A Dog Walks into a Nursing Home: Lessons in the Good Life from an Unlikely Teacher by Sue Halpern

A Dog Walks into a Nursing Home: Lessons in the Good Life from an Unlikely Teacher by Sue Halpern is a book that should interest just about everyone. If you do not currently have a relative in a nursing home, you may be wondering if living in a care facility is in your own future. The news that we hear about nursing homes is often bad: underfunded centers with insufficient staff, over-medicated patients, fire hazards, and patient abuse. It is a relief to read about a well-run facility with a caring professional staff that has a friendly dog visiting every Tuesday morning.

Pransky was a bit on the older side herself when Halpern began training her for certification as a therapy dog. Having never introduced Pransky to a leash, the author was uncertain her Labradoodle would pass the exam that would let them visit residents of a local nursing home. The story of how she passed is just the beginning of a string of sweet and sometimes sad stories. One of my favorites features Fran, a nursing home resident who starts a current events reading club (membership of one) who takes to Pransky but not the pesky preacher who wants to save her.

Even the best nursing homes are challenged keep the peace as much as meet the needs of all of its residents. Residents kept together are as bound to repel as to attract. The prospects of death are always lingering, as are loneliness and boredom. Visits by Pransky or other therapy animals gives some residents something for which to look forward. It is just one step to improving the lives of people unable to live on their own.

We are discusssing A Dog Walks into a Nursing Home at our church book group this week. I expect a lively discussion.

Halpern, Sue. A Dog Walks into a Nursing Home: Lessons in the Good Life from an Unlikely Teacher. Riverhead Books, 2013. 312p. ISBN 9781594487200.

Brain on Fire: My Month of Madness by Susannah Cahalan

Why was Susannah Cahalan, a promising, articulate reporter for the New York Post, suddenly rendered afraid, confused, awkward, lethargic, regressive, suspicious, and forgetful in 2009? Why did she sometimes explode in anger? Why did she lose her appetite and interest in almost everything? With test after test showing her to be normal and healthy, why was she losing control? One of her family's doctors assumed she was partying too much. Others thought she exhibited various psychotic diseases, but for weeks the condition could not be identified and worsened. Having read her book Brain on Fire: My Month of Madness, I can now tell you what was wrong, but you may not want to know quite yet. Cahalan reveals the solution late in her book, so I'll wait, too.

If you enjoy puzzles, stop reading this review now and get the book.

Brain on Fire may just seem to be a well-written true medical thriller and not much more, but there is much to ponder. The recently identified infection that debilitated Cahalan may have infected many people throughout history. They may have been unjustly branded shameful and locked away in mental institutions for life. Other just died suddenly without explanation. Our current thinking of some historical figures could change if we knew something like this infection was behind their behavior.

Cahalan is very fortunate to have been diagnoses and treated. Another thing to consider is our health care system. Because Cahalan was covered by a generous insurance policy from her employer and because her family kept insisting on further tests, she was cured. She could have been written off easily when her condition was at its worst.

I am assuming if you have read this far, you do not mind a spoiler. The culprit in the story was anti-NMDA-receptor autoimmune encephalitis. Cahalan reports on the research being conducted on this assumed to be rare disease. No one knows how she contracted it. When interviewed by Cahalan after her recovery, some doctors involved in the early parts of the story claimed to have never heard of it.

Cahalan, Susannah. Brain on Fire: My Month of Madness. Free Press, 2012. 264p. ISBN 9781451621372.

Zoobiquity: What Animals Can Teach Us About Health and the Science of Healing by Barbara Natterson-Horowitz and Kathryn Bowers

One of the benefits of listening to NPR Science Podcasts is learning about interesting science books. From NPR recently I learned about Zoobiquity: What Animals Can Teach Us About Health and the Science of Healing by Barbara Natterson-Horowitz and Kathryn Bowers. The pair coined the term "zoobiquity" to name interspecies medical studies, which they think go deeper than simple comparative anatomy. Physician Natterson-Horowitz particularly believes that her medical colleagues are slower than veterinarians in recognizing the convergence of their disciplines. She does not go so far as to suggest that animals get better care, but she does say that vets are far ahead in some fields of treatment. 

Of course, animal studies have long been conducted for the benefit of human medicine, but they have usually been limited to laboratory animals in sterile environments. The authors argue there is much also to be learned from the treatment of pets and from the lives of animals in the wild. They show how similarly animals and humans faint at times of danger, suffer from cancer, pursue sexual partners, abuse drugs, self-mutilate, and surrender to obesity. Almost any human trouble seems to have a corollary in the animal world that might provide insight.

Thanks to Bowers being a mainstream journalist, the text is kept from being too technical. Anyone with a pet will experience a few revelations. I recommend reading a chapter a date to not overdose on the fascinating detail. It will be in many public libraries.

Natterson-Horowitz, Barbara and Kathryn Bowers. Zoobiquity: What Animals Can Teach Us About Health and the Science of Healing. Alfred A. Knopf, 2012. 308p. ISBN 9780307593481.

The President is a Sick Man by Matthew Algeo

The health of a president is always of interest to the American public. Citizens expect to know if their leader is fit for the job, but a look at history shows that many serious medical conditions have been hidden by presidents and White House staff, often with the cooperation of a friendly press. Presidents Franklin Roosevelt, John Kennedy, and Ronald Reagan to varying degrees publicly projected good health and vigor while fighting serious diseases. Woodrow Wilson suffered a massive stroke 17 months before the end of his second term and was hidden from the public and Congress by his wife and top aides for most of his remaining time in office. Less known is that President Grover Cleveland, a politician applauded for honesty and openness, also hid what could have been a life threatening condition and the operation performed to save him.

According to Matthew Algeo in his book The President is a Sick Man, Cleveland discovered a lesion growing inside his mouth, on the side where he regularly chewed expensive cigars, just after starting his second term in 1893. Consumed by the Panic of 1893, he ignored the growth for a couple of months. At the time of his illness, he was leading a fight to repeal the Sherman Silver Purchase Act, which was forcing the U.S. Treasury to buy large amounts of silver monthly with funds it did not have to prop up silver-backed currency. Banks and big corporations were closing daily. The vote in Congress promised to be very close. Cleveland felt he would lose what support he had should the state of his health be known.

So, on July 1, he quietly left the White House with an advisor, secretly rode a train to New York, and boarded a friend's yacht, on which a team of surgeons and a dentist were assembled to remove the cancer, as well as four teeth and a large portion of the roof of his mouth. At sea, the doctors and the dentist were sworn to secrecy, and the press reported that Cleveland was on vacation. How Cleveland and his staff managed the ruse, what they did to deny a news story, and how the story became known many years later are parts of Algeo's story.

Readers seeing the title may expect a political diatribe, but The President is a Sick Man is a well-told history that reveals much about the country in the late 19th Century. With its comments about future administrations, it might also be a good choice for book groups who like the history of medicine and politics.

Algeo, Matthew. The President is a Sick Man. Chicago Review Press, 2011. ISBN 9781569763506

Making Rounds with Oscar: The Extraordinary Gift of an Ordinary Cat by David Dosa

Being a cat lover, I was ready for a good cat book when I picked up an advanced reading copy of Making Rounds with Oscar: The Extraordinary Gift of an Ordinary Cat by David Dosa. I am not sure why HarperCollins had advanced reading copies at its Public Library Association Conference booth when the book is already out and on many bestseller lists, but I am happy that I got a copy. I started reading it before I left Portland.

In the early chapters I worried a little that this story about a cat that seems to know when a dementia patient is ready to die might get a little sappy or sweet, but I don't think that ever happened. I think Dosa took his cue from Oscar, who chooses to give comfort only where comfort is needed. Oscar lightens the mood when he settles on the bed of the dying but he does not distract the living. They all know what his presence means - death is coming and it is time to accept it. Likewise, Dosa somewhat gently discusses death and dying but that is probably the best way for people to contemplate the passing of their parents and their own eventual deaths.

In Making Rounds with Oscar, Dosa recounts how his doubts that Oscar has a sense of when death is near were satisfied. In doing so, he tells a lot about work and life in a nursing home, the concerns of family members of patients, and the process of dying. The cat story is a softening element that lets him write about these less than happy subjects. As already seen by book sales, many readers will want to read this book. It would be an excellent choice for book club discussions and use with support groups.

Dosa, David. Making Rounds with Oscar: The Extraordinary Gift of an Ordinary Cat. Hyperion, 2010. ISBN 9781401323233

Free Medical Journals and Free Books 4 Doctors!

In the summer, I saw a note about Free Medical Journals. This website provides readers access to the text of articles in 1392 medical journals (as of October 28, 2009). In many cases, the latest issues are not free. Both JAMA and the New England Journal of Medicine offer their articles after six months, while BMJ (British Medical Journal) holds the texts for three years. The Canadian Medical Association Journal is free immediately. Readers may be somewhat frustrated by not being to get many of the articles as they are reported in the news, but at least, libraries who have had to drop medical periodicals for balancing budgets do have some recourse if fulltext is not in their subscription databases.

Organization and searching seems to be just by topic of journal as a whole. Users need to know medical terms to get good results, though searching "blood" does get "hematology."

What I did not know before is that there is also Free Books 4 Doctors! Despite the page title, it appears that anyone (not just doctors) can read from 365 medical texts. 38 of the titles are in Spanish. Other languages are also included, even Mongolian. Strangely, one of the books is a novel, Murder in Casteddu by Mary Miller.

Ehlers-Danlos Syndrome: A Reference Librarian Looks at Consumer Health Reference Sources

This is Ehlers-Danlos Syndrome Awareness Month. EDS is a group of connective tissue disorders which may, depending on the type and severity, make a person super flexible, reduce mobility, cause constant pain, or even threaten life. Basic to all is that a person's collagen is defective, resulting in stretched skin and dislocated joints. The Ehlers-Danlos National Foundation website is a good starting point for learning about the condition.

A good website from which to learn about the life of a person with EDS is LibrarianInBlack. Last week Sarah Houghton-Jan wrote about her life with EDS. As a dedicated librarian intent on educating readers, she embedded two videos about other EDS cases and photos showing hyperelastic skin and joints. She also included a link to the Ehlers-Danlos Support Group. You can also look through the recent posts and archives of LibrarianInBlack to see what an active person Sarah is despite her condition.

The following is a collection of EDS resources available in public libraries (many at the Downers Grove Public Library). Readers will notice that there is disagreement in the EDS literature as to how many types of the syndrome exist. No one source tells the whole story. Persons with EDS will, of course, seek many sources to help them understand their prognosis. Friends and family are urged to take time to also explore many resources.

Missing from the list are book-length EDS memoirs. I found none through our local library system catalog, Worldcat, or Amazon.


Reference Books

Dorland's Illustrated Medical Dictionary, 31st ed., 2007 - A user has to look at two entries to see all that the dictionary says about about EDS. On page 603 is an entry "Ehlers-Danlos Syndrome" which provides a pronunciation and the names of the two dermatologists for whom the syndrome is named, Edvard Ehler of Denmark, 1863-1937 and Henri Alexandre Danlos of France, 1844-1912. For more information, readers have to turn to page 1854 and look under "syndromes." Dorland's describes six types of EDS (down from ten) and includes a photo of hyperextensible skin.

American Medical Association Family Medical Guide, 4th ed., 2004. - This AMA guide has about a page of information about EDS under the heading of "Autosomal Dominant Disorders." Across pages 969-70 are paragraphs about symptoms, diagnosis, and treatment. Near the end is a stern warning to parents to reduce injuries by preventing their children from "showing off" their unusual flexibility.

Dictionary of Syndromes and Inherited Disorders by Patricia Gilbert, 3rd ed., 2000 - Gilbert says that an alternate name for the syndrome is "joint laxity." On pages 102-5, she describes population incidence of EDS, genetic causation, syndrome characteristics, and case management. She emphasizes the need for good dental care.

Current Medical Diagnosis and Treatment by Stephen J. McPhee and Maxine A. Papadakis, 2009 ed. - CMDT does not have a separate entry for EDS, but it is mentioned in entries for mitral valve prolapse (p. 301), cardiac involvement in miscellaneous systemic disease (p. 373), cardiac patient and pregnancy (p. 374), and thoracic aortic aneurysms (p. 414).

Harrison's Principles of Internal Medicine, 17th ed., 2008 - Harrison's includes about two large pages of professional level content about EDS, pages 2465-67. A chart explains eight types of EDS. The syndrome is also mentioned in entries about skin manifestations of internal disease (p. 335), bleeding (p. 366), valvular heart disease (p. 1472), cardiac manifestations of systemic diseases (p. 1499), aortic aneurysms (p. 1563), stroke (p. 2519), and osteoporosis (p. 2400).

Gale Encyclopedia of Medicine, 3rd ed., 2006 - Like other resources, the encyclopedia describes many types of EDS and explains family genetic patterns. Friends and family may appreciate the prognosis section, which describes the challenges of living with EDS. A total of five pages is included in the encyclopedia. Entries in two other Gale titles, Gale Encyclopedia of Children's Health and Gale Encyclopedia of Genetic Disorders, 2nd ed., resemble this entry. The latter, however, also mentions EDS in entries for other syndromes.

Genetic Disorders Sourcebook, 3rd ed., 2004 - Only two brief pages about EDS. A bit disappointing.

Encyclopedia of Genetic Disorders and Birth Defects by James Wynbrandt and Mark D. Ludman, 3rd ed., 2008 - The authors note that EDS experts have proposed that the official number of types of EDS be reduced to six, but they then describe ten types anyway. Two full pages of data.

Encyclopedia of Skin and Skin Disorders by Carol Turkington and Jeffrey S. Dover 3rd ed., 2007 - The authors focus on skin in their entry about EDS but also describe the overall condition of the EDS patient on pages 125-26.

Rudolph's Pediatrics, 21st ed., 2003 - This pediatrics medical guide describes the clinical features of six types of EDS and emphasizes injury prevention (shin guards, knee pads, braces). Surgical correction is also discussed.


Newspaper and Magazine Articles

"Kids' Illnesses Spark Battle with State: A California Mom Spent Years Trying to Figure Out What Made Her Children Sick, Then Almost Lost Them," Chicago Tribune, March 20, 2008, p. 4 - A story about how a pattern of bruises and injuries in her children nearly led to abuse charges against a mother whose children have EDS.

"A Life with Purpose," Swimming World, May 2005, pp. 29-30 - A profile of Nancy Burpee, a champion swimmer who has had EDS for 40 years.

"Coping with Livelong Pain," Toronto Star, April 30, 2009, p. U10 - A story about how a pain clinic is helping a mother and her two daughter, all of whom have Ehlers-Danlos syndrome.

"A Mother's Burden," Santa Fe New Mexican, August 8, 2007, p. D1 - A story about a mother and three daughters with EDS. Tells how use of braces reduced pain and injuries in the children.

"After a Multitude of Tests, an Answer from Grandmother's Memory," New York Times, August 24, 2004, p. E5 - A story about the difficulty of diagnosing EDS in infants and toddlers.


Websites

Ehlers-Danlos National Foundation - Sarah says that this is the website with the most useful information.

Ehlers-Danlos Support Group - This British site has a message board and a section with advice for living with EDS.

Mayo Clinic - The Mayo Clinic website includes a basic definition, symptoms, causes, complications, treatment, and advice for coping with the syndrome.

Medline Plus - This site from the National Library of Medicine and National Institute of Health tells us that EDS is also called "cutis elastica." The EDS page includes links to articles from nonprofit organizations and medical journals.

National Organization for Rare Disorders - Basic information on EDS, identifying eight types. The site has a list of recommended websites.

NLM Gateway - Search this website to find basic information, medical journal articles, and clinical trials that may be recruiting participants.


Final Note

My abbreviated notes about these resources, of course, oversimplify what they contain, but together they suggest the vast amount of information on the topic. Ironically, there is still much that is not known or understood, and being a rare condition, as Sarah explains, EDS is not a priority in medical research. I hope that you spend a bit of time with these resources to comprehend the uncertainty of the EDS experience and the hand dealt to people with the syndrome.