By Mary O’Brien, M.D.
Do you know what “Mitochondrial Deficiency Syndrome” is? Most people don’t. Unfortunately, that doesn’t stop them from weighing in on the case of little Charlie Gard. Charlie is an 11-month old baby with a rare and devastating genetic disorder that precludes normal functioning of mitochondria. Mitochondria are intracellular organelles that generate ATP (adenosine triphosphate). In essence, ATP represents energy at the cellular level. Without ATP, cells, especially brain and muscle cells, cannot function. The most sensitive and vulnerable cells in the body are those of the cerebral cortex. Little Charlie cannot see or hear or move or swallow or vocalize or think. No one can know with absolute certainty, but he probably cannot “feel” anything at this point. The word tragic is utterly inadequate.
The global media frenzy surrounding this heartbreaking situation is revealing and deeply disturbing. Controversy sells, and unfortunately, the less people know, the more adamant and emotional they often become. Those of us who have dealt with life and death situations for decades can help by elevating the level of conversation. Some timeless principles are useful:
- Embrace humility. Never be afraid to say “I don’t know enough about this situation to have a well-informed opinion.” That would be refreshing.
- Exercise the intellectual discipline to learn the facts involved. In medicine, every patient is unique. Arguments for or against life support or experimental treatments are pointless absent actual knowledge.
- Resist the temptation to become emotional. Unbridled emotions cause far more problems than they solve. Try to be the voice of reason.
- Try not to confuse or conflate the issues. People in nearly every media outlet have tried to make the case about socialized medicine, cost control, parental rights, the British court system, the European Union, or theology. The case of Charles Gard is about medical ethics.
- Focus on principles, not personalities. There is a colossal difference between saving life and prolonging death. Remember, there is never a moral imperative to render futile care.
Primum non nocere. (First, do no harm.) There’s a reason that Solomon prayed for wisdom.
By Mary O’Brien, M.D.
Triple-digit temperatures. Devastating storms. Disease-carrying insects. Rip currents. Shark attacks. Jelly fish stings. Fireworks accidents. Food poisoning.
This list of problems only scratches the surface of serious summertime challenges. But an ounce of prevention really is worth a pound of cure. With that in mind, let’s consider some tips for minimizing summertime maladies:
- Never leave an infant, child, adult, or pet in an unattended car. Temperatures can soar past 120 F within minutes, even with the windows cracked. Within 20 minutes, temperatures can exceed 140 F. Every summer, mere carelessness leads to terrible tragedies. Please educate the people around you.
- If a storm is close enough for you to hear thunder, it is close enough for you to be struck by lightning. Get inside a car or building. Do not seek shelter under a tree that could turn you into a veritable lightning rod.
- Most hurricane-related deaths occur as a result of drowning. People who are out and about can face dangerous flash floods. Never attempt to drive through standing water. It takes only six inches of water to move a vehicle. Unless you are a first responder, please stay put in the immediate aftermath of a severe storm.
- These days, mosquitoes are more than a nuisance. The West Nile virus is already active in many states and the Zika virus remains a threat to pregnant women in particular. Eliminating standing water such as bird baths, planters, or backed up gutters where mosquitoes can breed can help. Avoiding outside activity at dawn and dusk when mosquitoes are out in full force would also help. Spraying protocols and insect zappers or traps may be worthwhile.
- Be prudent at the beach. Warnings about rip currents, sharks, jellyfish, contaminants, or other dangers are not issued to ruin everyone’s fun. Every summer, needless tragedies occur because people do foolish things. Be the voice of reason for younger people around you.
- Drink alcohol sparingly, if at all. The vast majority of fatal boating accidents involve alcohol. Even on shore, alcohol and high temperatures can be a disastrous combination.
- Let professionals handle the fireworks. No one ever imagines they could be horribly burned or blinded by an accident with a firecracker. Sadly, that is not rare.
- Keep any meats or side dishes made with mayonnaise at proper temperatures — hot or cold. Food poisoning can have consequences far beyond an upset stomach. When in doubt, throw it out.
Summertime is supposed to be fun. With a little prudence and common sense, it can be precisely that.
By Barbara Sternberg, Ph.D.
Occurring in men and women with comparable frequency, obsessive-compulsive disorder (OCD) affects about 2.2 million Americans 18 years or age and older — one percent of the adult population of the United States. Initial symptoms usually manifest themselves in childhood, adolescence, or early adulthood, and median symptom onset is 19 years of age. One third of adults with OCD experience their first symptoms as children.
OCD is characterized by repetitive, intrusive, unwanted, and disturbing thoughts known as obsessions and by the performance of rituals known as compulsions — in an urgent attempt to control the anxiety that the obsessions generate.
Fear of social embarrassment, for example, could prompt someone with OCD to comb his or her hair so compulsively that the individual becomes unable to look away from the mirror. Thoughts of engaging in violence, bringing harm to loved ones, and having a persistent preoccupation with performing distasteful sexual acts or violating one’s religious beliefs are common obsessions. Common rituals include repeated hand-washing, counting, or touching objects (especially in a particular sequence).
People who have OCD may be preoccupied with order and symmetry, have trouble discarding things, and accumulate or hoard things they don’t need. Healthy people perform such rituals as repeatedly making sure the stove is off before leaving the house. People with OCD perform rituals that distress them, interfere with daily life, and provide no more than a temporary respite from their obsession-induced anxiety. Most people who have OCD are eventually enslaved by their own compulsions.
Research indicates that OCD may be a familial disorder. Many adults who have OCD recognize the futility of their actions, but children and some adults who have OCD are unaware that their behavior is unusual. The course of OCD can vary. Symptoms may emerge and disappear, ease or intensify, or prevent the individual from carrying out his or her responsibilities. Many people with OCD try to control their disorder by avoiding circumstances that trigger their obsessions or by self-medicating with alcohol or drugs.