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H A R T F O R D H O S P I T A L’ S W E L L N E S S M A G A Z I N E

W I N T E R

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Easing the pain...Palliative medicine comforts the body and soul

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Hartford Hospital’s Wellness Magazine

Editor: LeeMonroe Director of Public RelationsDesigner: ClarePhilipsWriter: JaneBradleyPhotography: Pages3,4-5,8:JoyMillerCalendarCoordinator: LuisaMachado

ROUNDSisaquarterlypublicationofHartfordHospital.Itisnotintendedtoprovidemedicaladviceonindividualhealthmatters.Pleaseconsultyourphysicianforanyhealthconcerns.

Hartford Hospital80SeymourStreet

Hartford,CT06�0�-5037(860)545-5000

Health Referral Service(860) 545-1888 or (800) 545-7664

www.harthosp.orgRounds Medical Advisory Board:

AdrienneBentman,M.D.DavidCrombie,M.D.JosephKlimek,M.D.AndrewSalner,M.D.LindaTaylor,M.D.

R O U N D S

H E A L T H T I P S

Today tattoos are in style, but what happens when the trend ends? People often get a tattoo on a whim. Now that one in seven Americans sports at least one tattoo, laser surgery for tattoo removal is booming.

Removal takes repeated laser treatments at substantial cost. Laser surgery must be performed slowly over the course of a year to destroy pigment-containing cells without damaging underly-ing skin. Multicolor tattoos are particularly hard to remove, and people of color often have trouble because of their skin’s natural pigmentation. Black ink is actually the easiest to remove with laser light.

Treated skin turns white, then black and blue, and may scab or swell after laser surgery. No makeup can be worn for a week to hide the ugly discoloration because the skin is so fragile. Over the course of a couple of months, the pigmented lesions slowly fade and the process is repeated. Rarely, bleeding, scarring or infection can occur.

Avoid any tattoo parlor where tattoo artists re-use needles, don’t wear gloves or “double-dip” into a jar of ink used for more than one customer. Insist on sterile needles in unopened pack-ages. Select a reputable and licensed tattoo parlor to minimize the risk of hepatitis or infection from unsanitary needles. The American Society for Dermatologic Surgery warns that attempt-ing to give yourself a tattoo is extremely dangerous—infections can turn deadly.

Viral VengeanceLurkingsilentlyinthenerves,dormantfordecades,achild-hoodinfectionoftenmakesanunwelcomereappearanceaspeopleage.Shingles(herpes zoster)resultsfromapainfulreactivationofthesamevaricella-zostervirusthatcauseschickenpoxinkids.

Shingleseruptanywhere,usuallyononesideofthebody,sincethespreadofvirusislimitedtoskinsuppliedbyaparticularnerve.“Becausethevirusattacksnerves,shinglescancauselastingneurologicaldeficits,muscleweakness,facialparalysisorcornealscarringintheeye,”explainsStephenConway,M.D.,aHartfordHospitalneu-rologist.“Therashcangoaway,leavingpermanentresidualpaincalledpost-herpeticneuralgia.”

Althoughpainusuallysubsidesafteramonthorso,post-herpeticneuralgiaafflictsabout�0percentoftheestimatedonemillionAmericanswhodevelopshingleseachyear.Nervepainishardertotreatthanotherkindsofpain.Surprisingly,anti-seizuremedicationsworkbetterthannar-coticsfornervepain.“Aftershingles,somepeopleareleftwithburning,stabbing,shooting,electricshock-likepain,”saysRichardGannon,Pharm.D.,directorofthePharmacyPainManagementService.

NewtreatmentsapprovedbytheFoodandDrugAdmin-istrationforpost-herpeticneuralgiaincludetheLidoderm

patchcontainingthelocalanestheticlidocaine,whichblockssignalsfromdamagednerveendingswithoutbeingsignificantlyabsorbedintothebloodstream.FDA-approvedoralmedicationsincludetheanti-seizuremedicationsNeu-rontinandLyricaandtheantidepressantCymbalta.Inclini-caltrials,anewvaccinemarkedlyreducedtheincidenceofpost-herpeticneuralgiainolderadults.

Seeyourprimarycarephysicianpromptlyifyouexperi-encenumbness,tingling,itchingandpain,whichoftenpre-cedethetelltaleblisteringrash.Antiviralmedicationscanshortenthedurationofashinglesoutbreakandminimizelaterpainifgivenearly.

Easy to Get, Easier to Regret

3

PHYSICIAN PROFILE

Paincreatesfear,andfearintensifiespain.Manypeople

aremorefrightenedofpainthantheyareofdying.Theprocessofdevelopinglivingwillsandadvancedirectivesmayhelppa-tientscometotermswithdeathandpotentiallyalleviatesomeofthedepression,angerandanxietybyofferingthemsomemeasureofcontrolattheendoftheirlives.

Overtime,theword“hos-pice”hasbecomeassociatedwiththeterminalcareofcancerpatients,while“palliativecare”hasbroadenedtoincludesuchchronicillnessesasstroke,AIDS,

heartdiseaseandlungdisease.MorethanhalfofthepalliativecarepatientsatHartfordHospitalhaveadiagnosisotherthancancer.Todaypalliativecarehascometomean“comfortmeasures”designedtomanagesymptoms,relievepainandofferemotionalandspiritualsupportthroughwhatareoften,butnotalways,thepatient’slastdays.

AtHartfordHospital,aninterdisciplinarypalliativecareteamworkswithphysicians,careprovidersandfamiliestoassurequalityoflifeforpatientshospitalizedwithgraveillnesses.Theteamcomprisesphysicians,apsychiatrist,anurse,asocialworker,achap-lainandapharmacist,aswellasanesthesiologistsandotherspecialistsasneeded.“Ourgoalistorelievesuffering,”saysSharonDiamen,M.D.,associatedirectorofMedicineandaco-directorofthePalliativeMedicineConsultService.“Youcan’ttreatpaininisolation.Whatisthetotalburdenofsuffering?Painmeansdifferentthingstodifferentpeople.Sufferingincludesphysical,emotional,socialorspiritualpain.”

Atsomepointinaterminalillness,heroicmedicalinterventionslosetheirpowertohealthebody.Althoughpalliativecaredoesn’truleoutlife-prolongingtherapies,pa-tientsmaychoosetospendtheirfinaldayswiththeirfamilies,secureintheknowledgethattheircaregiversaredoingeverythingintheirpowertokeepthemcomfortable.Fordyingpatients,abandoninganendlessroundoftestsandtreatmentsmaybringrelief.

Forpatientsinseverepain,medicationscanbeprescribedtocontrolpainandrelievesymptoms.“Ourapproachtotreatingacutepost-surgicalortraumapaindiffersfromthewaywetreatchronicpain,”saysRichardGannon,Pharm.D.,amemberofthepalliativecareservice.“Severepaindoesn’tnecessarilyrequireaddictivenarcotics,butpatientswithcertainchronicdiseasesneedpainmedicationsjustlikeadiabeticneedsinsulin.”

Manycancerpatientsworryneedlesslyaboutbecomingaddictedtopainmedications.“Addictionisobsession,craving,psychologicaldependencythat’soutofcontrol,”saysGannon.“Forcancerpatientsreceivingpalliativecare,methadoneisagreatanalgesicthathasfewersideeffectsandisfarlessexpensivethanoxycontinorothernarcotics.Whilewecan’talwaysmakepatientscompletelypain-free,wecankeepthemcomfortable.”

Recently,thepalliativecareteamwascalledtothebedsideofapatientwhotoldhisnursehewantedtodie.“Hewasextremelyanxious,”recallsDr.Diamen.“Hewassuffer-ingfromshortnessofbreath,alongwithseverebackandchestpain.WhenIspokewithhim,Irealizedthathedidn’treallywanttodie,hejustwantedrelief.”

“Wewantpatientstofeelsupportedandnotafraid,”addsColleenMulkerin,MSW,LCSW,aco-directoroftheservice.“Wecareforthemsimplybylisteningtowhattheysay.Wegivecontrolbacktopatientsbyhelpingthemhaverealisticexpectationsaboutthecourseandoutcomeoftheirdisease.”

Sharon A. Diamen, M.D.Sharon A. Diamen, M.D., is associate director of Hartford Hospital’s Depart-ment of Medicine, medical director of Ambulatory Services and co-director of the Palliative Medicine Consult Service.

A graduate of the University of Connecticut School of Medicine, Dr. Diamen joined Hartford Hospital in 1985 as assistant direc-tor of the Department of Medicine. Board-certified in internal medicine and pulmonary disease, she did her residency in internal medicine at Yale-New Haven Hospital, followed by specialty training in pulmonary disease at Yale University.

In July, she was named co-director of the Palliative Medicine Consult Service, a collaborative team of rep-resentatives from pastoral services, pharmacy pain management, psychiatry, nursing, social work and surgical critical care. When she’s not spending long days visiting patients and talking with families in the hospital, she enjoys garden-ing, kayaking, birding, hik-ing and caring for a virtual menagerie of pets.

Pain and Palliation

4

WHAT’S GOING AROUND…News & Breakthroughs

P I 0 N E E R I N G

Fibroidtumorsoftheuterusafflictabout40percentofwomenoverage40andaccountforathirdofthe

600,000hysterectomiesperformedeachyearintheUnitedStates.Morethanaquarterofthoseofchildbearingage—andasmanyashalfofallAfricanAmericanwomen—sufferfromthesebenignbutoftentroublesomeuterinegrowths.Especiallyafterage40,fibroidscancauseheavymenstrualbleeding,backandpelvicpain,urinaryfrequencyorpressureonthebladder.

“Itellpatientsthattheyshouldn’tundergoanyproce-dureunlesstheirfibroidsarecausingproblems,”explainsJohnGreene,M.D.,assistantdirectorofHartfordHospital’sDepartmentofObstetricsandGynecology.“Duringpreg-nancy,fibroidscantripleinsize,causingprematurelabororothercomplications.Symptomslikeheavyorirregularbleedingmayworsenasawomannearsmenopause.”

Nowanewnon-surgicalapproachcalleduterine artery embolizationstarvesthefibroidofbloodsupplyandshrivelsthetumorawayovertime.“Fibroidsarevasculartumorsthatneedarichbloodsupply,”explainsHartfordHospital’sheadofinterventionalradiology,DomenicA.Zambuto,M.D.

“Deprivedofblood,thetumorsshrinkanddie.”Interventionalradiologistsuseminimallyinvasivetech-

niquesandhigh-resolutionimagingtechnologiestoguideinstrumentsthroughthevesselstothefarthestreachesofthebody.Withthepatientconsciousunderintravenoussedation,theinterventionalradiologistmakesasmallinci-sioninthegroinandthreadsanarrowtube,orcatheter,upthroughthefemoralarteryintofirstoneandthentheotherofthetwouterinearteries.Tinyplasticparticlesareinjectedintoeacharterytoplugthebloodvesselsleadingtothefibroids.Onceitsbloodsupplyiscutoff,thetumorbreaksdownandisre-absorbedbythebody.

Theoutpatientprocedureoffersamuchshorterrecoverytimethansurgicalremovalofthefibroidsorhysterectomy(removaloftheuterus).“Sincepatientshavesignificantpainandcrampingaftertheprocedure,weadministera‘cocktail’ofpainmedications,antibioticsandanalgesics,”explainsDr.Greene.“Insteadofthetypicalsix-weekpost-surgicalrecoveryafterahysterectomy,womenwhoundergoembolizationareusuallybackatworkinaweek.”

Two-thirdsofwomenwithheavybleedingreportsignificantimprovementaftertheprocedure,althoughabout�0percentexperience“post-embolizationsyndrome,”characterizedbyfever,pelvicpain,malaiseandmuscleaches.“Theprocedurecanberepeatediffibroidsrecur,”addsDr.Zambuto.“Manywomenwithsymptomaticfibroidssuffersilentlybecausetheydon’tknownewtreatmentoptionsexist.”

Fishy FactsEatingfishweeklylowerstheriskofdementia,prob-ablyduetobrain-boostingfattyacidsinomega-3fishoilsthathavealsobeenshowntocutstrokerisk,accordingtoasix-yearstudyatRushUniver-sityMedicalCenter.TheresearchersconfirmedtheresultsofEuropeanstudiesthatshowedeatingfishorseafoodappearstopro-tecttheagingbrainfromdementia.

Breathing LessonsThe New England Journal of Medicinereportsthatbreathlessness(dyspnea)isamorereliablepredictorofdeathfromheartproblemsthanchestpaincausedbycoronaryarterydisease.ResearchersatCalifornia’sCedars-SinaiMedicalCenterfoundthatpeoplewithdyspneabutnohistoryofcoronarydiseasewerefourtimesmorelikelythanthosewithoutbreathingproblemstodiefromheartdisease.

Race for the CureSpecificmutationsonthegenesBRCA�andBRCA�havelongbeenknowntoraisebreastcancerriskamongwhites,especiallyAshkenaziJews.Afterfind-ingdifferentmutationsonthesamegenesinAfricanAmericanswithastrongfamilyhistoryofthedis-ease,UniversityofChicagoMedicalCenterresearchersarecallingforwiderge-netictestingamongethnicgroups.

Scleroderma HopeThecancerdrugpaclitaxel(Taxol)mayslowskinthick-eningandsmallbloodvesseldestructioninsclerodermasufferers,saysaDukeUni-versityMedicalCenterstudythatoffersnewinsightsintothedebilitatingdis-ease.Scleroderma,achronic,life-threateningdegenera-tivedisease,causestissuedamage,hardeningoftheskin,shrinkingofmusclesanddamagetoorgansandbloodvessels.

Minimally Invasive Alternative to Hysterectomy for Fibroids

See Drs. Zambuto (lleft) and Greene, along with interventional radiologist Michael Hallisey, M.D., perform the procedure in a webcast archived on the hospital’s website, www.harthosp.org.

5

T H E N E W M E D I C I N E

Burden of Care Caregiversforafamilymemberwithcanceroftenneglecttheirownmentalhealth.TheJournal of Clini-cal Oncologyreportsthat�6percentofcaregiversmetthediagnosticcriteriaforpanicdisorder,majordepressivedisorder,post-traumaticstressdisorderorgeneralizedanxietydisorder.Fewerthanhalfhadsoughtprofessionalhelpfortheirmentalhealthafteralovedone’sdiagnosis.

Wake A Walker?Shouldyourouseasleep-walker?Mythsaboundaboutcausingaheartattackbysuddenlywakingsome-onewho’swanderinginadaze.ExpertsattheSleepDisordersCenteratNewYorkUniversityrecommendguidingthesleepwalkerbacktobedbythearmorelbow.Sleepwalking,whichoftenrunsinfamilies,maybelinkedtosleepapneaorrestlesslegssyndrome.

Stemming the DamageParalyzedmicebeganwalkingagainafterinjec-tionsofhumanstemcellsrepaireddamagecausedbyspinalcordinjury.Surpris-ingly,thestemcellsnotonlyformednewnervecells,butalsomyelin,thebiologi-calinsulationthatshieldsnervefibers.Thestemcellsseemtoformconnec-tionsthathelpbridgetheinjuredspinalcord,sayresearchersattheUniver-sityofCalifornia,Irvine.

Bird Flu Test Takes OffAnewtestpinpointsinflu-enzastrains,includingtheH5N�avianflu,inhoursratherthandays,sayre-searchersattheUniversityofColoradowhohopetode-velopthediagnostic“chip”intoanon-the-spottestforflu.Strainanalysisnowtakesaboutthreetofourdays,toolongifahighlyvirulenthuman-adaptedformofbirdflubecomesapandemic.

Asobesityratesclimb,alarmingnumbersofAmericansaretippingthescalesat300poundsormore.More

thanninemillionpeopleintheUnitedStatessufferfromclinicallysevereormorbidobesity,achronicdiseasedefinedasanexcessweightof�00poundsormoreoveridealbodyweight.

Withnoshortageofdietandexerciseplans,whydosomepeopleseemunabletoloseweight?Obesityamongadultshasdoubledsince�980,whilethenumberofover-weightadolescentshastripled.TheNationalInstitutesofHealthfoundthatmedicallysupervisedweightlossprogramsfailedupto98percentofthetimeoverafive-yearperiod.Sedentarylifestyles,slapdasheatinghabitsandhereditycontributetomorbidobesityinsusceptibleindividuals,butevena�0percentgainoveridealbodyweightraisestheriskofdiabetes,hypertension,highcholesterol,jointproblems,cancerandcoronaryarterydisease.

HartfordHospitalisnowofferinganinnovative,safeandeffectivesur-gicalinterventionformorbidlyobeseindividualswhohaverepeatedlyfailedmoreconservativeweightreductionalternativessuchassuperviseddiet,exerciseandbehavior-modificationprograms.“TheLAP-BANDsystemislessinvasivethangastricbypassbutstillrequiresthesamehighlevelofpatientcommitment,”saysDar-renTishler,M.D.,directorofbariatric(weightloss)surgeryatHartfordHospital.“TheadjustableLAP-BAND

LAP-BAND® Is a Cinch for the Stomachrequiresnocuttingofthestomachorintestineanddoesnotalterthenormalanatomy.”

Usingminimallyinvasivelaparoscopictechniques,Dr.Tishlerbucklesaninflatablesiliconebandjustbelowthejunctionbetweentheesophagusandstomach.Theadjustablebandisconnectedbytubingtoareservoirun-dertheskin.Aftertheoperation,Dr.Tishlerperiodicallyadjuststhebandthroughaportundertheskin.Thesmallpouchcreatedbythebandlimitstheamountoffoodthatcanbeeatenatanyonetime,whichallowspatientstofeelfullandsatisfiedaftereatingonlyasmallmeal.Thebandisdesignedtostayinplaceindefinitely,butcanbesurgicallyremovedifnecessary.

Althoughsurgeryforweightreductioncanhelppatientsloseweight,itisn’tamiraclecure.Thisnewsurgicaloptionissimplyanothertoolinthesurgicalweightlossprogram’smultidisciplinarymenuofnutritionclasses,exerciseandsupportgroups.

“Worldwide,theLAP-BANDisthemostcommonlyperformedobesitysurgerywithmorethan�00,000patientstreatedtodate,”addsDr.Tishler.“Nutritionalandsurgicalrisksaresignificantlylowerthanwithgastricbypassandmortalityis�0timeslower.”Aswithanymedi-caltreatment,patientsshouldcare-fullyweightherisksandbenefitsoftheprocedure.Forweightlosstobelasting,patientsmustmakeacommitmenttopermanentlifelongchangesinhabitsofeatingandexercise.

Dr. Darren Tishler holds a LAP-BAND for minimally invasive weight loss surgery.

6

|intheDOCTOR’S OFFICE |

Nearly four out of five people in the United States suffer from back pain at some time in their lives. Sciatica sends shooting pains down the nerves radiating from the lower back into the legs. Arthritis or other chronic joint pain afflicts nearly 70 million Americans, while low back pain is often caused by exertion and muscle strain. Low back pain is the leading cause of job-related disability in individuals under age 50.

“Strengthening the abdominal and back muscles helps prevent low back pain,” says Gerald J. Becker, M.D., an orthopedic and spinal

surgeon. “To minimize stress on your spine, make a concerted ef-fort to sit up straight, pull in your belly muscles and use the arms to get up from a chair. Pilates exercise or physical therapy can strengthen torso muscles.”

As people age, disks degenerate and supporting muscles shrink, thanks to a combination of a sedentary lifestyle, lack of exercise, cigarette smoking and obesity. Before surgery, patients should lose weight and quit smoking for a couple of months. “Smokers don’t heal bone properly,” says Dr. Becker. “And minimally invasive techniques don’t work as well in heavy people.”

Back pain may come from damage to an intervertebral disk, a fluid-filled shock-absorbing ring of cartilage between each of the backbones that serves as a cushion for the spinal column. When the ring of cartilage tears and fluid leaks out, the extremely pain-ful “herniated” disk presses on the nerves around the backbone and may require surgery.

Last year, sufferers underwent approximately 150,000 opera-tions to “fuse” their unstable spines in the hope of relieving pain. In a lower-lumbar spinal fusion, surgeons remove one or more degenerated disks and mechanically brace the spine with metal rods and bone grafts.

Dr. Becker warns people with severe or chronic back pain to avoid taking narcotic painkillers like codeine, Oxycontin, Perco-cet and morphine if they think they may need an operation. “How will patients cope with pain after surgery?” asks Dr. Becker. “The ideal patient is someone who has never taken a narcotic before.”

Common causes of back pain

ARTHRITIS(Spondylosis)

STRAINSANDSPRAINSLow Back(LUMBAR)

SCIATICA

SYMPTOMS CAUSES TREATMENTS

Shootingpaininthesciaticnervethatrunsfromthebackdownintothelegorfeet,usuallyononeside;burningortinglingpainradiatingfromthelowerbackthroughthebackofthethightothefrontoftheshin.

Osteoarthritis;jointsaffect-edbydegenerativechanges;localizedpaininfacetjointsofthespine;stiffness

Pain,musclespasm,relatedtoactivityandrestrictedtothelowbackandupperbuttocks

Pressureonthesciaticnerve,herniateddisk(alsocalledruptured disk, pinchednerve, slipped disk)

Injury,occupation,excessweightandgenetics;worncartilage;bonyspurs

Lowbackmuscleinjury;faultylifting;poorphysicalcondition;strain(musclefibersstretchedortorn);sprain(ligamentstorn)

Physicaltherapy;quitsmoking;loseweight;NSAIDs(aspirin,naproxenandibuprofen),topicalanalgesics,spinalfusion

Exercise,stretching,physicaltherapy,NSAIDs(aspirin,naproxenandibuprofen),tricyclicanti-depressants,anticonvulsantdrugs,epiduralsteroidinjections,surgery

Physicaltherapy,backstrengtheningexercises;epiduralsteroidinjections;R-I-C-E(rest,ice,compres-sionandelevation)

Back Talk

7

Psychosisseemstostrikeinyoungadulthood,bringingdelusions,hal-lucinationsanddisorderedthinkingatatimeoflifewhenpeopleoften

feelvulnerableandconfused.Thefirstplungeintoapsychoticepisodesometimessignalsthebeginningofalongdescentintoalifetimeofmentalillness.

Psychosisafflictsanestimatedthreeinevery�00youngadults.Withtreatment,somerecoverfromapsychoticepisode,whileothersbeginarelentlessjourneytowardchronicdisability.NowapilotprojectisunderwayattheInstituteofLiving(IOL)tostudyhowwellpeopleofcollegeagewithpsychoticsymptomsrespondtoearlyinterventionandtreatmentwithanti-psychoticmedications,groupandindividualtherapy,andfamilysupport.

TheIOLteamaimstoidentifythoseage�8to�5whoareshowingthefirstsymptomsofaclinicaldiagnosislikeschizophrenia,bipolardisorder,orpsychoticdepression.Alcoholordrugusemayalsobeafactor.“Ourgoalistotreatpsychosisinyoungadultsasearlyaspossibleinanintensivesix-monthprogram,”explainsStevenH.Madonick,M.D.,theIOLpsychiatristwhoisleadingthepilotprojectalongwithDirectoroftheFamilyResourceCenterLawrenceHaber,Ph.D.,andDavidVaughan,LCSW.“Intermsofre-coveryandremission,age�8worksbetterthanage35.Inthepast,byage��peoplewouldoftenbeinthepublicsystemandonthewaytofull-blownpsychoticillness.”

Althoughthepilotprojecthassofarenrolledonlyafewpatients,Dr.Madonickbelievessomedayearlytreatmentwillbeanestablishedpartofclinicalpractice.“We’relookingforpeoplenotyetcaughtinthedownwardspiralofanillness,”saysDr.Madonick.“Youngadultsoftenstillhavefamilysupportandtheresourcesthataccompanyit.Mosthaven’tbeenhospital-izedmorethanonceortwice.Atthebeginningofanillness,theytendtorespondtolowerdosesofmedicationsandhavelesscollateraldamagetotheirpsychosocialdevelopment.”

Oneofthefirstpatientswasacollegestudentwhobecamesodisturbedthathewalkedoutontotheledgeofahigh-risebuilding.“Hisparanoiawassoextremewhenhewasfirsthospitalizedthathethoughtthenursesweretryingtopoisonhim,”recallsDr.Madonick.“Nowhe’sbeingtreatedwithantipsychoticmedication,backincollegeanddoingwell.”

Dr.Madonickalsostressesthevalueoffamilyeducation.“Parentsoftensufferfromdenial,”heexplains.“Unlikeatumor,mentalillnessisintangible.Noonewantstoseethatachildisfallingapart.Parentsgetangrybecausetheirsonwreckedthecar,hisroomisuninhabitableorhehasn’tbathedindays.Expressionofgreatangerorotherintenseemotionputsincrediblepressureonsomeonewhosethoughtsarealreadydisorganized.”

Familyeducationsessions,alongwithindividualandgrouptherapy,keepdesperateparentsfrombecomingcontrollingoroverprotective.“Researchshowsthattheparents’expressedemotions,oftentheresultoffearoranger,canbeasimportanttotheirchildren’srecoveryasmedicationcompliance,”hesays.“Eventhemostfunctionalfamilyischallenged.”

“BythetimeIbecamepsychoticmylifehaddeterioratedandIwasdelusional,”recallsSarah(notherrealname),whobecamepsychoticat�9andisnowdoingwellonrelativelylow-dosemedications.“Myparentsdidn’trealizetheextentofmyproblemsandhowourfamilydynamics—specificallymyfather’sdrinking—wereaffectingmenegatively.Therewereplentyofredflagsthatmighthavepromptedaquickerintervention.Iurgeparentstobewillingtoaddressfamilyproblems.Don’tloseheartifyourchildbecomespsychotic.Ifmyparentshadrealizedsoonerthatthewholefamilyneededhelp,thingsmighthavebeendifferent.”

For more information about participating in the pilot project, call 860-545-7665.

Pilot Project

for Psychotic

Young Adults

NonProfitOrganizationU.S.Postage

PAIDHartford,CT

PermitNo.436�

80 Seymour Street

Hartford, Ct 06102-5037

Preheatovento450°.Wrapgarliclooselyinfoil.Putgarlicclovesandeggplantsonabakingsheetwitharim.Roastuntileggplantsandgarlicare

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(servingsize:3pitasand3tbs.dip)Calories:44;Protein:�g;Carbohydrate:4g;Fiber:.65g;TotalFat:�.9g(73%monounsaturated);Sodium:��7mgRecipe analyzed by Brunella Ibarrola, MS, RD, CD-N.

A cup of plain lowfat or nonfat

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protein, one and a half times

the calcium and as much

magnesium, riboflavin and

vitamins B6 and B12 as a cup

of lowfat milk. Beyond its bone-

building benefits, the “active

cultures” in yogurt help digest

the naturally occurring milk

sugar that causes bloating

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tolerant individuals. The only

snag—unlike milk, yogurt is

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min D, necessary for calcium

absorption in the body.