Physician Blog -- Kate Scannell, MD

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 01/22/12

In the early 1970s, my friend's father died on stage while receiving a golden watch from his boss to mark his retirement. Grasping the watch in one hand, he reportedly clutched his chest with the other and collapsed. He could not be revived. His sudden death had been completely unexpected, and his family was devastated. His death was officially attributed to a heart attack.

Afterward, my grieving friend speculated that her father's death had been triggered by the stress and heightened emotions he'd been experiencing over the unwelcome prospect of retirement. He'd been a dedicated "company man" his entire adult life, someone who had found meaning and personal fulfillment through his job at the auto plant. He couldn't imagine living without the satisfying daily routine of his work and the companionship of co-workers.

I knew nothing at the time about cardiology, the heart's autonomic neural regulation or the body's powerful, smoldering brew of stress hormones. However, I was convinced by what had happened to my friend's father that a heart could be broken by grief and loss. That it could shatter under the unbearable weight of despair.

Years later, after becoming a physician, I often was reminded of my friend's father. Over time, I cared for patients who suffered heart attacks or died unexpectedly while experiencing intense emotional states. I knew patients who developed chest pain and heart problems on the anniversary date of a divorce or a loved one's death. While once providing phone-line duty for a hospital on New Year's Eve, I handled a call from an elderly woman who wanted to know if she might be having a heart attack -- or, as she speculated, whether it was "just my widowed heart breaking" on this first turn of a new year without her husband.

Over time, the medical profession has increasingly -- and sometimes begrudgingly -- acknowledged a powerful mind-body connection that profoundly affects how humans mentally experience and physically express health and disease. In this regard, it recognized the "broken heart syndrome" in the mid-1980s as a legitimate medical condition in which heart attacks could be caused by intense emotional or physical stress -- not blocked arteries or the "coronary artery disease" we usually expect to find during cardiac testing.

Experts think broken heart syndrome is caused by adrenaline surges triggered during physical trauma or acute emotional states such as bereavement, anxiety and anger. Analogous to a deer "frozen in the headlights," the heart is "stunned" and immobilized in a brisk wash of adrenaline. Severe heart muscle weakness (cardiomyopathy) ensues, accompanied by typical symptoms of a heart attack -- such as chest pain or shortness of breath.

In the '90s, Japanese researchers noted that the actual physical appearance of someone's heart could change if their heart attack had been preceded by intense emotional or physical stress. Using modern radiographic techniques, they demonstrated that a segment of stunned heart muscle would balloon out and assume a flask-like shape resembling a Japanese octopus trap or pot -- that is, a "tako-tsubo." The term "takotsubo cardiomyopathy" was coined to describe this phenomenon.

This storied background now leads us to a noteworthy report published this month in the journal Circulation. Finally -- after many scattered tales in the medical literature documenting the reality of stress-induced heart attacks -- someone has methodically and systematically examined whether a heart attack might in fact be triggered by a loved one's death. (more…)

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 01/07/2012

Is it OK for an anesthesiologist to play Angry Birds on his iPhone while administering anesthesia during a gallbladder surgery? During your gallbladder surgery?

What do you think about a surgeon voice-dialing her colleagues or chatting with family during the operation?

Although we've inhabited the Digital Age for many years, only recently have we begun to examine how it might affect us personally as patients and doctors, and whether overall patient safety and care have actually improved.

This inquiry is long overdue, and, as recent studies suggest, urgent. (more…)

By Dr. Kate Scannell, Syndicated columnist
First published in print: 12/25/2011

The top 10 medical stories chosen for 2011 are distinguished for their broad reach into people's lives. I look to the new year with hope that 2012's list contains much good health news for us.

Drug shortage: Our nationwide prescription drug shortage worsened this year, compromising some patients' health while also revealing systemic problems with pharmaceutical production and regulation. At least 250 drug shortages were reported, with hospitals facing worrisome scarcity of lifesaving medications including chemotherapies, heart drugs and antibiotics. An executive order signed in October by President Obama broadened the Food and Drug Administration's authority to expand its reporting of potential drug shortages, expedite regulatory reviews and monitor for opportunistic price-gouging on sales of scarce drugs. Still, the FDA cannot require pharmaceutical companies to resume or increase drug supplies -- and pharmaceutical companies are not legally obligated to do so.

Celebs help: Celebrities can influence societal views about health and disease. They can share the spotlight with public health issues to make them more visible to millions of people. The death of 27-year-old singer Amy Winehouse in July sadly illuminated the health hazards of excessive drinking. In November, the involuntary manslaughter conviction of Michael Jackson's physician cast a dark light on prescription drug abuse. When former first lady Betty Ford died in July, we were reminded about the power of one person's voice to speak truth to silence in changing how people viewed illnesses such as cancers and addictions. (more…)

By Dr. Kate Scannell, Syndicated columnist
First published in print: 12/11/2011

We should not need to make certain laws. Without requiring state or federal legislation, we should automatically know that it's wrong to, say, kick a puppy. To bully gay students in public schools. To maliciously impersonate someone through social media with the aim of harmingthem. To not inform your customers when their personal information has been stolen from your company's computer databases.

Yet, admittedly, laws against these behaviors arose precisely because puppies were being abused, gay students were being harassed, people were ruthlessly slandered on the Internet, and unwitting consumers were falling prey to identity theft. And while such laws may fail to convince a puppy-kicker or cyberbully of their moral merit, still, they serve to discourage some bad behavior with threats of penalties and public sanction.

This brings us to current news about our nation's critical prescription drug shortage and a related bill being introduced next week in Congress. The new bill aims to penalize "unscrupulous drug distributors" w ho price-gouge hospitals for lifesaving medications in current short supply. If the bill is enacted, it would become a federal crime for distributors to demand hugely marked-up prices for these scarce drugs -- as many of them are now doing. (more…)

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: November 27, 2011

Like many Americans this past week, my friends and I shared a turkey feast and gave thanks for all that was good in our lives and the world. But this annual ritual is always difficult for me, because I also think about things for which I am not grateful -- the economic and political turmoil in the world, people starving and homeless, my patients who have suffered and died, and ...

Still, I routinely manage to keep my sadness private, off the proverbial table. Pumpkin pie helps. So does a little wine.

While listening to my friends' expressions of gratitude, I am profoundly impressed with the role that happenstance has played in shaping everyone's fortunes (and hardships). Personal intention and deliberate actions have certainly played defining roles, but, to a large extent, our lot in life is the "real" estate of providence and serendipity. Through no free choice or conscious planning, we are born into poverty or wealth, in times and places associated with war or peace, to good or bad parents, and with variable genetic odds of living healthy lives. Our survival and opportunities to flourish in the world largely begin "as luck would have it." (more…)

By Dr. Kate Scannell, Syndicated columnist
First publised in print: 11/12/2011

I was checking out the broccoli at the local grocery store when an ex-patient tapped me on the shoulder and began a conversation. I was relieved that he found me in the fresh produce section rather than the wine or bakery aisles.

Naturally, he updated me about his chronic medical problems. I was sorry to hear that his diabetes had become difficult to control, all the while registering the high-calorie, processed foods in his shopping cart -- along with the discounted post-Halloween candy.

Nonetheless, he started complaining about his current doctor -- her "uncaring nature." He was annoyed by her slowness in responding to his recent request for a prescription. He was frustrated with her for "looking at the computer screen all the time" they were together in clinic. And after reciting a sad litany of further grievances, he paused dramatically for a moment before asking, "But you know what irks me the most about her?"

He stared intensely at me and waited, with an expectant smile on his face. Not knowing the answer, I began to wilt faster than the broccoli in my sweaty hands. The "doctor in me" wanted to answer his question correctly and assuredly, because he seemed to be suffering such estrangement from his current physician. He needed a healing dose of connection with an MD, I thought.

Luckily, a grocery clerk appeared and asked whether she could help us. My ex-patient instantly replied, "No. I'm just telling my old doctor here how my new doctor has never examined me." (more…)

By Dr. Kate Scannell, Syndicated Columnist
First published in print: 10/29/2011

You don't expect to read a Halloween story in the staid New England Journal of Medicine. But there it was this week -- a chilling tale about menacing hormones that kept taunting dieters to eat!

Dieters have long-suspected the presence of powerful adversarial forces laying "in weight" of any seemingly successful dieting effort. Lost pounds seem to return automatically, like cloying "boo!"-merangs.

Many dieters are dispirited by such frustrating experiences. They commonly convey a sense of feeling haunted by powerful internal messages that relentlessly coax them back to the snack table, scare them into believing they must -- and will -- return to their pre-diet weights.

Finally, Australian researchers have confirmed those dieters' suspicions. (more…)

By Dr. Kate Scannell, Syndicated Columnist
First published in print: 10/23/2011

After injecting himself with cocaine, the acclaimed New York surgeon -- who would come to be known as the "Father of Modern Surgery" -- proceeded to the trauma room where he'd been summoned by hospital staff. Awaiting his arrival was a construction worker with life-threatening bone fractures who was "writhing in agony." But, rather than picking up a scalpel and treating the laborer, the surgeon, Dr William Halsted, "turned on his heels, walked out of the hospital, and hailed a cab to gallop him to his home. ... Once there, he sank into a cocaine oblivion that lasted more than seven months."

Meanwhile, across the Atlantic and 12 days after Halsted fled the hospital, the Viennese physician who would become the "Father of Psychoanalysis" began composing love letters -- about cocaine -- to his fiancée, Martha. In those letters, Sigmund Freud wrote about his self-experimentation with "this magical substance" -- the way it lifted him "to the heights in a wonderful fashion." Two months later, he would publish his legendary monograph, "Über Coca" -- a "song of praise" to cocaine.

Through compellingly told stories of these two physicians, author and medical historian Howard Markel takes us on a sometimes-cringing tour of the medical establishment during the late-19th and early-20th centuries -- and, as we discover, much of what we encounter seems hauntingly familiar today. In his new book, "An Anatomy of Addiction -- Sigmund Freud, William Halsted, and the Miracle Drug Cocaine," Markel also tells a timeless and over-arching tale about medical practice "under the influence" of commerce and happenstance. (more…)

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 10/01/2011

Vince Lombardi once famously declared that, in football, "The best defense is a good offense."

I thought about the coach's words while reading a new study about doctors ordering unnecessary medical tests and procedures -- whether practicing medicine on the defense or offense. The study was eye-opening in that it surveyed views about unnecessary medical care from the unique perspectives of 627 U.S. physicians on the front-line of medical practice -- internists and family practitioners who often call the plays that determine whether tests or subspecialty referrals are ordered.

In essence, this report in last week's Archives of Internal Medicine reveals that many doctors, by their own admission, believe that too many patients get too much care. And, after analyzing the explanations proposed by the doctors, the authors offer this striking conclusion: "Physicians believe they are paid to do more, and exposed to legal punishment if they do less." (more…)

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 09/18/2011

Sherlock Holmes famously partnered with his Doctor Watson to help solve the most baffling mysteries of his day. Soon, doctors in clinics will be partnering with another famous Watson, ostensibly to help solve diagnostic conundrums for patients.

Last week, IBM and health insurer WellPoint Inc. jointly announced that supercomputer Watson -- best known for trouncing human contestants on the TV game show "Jeopardy!" -- was being put to work as a doctor's aide. Or as an insurance agent. Maybe both. It's hard to compute just yet. (more…)