TEAM BMC WANTS YOU! Got a bike and a big heart? Come join BMC’s cycling team this September to help us raise money for our pediatric programs during the Rodman Ride for Kids. We are looking for teammates willing to bike 25, 50 or 100 miles for our great cause. Take a look at Team BMC’s homepage to find out more and sign up today!
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AFTER A STROKE, FAMILY MATRIARCH LOOKS TOWARD THE FUTURE On December 28, 2009, Barbara Hackett woke up in her South Boston apartment near Carson Beach with the same intention she has every morning.
“I woke up to put the kettle on for a cup of tea, but I found that I couldn’t get up and fell down out of bed. I don’t remember anything after that,” she said.
Knowing her 82-year-old mother had not been feeling well for the past several days, Wendy Hosmer called Barbara at 8:30 a.m. from her home in Florida to remind her about her doctor’s appointment later that day. But when the answering machine kept picking up her call, she became very concerned.
“I called my sister who lives nearby to see if she could go and check on her, and she called my mother’s upstairs neighbor. It was her neighbor who found her on the floor paralyzed and unable to speak,” remembered Wendy, her calm voice slightly quavering.
The neighbor called 911, and the ambulance delivered Barbara to Boston Medical Center, where she was quickly triaged as a stroke victim. Each minute became critical for Barbara’s prognosis. Thanh Nguyen, M.D., F.R.C.P.C., director of interventional neuroradiology and interventional neurology at BMC, oversaw Barbara’s treatment.
“Since she woke up with a stroke, we couldn’t be sure when the stroke started, and we couldn’t treat her with clot-busting drugs. We immediately did MRI imaging which showed that very little brain had died, but there was a large territory of brain at risk,” said Dr. Nguyen.
Because Barbara was suffering from severe physical impairments and scans showed much of her brain was still healthy but at risk for a larger stroke, Dr. Nguyen recommended an innovative intervention that uses a microcatheter and aspiration device to remove the blood clot causing her stroke. With Barbara’s daughters consent, Dr. Nguyen and her team immediately prepared Barbara for the procedure. They inserted a tiny catheter in her groin and delicately guided the aspiration device with the help of a fluoroscope to the clot in her brain. They suctioned out the clot and restored her blood supply. Within hours of the procedure, Barbara was able to move her left arm and leg and speak more clearly.
“Barbara was very lucky to have such a caring and concerned family. If they had found her any later, it is possible that we would not have been able to offer intervention if the stroke was complete or non-salvageable. She made a remarkable recovery,” said Dr. Nguyen.
Twenty-three days later, thanks to physical therapy to help her re-learn to walk, Barbara was able to leave the hospital without the use of a walker or cane.
“Before the stroke my mother was more like an active 55-year-old, now she feels her age, she is a little shaky on her feet but nothing you would notice unless you lived day-to-day with her,” said Wendy, who has moved in with her mother to help with her care.
Today, Barbara is once again enjoying her daily cups of tea and the love and support of her family, including her three daughters, one son and her 14 grandchildren. She is eagerly anticipating the birth of her 30th great grandchild in July.
“I owe my life to BMC, I am so grateful,” she said.
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Barbara Hackett made a remarkable recovery from a stroke that left her temporarily paralyzed. She now looks forward to meeting her 30th great grandchild, who will be born this July.
BMC SUPPORTS PARENTS WITH AUTISTIC CHILDREN EVERY STEP OF THE WAY “Autism is a very, very hard disorder for families to grapple with. Once a child is diagnosed, we work really hard to provide compassionate, pragmatic care and support, not just for the child but for the parents as well,” said Marilyn Augustyn, M.D., director of the Division of Developmental and Behavioral Pediatrics at Boston Medical Center.
BMC’s reputation for clinical excellence and involvement in important research in autism spectrum disorders (ASDs) has drawn families from around the region for diagnosis and treatment here, but what continues to set BMC apart from other institutions its focus on addressing the needs of vulnerable families in Boston to help parents navigate the challenges of a difficult diagnosis. As New England’s largest safety-net hospital, BMC serves some of the region’s poorest families, many of whom are unprepared to meet the special needs of an autistic child.
“There is no validity to the idea that autism is a disorder that plagues only the educated upper middle class. There are simply vast disparities in diagnosis and services for low-income families,” said Dr. Augustyn.
As part of the Autism Consortium (a collaboration across major teaching hospitals and institutions in the Boston area dedicated to accelerating research and understanding of ASDs), the program employs specialized staff to help families living in the Boston area find the services they need. BMC Autism Resource Specialist Shari King, M.A., provides ongoing support to families in concert with clinician recommendations, helping caregivers access resources, therapies and programs available throughout the state. She also helps enroll eligible BMC patients for state and federal aid, including the annual Massachusetts Autism Waiver Program, which provides 100 families in Massachusetts with additional support for their children.
A supportive school environment is also critical to help autistic children overcome some of the challenges they face. Working closely with BMC’s Medical-Legal Partnership, BMC Autism Educational Specialist Crista Graves, M.Ed., makes school visits to observe individual patients and to advocate for enrollment in special education classes or, if needed, transfer to a more specialized school.
BMC provides unique educational resources and support for parents with newly diagnosed children including multi-language brochures and informational websites such as www.specialkidsspecialhelp.org. Clinic staff also offer free parent training classes in multiple languages throughout the year, providing parents with hands-on skills designed to target their children’s problem behavior.
Beyond providing tailored support to individual patients, BMC is investigating ways to help parents cope with the stress associated with the day-to-day care of a child with autism. BMC is partnering with the Health Resources and Services Administration in a clinical study that provides problem solving education to mothers with young autistic children. Researchers are gauging whether knowledge of problem solving techniques can decrease stress and depression in caregivers.
“Autism is a long walk for parents, but we are there walking right beside them,” said Dr. Augustyn.
BMC’s Autism Program includes BMC clinicians and staff from the divisions of Child Neurology and Developmental and Behavioral Pediatrics. The program focuses on a multidisciplinary approach to provide diagnosis, treatment and long-term management for children with ASDs.
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It is estimated that as many as one in 100 children in the United States has an autism spectrum disorder. BMC works to support low-income families caring for children with the disease.
ASK THE EXPERT: SAVVY SUNSCREEN TIPS In recent medical studies, some sunscreen ingredients have come under scrutiny for posing health risks. BMC News asked Deborah L. Cummins, M.D., director of Mohs and dermatologic surgery at Boston Medical Center, to talk about the benefits of sunscreen and the recent controversy surrounding it and to offer tips on choosing the safest sunblock this summer.
BMC News: First of all Dr. Cummins, why is it important to use sunblock? What are the dangers of sun exposure and how do sunscreens protect us?
Dr. Cummins: Ultraviolet (UV) light exposure from natural sunlight and tanning beds is a proven carcinogen that increases risk of skin cancers. UV exposure is the most preventable risk factor for skin cancer. Sunscreen use is one method to protect skin from the harmful effects of UV rays.
Sunscreens have been proven to prevent squamous cell carcinoma and actinic keratoses (pre-cancers). Sunscreens probably also protect against melanoma, the most deadly form of skin cancer. Mice studies have shown that sunscreens protect against melanoma. This phenomenon has been more difficult to prove in human studies because people who use sunscreen regularly often stay out in the sun longer. Dermatologists recommend that sunscreens should not be used as a means to allow longer sun exposure because sunscreens do not provide complete protection from the sun
BMC News: If sunscreen alone cannot protect against melanoma, what other precautions should people take to protect themselves?
Dr. Cummins: Physical barriers to sun (hats, protective clothing, shade, and remaining indoors during peak sun hours) have been proven to decrease risk of melanoma and other skin cancers. It is widely agreed that these are the most effective methods of sun protection. Sunscreens should be used in addition to these methods to protect sites such as face and arms that cannot conveniently be kept fully covered. Sunscreens should not be considered a substitute for these other forms of sun protection.
BMC News: What about sun protection factor (SPF) numbers, do higher numbers mean better UV protection?
Dr. Cummins: SPF does matter and generally higher SPF is preferable. However, studies indicate that SPF labels are not reliable. In reality, the sun protection afforded is only a small fraction of the SPF number listed on the sunscreen bottle due to several factors including breakdown of active ingredients, insufficient application and failure to reapply every two hours and after swimming. SPF is only half the story. SPF describes the level of UVB protection (UV light spectrum from 290 nm to 320 nm wavelengths). The sun’s UVA rays (320 nm to 400 nm) are also harmful and it is important to select a sunscreen that has broad-spectrum UVA coverage. At present there is no grading system to rate sunscreen UVA protection. A four star system for grading UVA protection is being considered by the Food and Drug Administration. Until that grading system is released, examination of active ingredients can help identify sunscreens with broad UVA protection. Agents that are broadly effective against UVA include titanium dioxide, zinc oxide, and avobenzone (parsol 1789). Mexoryl is particularly effective for short-wave UVA.
BMC News: There has been a lot in the news regarding the health risks of vitamin D deficiency. Since sun is the main source of vitamin D, do we lose out on this important nutrient by applying sunscreen? It seems like a Catch-22 situation.
Dr. Cummins: Vitamin D is produced with sun exposure and may result in better health. Although sunscreen and sun protection may lower vitamin D levels, it can be safely replenished with a vitamin D pill at a dose of approximately 1,000-2,000 IU daily. In this way, vitamin D levels can be optimized without exposure to the harmful UV light that causes skin cancers. Many physicians now include vitamin D levels among their routine screening labs to identify people who would most benefit from oral supplementation.
BMC News: There has been recent controversy surrounding ingredients in sunscreen. What exactly is the concern, and what should we be looking for in a safe sunscreen?
Dr. Cummins: The Environmental Working Group recently made headlines when they reported a potential risk associated with vitamin A derivatives such as retinyl palmitate (a common sunscreen additive). The concerns are based on an FDA study showing that lab rats coated in retinyl palmitate and exposed to light developed skin cancers up to 21% faster than similar rats without retinyl palmitate in their cream. It is unclear whether retinyl palmitate poses a risk to humans, but until more data is available, it may be wise to choose sunscreens without vitamin A derivatives.
In addition, titanium dioxide and zinc oxide sunscreens have been favored by many dermatologists due to broad-spectrum UV protection and stability. These agents work by physically blocking light in contrast to chemical sunscreens that undergo a chemical reaction to absorb light. However standard size titanium and zinc particles have an undesirable opaque white appearance when applied to the skin. For this reason, sunscreen manufacturers currently process titanium and zinc into nanoparticles (small particles measuring 1-100 nanometers), which makes the sunblock less opaque. Recently, concern has been raised because, due to their small size, nanoparticles can be absorbed from the skin into the body. It is not clear whether this absorption correlates with any true health risks and it is probable that the benefits from the excellent UV protection outweigh the theoretical risks of titanium and zinc absorption.
Oxybenzone can also be absorbed through the skin and may have hormonal effects. It is not clear whether this translates to actual health risks, but it would be reasonable to avoid this agent, particularly among pregnant women.
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BMC dermatologist
Dr. Deborah Cummins offers advice for choosing and using sunscreen this summer.
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