a body-hugging costume, tights, a motorcycle helmet and a flowing cape.

His grandmother was a super hero of sorts, because she had helped save 10 people from the Nazis during World War II, said Sacha. He also traced inspiration to Stan Lee, a Jewish artist who created the X-Men, The Hulk and the Fantastic Four for Marvel comics. “I wanted to ask what happens to these super heroes when they get old in these photographs with my grandmother.”

Lest this seem a bit trivial to readers of this blog, consider this passage from Sacha’s introduction to “Mamika: My Might Little Grandmother”:

In a society where youth is the supreme value; where wrinkles have to be camouflaged; where old people are hidden as soon as they become cumbersome, where, for lack of time or desire, it is easier to put our elders in hospices rather than take care of them, I wanted to show that happiness in aging was also possible.

In our Skype conversation, Sacha confessed to anxiety about losing his grandmother, and said, “I always was very worried about what would happen if my grandmother disappeared. Because she is exceptional.”

“I am not normal,” Frederika piped up at his side, her face deeply wrinkled, her short hair beautifully coiffed, seemingly very satisfied with herself.

“So, making these pictures to me is the best thing that could happen,” Sacha continued, “because now my grandma is immortal and it seems everyone knows her. I am giving to everybody in the world a bit of my grandma.”

This wonderful expression of caring and creativity has expanded my view of intergenerational relations in this new old age. What about you?

Read More..

Well: Myths of Weight Loss Are Plentiful, Researcher Says

If schools reinstated physical education classes, a lot of fat children would lose weight. And they might never have gotten fat in the first place if their mothers had just breast fed them when they were babies. But be warned: obese people should definitely steer clear of crash diets. And they can lose more than 50 pounds in five years simply by walking a mile a day.

Those are among the myths and unproven assumptions about obesity and weight loss that have been repeated so often and with such conviction that even scientists like David B. Allison, who directs the Nutrition Obesity Research Center at the University of Alabama at Birmingham, have fallen for some of them.

Now, he is trying to set the record straight. In an article published online today in The New England Journal of Medicine, he and his colleagues lay out seven myths and six unsubstantiated presumptions about obesity. They also list nine facts that, unfortunately, promise little in the way of quick fixes for the weight-obsessed. Example: “Trying to go on a diet or recommending that someone go on a diet does not generally work well in the long term.”

Obesity experts applauded this plain-spoken effort to dispel widespread confusion about obesity. The field, they say, has become something of a quagmire.

“In my view,” said Dr. Jeffrey M. Friedman, a Rockefeller University obesity researcher, “there is more misinformation pretending to be fact in this field than in any other I can think of.”

Others agreed, saying it was about time someone tried to set the record straight.

“I feel like cheering,” said Madelyn Fernstrom, founding director of the University of Pittsburgh Weight Management Center. When it comes to obesity beliefs, she said, “We are spinning out of control.”

Steven N. Blair, an exercise and obesity researcher at the University of South Carolina, said his own students believe many of the myths. “I like to challenge my students. Can you show me the data? Too often that doesn’t come into it.”

Dr. Allison sought to establish what is known to be unequivocally true about obesity and weight loss.

His first thought was that, of course, weighing oneself daily helped control weight. He checked for the conclusive studies he knew must exist. They did not.

“My goodness, after 50-plus years of studying obesity in earnest and all the public wringing of hands, why don’t we know this answer?” Dr. Allison asked. “What’s striking is how easy it would be to check. Take a couple of thousand people and randomly assign them to weigh themselves every day or not.”

Yet it has not been done.

Instead, people often rely on weak studies that get repeated ad infinitum. It is commonly thought, for example, that people who eat breakfast are thinner. But that notion is based on studies of people who happened to eat breakfast. Researchers then asked if they were fatter or thinner than people who happened not to eat breakfast — and found an association between eating breakfast and being thinner. But such studies can be misleading because the two groups might be different in other ways that cause the breakfast eaters to be thinner. But no one has randomly assigned people to eat breakfast or not, which could cinch the argument.

So, Dr. Allison asks, why do yet another study of the association between thinness and breakfast? “Yet, I can tell you that in the last two weeks I saw an association study of breakfast eating in Islamabad and another in Inner Mongolia and another in a country I never heard of.”

“Why are we doing these?” Dr. Allison asked. “All that time and effort is essentially wasted. The question is: ‘Is it a causal association?’” To get the answer, he added, “Do the clinical trial.”

He decided to do it himself, with university research funds. A few hundred people will be recruited and will be randomly assigned to one of three groups. Some will be told to eat breakfast every day, others to skip breakfast, and the third group will be given vague advice about whether to eat it or not.

As he delved into the obesity literature, Dr. Allison began to ask himself why some myths and misconceptions are so commonplace. Often, he decided, the beliefs reflected a “reasonableness bias.” The advice sounds so reasonable it must be true. For example, the idea that people do the best on weight-loss programs if they set reasonable goals sounds so sensible.

“We all want to be reasonable,” Dr. Allison said. But, he said, when he examined weight-loss studies he found no consistent association between the ambitiousness of the goal and how much weight was lost and how long it had stayed off. This myth, though, illustrates the tricky ground weight-loss programs have to navigate when advising dieters. The problem is that on average people do not lose much – 10 percent of their weight is typical – but setting 10 percent as a goal is not necessarily the best strategy. A very few lose a lot more and some people may be inspired by the thought of a really life-changing weight loss.

“If a patient says, ‘Do you think it is reasonable for me to lose 25 percent of my body weight,’ the honest answer is, ‘No. Not without surgery,’” Dr. Allison said. But, he said, “If a patient says, ‘My goal is to lose 25 percent of my body weight,’ I would say, ‘Go for it.’”

Yet all this negativism bothers people, Dr. Allison conceded. When he talks about his findings to scientists, they often say: “O.K., you’ve convinced us. But what can we do? We’ve got to do something.” He replies that scientists have an ethical duty to make clear what is established and what is speculation. And while it is fine to recommend things like bike paths or weighing yourself daily, scientists must make sure they preface their advice with the caveat that these things seem sensible but have not been proven.

Among the best established methods is weight-loss surgery, which, of course, is not right for most people. But surgeons have done careful studies to show that on average people lose substanial amounts of weight and their health improves, Dr. Allison said. For dieters, the best results occur with structured programs, like ones that supply complete meals or meal replacements.

In the meantime, Dr. Allison said, it is incumbent upon scientists to change their ways. “We need to do rigorous studies,” he said. “We need to stop doing association studies after an association has clearly been demonstrated.”

“I never said we have to wait for perfect knowledge,” Dr. Allison said. But, as John Lennon said, “Just give me some truth.”

---

Here is an overview of the obesity myths looked at by the researchers and what is known to be true:

MYTHS

Small things make a big difference. Walking a mile a day can lead to a loss of more than 50 pounds in five years.

Set a realistic goal to lose a modest amount.

People who are too ambitious will get frustrated and give up.

You have to be mentally ready to diet or you will never succeed.

Slow and steady is the way to lose. If you lose weight too fast you will lose less in the long run.

Ideas not yet proven TRUE OR FALSE

Diet and exercise habits in childhood set the stage for the rest of life.

Add lots of fruits and vegetables to your diet to lose weight or not gain as much.

Yo-yo diets lead to increased death rates.

People who snack gain weight and get fat.

If you add bike paths, jogging trails, sidewalks and parks, people will not be as fat.

FACTS — GOOD EVIDENCE TO SUPPORT

Heredity is important but is not destiny.

Exercise helps with weight maintenance.

Weight loss is greater with programs that provide meals.

Some prescription drugs help with weight loss and maintenance.

Weight-loss surgery in appropriate patients can lead to long-term weight loss, less diabetes and a lower death rate.

Read More..

Phys Ed: Helmets for Ski and Snowboard Safety

Recently, researchers from the department of sport science at the University of Innsbruck in Austria stood on the slopes at a local ski resort and trained a radar gun on a group of about 500 skiers and snowboarders, each of whom had completed a lengthy personality questionnaire about whether he or she tended to be cautious or a risk taker.

The researchers had asked their volunteers to wear their normal ski gear and schuss or ride down the slopes at their preferred speed. Although they hadn’t informed the volunteers, their primary aim was to determine whether wearing a helmet increased people’s willingness to take risks, in which case helmets could actually decrease safety on the slopes.

What they found was reassuring.

To many of us who hit the slopes with, in my case, literal regularity — I’m an ungainly novice snowboarder — the value of wearing a helmet can seem self-evident. They protect your head from severe injury. During the Big Air finals at the Winter X Games in Aspen, Colo., this past weekend, for instance, 23-year-old Icelandic snowboarder Halldor Helgason over-rotated on a triple back flip, landed head-first on the snow, and was briefly knocked unconscious. But like the other competitors he was wearing a helmet, and didn’t fracture his skull.

Indeed, studies have concluded that helmets reduce the risk of a serious head injury by as much as 60 percent. But a surprising number of safety experts and snowsport enthusiasts remain unconvinced that helmets reduce overall injury risk.

Why? A telling 2009 survey of ski patrollers from across the country found that 77 percent did not wear helmets because they worried that the headgear could reduce their peripheral vision, hearing and response times, making them slower and clumsier. In addition, many worried that if they wore helmets, less-adept skiers and snowboarders might do likewise, feel invulnerable and engage in riskier behavior on the slopes.

In the past several years, a number of researchers have attempted to resolve these concerns, for or against helmets. And in almost all instances, helmets have proved their value.

In the Innsbruck speed experiment, the researchers found that people whom the questionnaires showed to be risk takers skied and rode faster than those who were by nature cautious. No surprise.

But wearing a helmet did not increase people’s speed, as would be expected if the headgear encouraged risk taking. Cautious people were slower than risk-takers, whether they wore helmets or not; and risk-takers were fast, whether their heads were helmeted or bare.

Interestingly, the skiers and riders who were the most likely, in general, to don a helmet were the most expert, the men and women with the most talent and hours on the slopes. Experience seemed to have taught them the value of a helmet.

Off of the slopes, other new studies have brought skiers and snowboarders into the lab to test their reaction times and vision with and without helmets. Peripheral vision and response times are a serious safety concern in a sport where skiers and riders rapidly converge from multiple directions.

But when researchers asked snowboarders and skiers to wear caps, helmets, goggles or various combinations of each for a 2011 study and then had them sit before a computer screen and press a button when certain images popped up, they found that volunteers’ peripheral vision and reaction times were virtually unchanged when they wore a helmet, compared with wearing a hat. Goggles slightly reduced peripheral vision and increased response times. But helmets had no significant effect.

Even when researchers added music, testing snowboarders and skiers wearing Bluetooth-audio equipped helmets, response times did not increase significantly from when they wore wool caps.

So why do up to 40 percent of skiers and snowboarders still avoid helmets?

“The biggest reason, I think, is that many people never expect to fall,” says Dr. Adil H. Haider, a trauma surgeon and associate professor of surgery at Johns Hopkins University in Baltimore and co-author of a major new review of studies related to winter helmet use. “That attitude is especially common in people, like me, who are comfortable on blue runs but maybe not on blacks, and even more so in beginners.”

But a study published last spring detailing snowboarding injuries over the course of 18 seasons at a Vermont ski resort found that the riders at greatest risk of hurting themselves were female beginners. I sympathize.

The takeaway from the growing body of science about ski helmets is in fact unequivocal, Dr. Haider said. “Helmets are safe. They don’t seem to increase risk taking. And they protect against serious, even fatal head injuries.”

The Eastern Association for the Surgery of Trauma, of which Dr. Haider is a member, has issued a recommendation that “all recreational skiers and snowboarders should wear safety helmets,” making them the first medical group to go on record advocating universal helmet use.

Perhaps even more persuasive, Dr. Haider has given helmets to all of his family members and colleagues who ski or ride. “As a trauma surgeon, I know how difficult it is to fix a brain,” he said. “So everyone I care about wears a helmet.”

Read More..

Well: Celery Recipes for Health

For many people, celery is best used as a garnish, part of a snack tray or perhaps to stir a Bloody Mary. But to Martha Rose Shulman, the Recipes for Health columnist, celery can be a main course. She writes:

I’m a big fan of celery, both raw and cooked, as the main ingredient or as one of several featured ingredients in a dish. You can do the traditional thing with raw celery and dice it up and add it to a potato, tuna or egg salad, or you can make a celery salad, slicing the branches as thin as you can get them and tossing them with herbs, radishes, oil and vinegar, and blue cheese. If you are cooking with celery, don’t stop at one branch when you make soup. The celery contributes a wonderful herbal flavor dimension. It retains its texture for a long time when you cook it, so I used it as the main vegetable in a risotto and loved the way it stood up to the creamy rice.

Here are five ways to move celery off the snack tray and on to center plate.

Lentil, Celery and Tomato Minestrone: With extra celery, traditional minestrone soup takes on a whole new layer of flavor.

---

Pan-Cooked Celery With Tomatoes and Parsley: A way to serve celery as a side dish, or as a topping for grains or pasta.

---

Celery and Radish Salad With Gorgonzola: Use the delicate hearts of celery for this light and delicious salad.

---

Celery Risotto With Dandelion Greens or Kale: Celery contrasts nicely with the rice in this aromatic risotto.

---

Puréed Broccoli and Celery Soup: A broccoli soup with an added dimension of flavor.

---

Read More..

Well: Ask Well: Squats for Aging Knees

You are already doing many things right, in terms of taking care of your aging knees. In particular, it sounds as if you are keeping your weight under control. Carrying extra pounds undoubtedly strains knees and contributes to pain and eventually arthritis.

You mention weight training, too, which is also valuable. Sturdy leg muscles, particularly those at the front and back of the thighs, stabilize the knee, says Joseph Hart, an assistant professor of kinesiology and certified athletic trainer at the University of Virginia, who often works with patients with knee pain.

An easy exercise to target those muscles is the squat. Although many of us have heard that squats harm knees, the exercise is actually “quite good for the knees, if you do the squats correctly,” Dr. Hart says. Simply stand with your legs shoulder-width apart and bend your legs until your thighs are almost, but not completely, parallel to the ground. Keep your upper body straight. Don’t bend forward, he says, since that movement can strain the knees. Try to complete 20 squats, using no weight at first. When that becomes easy, Dr. Hart suggests, hold a barbell with weights attached. Or simply clutch a full milk carton, which is my cheapskate’s squats routine.

Straight leg lifts are also useful for knee health. Sit on the floor with your back straight and one leg extended and the other bent toward your chest. In this position, lift the straight leg slightly off the ground and hold for 10 seconds. Repeat 10 to 20 times and then switch legs.

You can also find other exercises that target the knees in this video, “Increasing Knee Stability.”

Of course, before starting any exercise program, consult a physician, especially, Dr. Hart says, if your knees often ache, feel stiff or emit a strange, clicking noise, which could be symptoms of arthritis.

Read More..

Well: Ask Well: Squats for Aging Knees

You are already doing many things right, in terms of taking care of your aging knees. In particular, it sounds as if you are keeping your weight under control. Carrying extra pounds undoubtedly strains knees and contributes to pain and eventually arthritis.

You mention weight training, too, which is also valuable. Sturdy leg muscles, particularly those at the front and back of the thighs, stabilize the knee, says Joseph Hart, an assistant professor of kinesiology and certified athletic trainer at the University of Virginia, who often works with patients with knee pain.

An easy exercise to target those muscles is the squat. Although many of us have heard that squats harm knees, the exercise is actually “quite good for the knees, if you do the squats correctly,” Dr. Hart says. Simply stand with your legs shoulder-width apart and bend your legs until your thighs are almost, but not completely, parallel to the ground. Keep your upper body straight. Don’t bend forward, he says, since that movement can strain the knees. Try to complete 20 squats, using no weight at first. When that becomes easy, Dr. Hart suggests, hold a barbell with weights attached. Or simply clutch a full milk carton, which is my cheapskate’s squats routine.

Straight leg lifts are also useful for knee health. Sit on the floor with your back straight and one leg extended and the other bent toward your chest. In this position, lift the straight leg slightly off the ground and hold for 10 seconds. Repeat 10 to 20 times and then switch legs.

You can also find other exercises that target the knees in this video, “Increasing Knee Stability.”

Of course, before starting any exercise program, consult a physician, especially, Dr. Hart says, if your knees often ache, feel stiff or emit a strange, clicking noise, which could be symptoms of arthritis.

Read More..

Diner’s Journal Blog: PepsiCo Will Halt Use of Additive in Gatorade

PepsiCo announced on Friday that it would no longer use an ingredient in Gatorade after consumers complained.

The ingredient, brominated vegetable oil, which was used in citrus versions of the sports drink to prevent the flavorings from separating, was the object of a petition started on Change.org by Sarah Kavanagh, a 15-year-old from Hattiesburg, Miss., who became concerned about the ingredient after reading about it online. Studies have suggested there are possible side effects, including neurological disorders and altered thyroid hormones.

The petition attracted more than 200,000 signatures, and this week, Ms. Kavanagh was in New York City to tape a segment for “The Dr. Oz Show.” She visited The New York Times on Wednesday and while there said, “I just don’t understand why they can’t use something else instead of B.V.O.”

“I was in algebra class and one of my friends kicked me and said, ‘Have you seen this on Twitter?’ ” Ms. Kavanagh said in a phone interview on Friday evening. “I asked the teacher if I could slip out to the bathroom, and I called my mom and said, ‘Mom, we won.’ ”

Molly Carter, a spokeswoman for Gatorade, said the company had been testing alternatives to the chemical for roughly a year “due to customer feedback.” She said Gatorade initially was not going to make an announcement, “since we don’t find a health and safety risk with B.V.O.”

Because of the petition, though, Ms. Carter said the company had changed its mind, and an unidentified executive there gave Beverage Digest, a trade publication, the news for its Jan. 25 issue.

Previously, a spokesman for PepsiCo had said in an e-mail, “We appreciate Sarah as a fan of Gatorade, and her concern has been heard.”

Brominated vegetable oil will be replaced by sucrose acetate isobutyrate, an emulsifier that is “generally recognized as safe” as a food additive by the Food and Drug Administration. The new ingredient will be added to orange, citrus cooler and lemonade Gatorade, as well Gatorade X-Factor orange, Gatorade Xtremo citrus cooler and a powdered form of the drink called “glacier freeze.”

Ms. Carter said consumers would start seeing the new ingredient over the next few months as existing supplies of Gatorade sell out and are replaced.

Health advocates applauded the company’s move. “Kudos to PepsiCo for doing the responsible thing on its own and not waiting for the F.D.A. to force it to,” said Michael Jacobson, executive director of the Center for Science in the Public Interest.

Mr. Jacobson has championed the removal of brominated vegetable oil from foods and beverages for the last several decades, but the F.D.A. has left it in a sort of limbo, citing budgetary constraints that it says keep it from going through the process needed to formally ban the chemical or declare it safe once and for all.

Brominated vegetable oil is banned as a food ingredient in Japan and the European Union. About 10 percent of drinks sold in the United States contain it, including Mountain Dew, which is also made by PepsiCo; some flavors of Powerade and Fresca from Coca-Cola; and Squirt and Sunkist Peach Soda, made by the Dr Pepper Snapple Group.

PepsiCo said it had no plans to remove the ingredient from Mountain Dew and Diet Mountain Dew, both of which generate more than $1 billion in annual sales.

Heather White, executive director at the Environmental Working Group, said of PepsiCo’s decision, “We can only hope that other companies will follow suit.” She added, “We need to overhaul how F.D.A. keeps up with the latest science on food additives to better protect public health.”

Ms. Kavanagh agreed. “I’ve been thinking about ways to take this to the next level, and I’m thinking about taking it to the F.D.A. and asking them why they aren’t doing something about it,” she said. “I’m not sure yet, but I think that’s where I’d like to go with this.”

---

This post has been revised to reflect the following correction:

Correction: January 26, 2013

An earlier version of this article misspelled the surname of the 15-year-old who started a petition on Change.org to end the use of brominated vegetable oil in Gatorade. She is Sarah Kavanagh, not Kavanaugh.

A version of this article appeared in print on 01/26/2013, on page B1 of the NewYork edition with the headline: PepsiCo Will Halt Additive Use In Gatorade.

Read More..