Persistence paid off for paralyzed dad
Sun, 25 Mar 2007 02:44:40 GMTBy CARLA K. JOHNSON, Associated Press Writer
CHICAGO - In the weeks following the car accident that left him paralyzed below the waist, Geoff Luther was haunted by worries that he'd lost the chance to be a father.
"It was some of the stuff I was thinking about the most," said Luther. "What about having children? What about getting married? Can you naturally conceive a family?"
His questions are shared by thousands of young men each year who suffer paralyzing spinal injuries. But many may give up hope — or undergo unnecessary, invasive procedures — because their doctors don't know about simple ways to help them.
Geoff was 28 years old and working for his father's tool and dye company in Milwaukee in 1991 when his car rolled over on the icy road after a deer hunting trip. After the accident, he grew closer to a woman he had met while both were dating other people. Tammy Russell, who thought Geoff was "arrogant" before the accident, found herself drawn to a man who had changed physically and emotionally.
She fell in love and in 1993 married the man who showed her a determined spirit and a growing ability to appreciate life.
"If I want him to do something, I tell him he can't do it," she said.
Doctors at the Rehabilitation Institute of Chicago told Geoff, 43, that most men with spinal cord injuries can father children. But the treatments that allowed him and Tammy, 39, to conceive aren't offered to many injured men.
Instead some fertility doctors jump immediately to expensive, invasive procedures, such as surgically extracting sperm from the testes, when confronted by a man in a wheelchair.
The Luthers, who live in Oak Brook, Ill., avoided that procedure. Nonetheless, it took six years and, they acknowledge frankly, tens of thousands of dollars, some contributed by his father, before they succeeded. But after a tour through most of the methods and procedures of rehab fertility medicine, the Luthers conceived their son, Trent, now 6, and daughter Kayla, now 3.
"We went through it all," Tammy said.
Their story illustrates how determined couples can conceive with guidance from medical professionals who are well-versed in techniques that work for paralyzed men.
What helped in Geoff's case was a device that triggers ejaculation with a low-voltage impulse of electricity, a procedure borrowed from animal husbandry and developed for use in humans by Dr. Carol J. Bennett and her colleagues at the University of Michigan's urology department.
Geoff remembers asking his doctor: "How will you know when you have it turned up high enough? Will my ears start smoking or what?"
The low-voltage impulse worked for Geoff, but his sperm quality was low. So, a single sperm was injected into one of Tammy's eggs to create an embryo. That embryo was implanted in the womb and Trent was conceived. A few years later, Kayla was conceived the same way.
"I loved being pregnant," Tammy said.
Unfortunately, many fertility centers don't know the basics.
Nancy Brackett, a researcher at the Miami Project to Cure Paralysis, surveyed more than 100 fertility centers and discovered that 28 percent don't offer two simple techniques that rehab experts have used successfully for years and that work for 95 percent of paraplegic and quadriplegic men. Brackett published her findings in the October issue of Fertility and Sterility, a journal read by reproductive medicine doctors, and now she has made the issue her soapbox.
Most men with spinal cord injuries have varying degrees of difficulty with erection and ejaculation. Medications like Viagra help some. Others need only a special vibrator to collect sperm; insemination of their partners can be done with a syringe in private, at home.
Paul and Shelly LeVasseur of Winfield, Ill., felt lucky they could conceive at home.
"There are times when it is rather clinical and there are times when it is very romantic," Paul LeVasseur said. Their children are Ben, 6, and Danielle, 2, and they are trying for another.
Brackett wants doctors to try simple solutions before assuming they must use surgical means to retrieve sperm from the testes of injured men. In Brackett's survey, some doctors said they lacked training or equipment, or were unfamiliar with the methods.
"If we forget these simple things, it's almost like going backward," Brackett said. "It does a disservice to these patients."
Miami Project researchers are also studying compounds in the semen of injured men that have a poisonous effect on sperm. The research could lead to a drug that would counteract the effect, Brackett said.
Of the 11,000 spinal cord injuries annually in the United States, 80 percent are among men between the ages of 16 and 45 — the prime reproductive years.
Rehabilitation Institute nurse practitioner Diane Rowles, who teaches a class called Sexuality and Fertility to patients, said sex is "a very private topic, a very personal topic." But if medical staff members don't educate spine injury patients about sex and fertility, they may assume the worst: that they're not able to have a sex life or father children.
"It's a big thing. You just can't leave it out," Rowles said. "They need to learn about it, too."
The Luthers' children haven't asked where babies come from. Tammy said someday, if they ask, she'll tell them about many different ways children come into the world, from adoption to reproduction with medical help.
Geoff said he doesn't know what he would say. "I still haven't had that talk with my mom and dad, so I'm not sure," he said.
For men with spinal cord injuries who want to be fathers, Geoff offers this advice: "Search out the best doctors, or you can waste a lot of time and resources."
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On the Net:
Miami Project to Cure Paralysis: http://www.miamiproject.miami.edu/
Rehabilitation Institute of Chicago: http://www.ric.org/
Filmmaker Beijing more open about AIDS
Sun, 25 Mar 2007 06:03:53 GMTBy MIN LEE, AP Entertainment Writer
HONG KONG - A filmmaker who won an Oscar for a documentary about orphans of Chinese http://www.bloodofyingzhou.com
Ruby Yang's China AIDS Media Project:
http://www.chinaaidsmedia.com
New heart stents pass key tests
Sun, 25 Mar 2007 02:44:52 GMTBy MARILYNN MARCHIONE, AP Medical Writer
NEW ORLEANS - A new crop of experimental heart stents have passed some key safety and effectiveness tests and may one day offer alternatives to the controversial stents currently used to keep unclogged arteries open, doctors reported Saturday.
One is designed to dissolve after doing its job, leaving nothing behind to trigger blood clots — a worry with the most popular stents sold now. Another attracts special cells to help the artery heal. A third is super-thin and uses a novel drug to keep scar tissue from reblocking the vessel.
All are seeking a slice of the $6 billion market for these tiny mesh scaffolds, which are placed in arteries during angioplasty, an artery-clearing procedure that more than a million Americans have each year.
Its popularity has faded with news that the drug-coated stents used in most of these procedures can raise the risk of blood clots many months later.
Two brands are sold in the United States: Taxus, by Boston Scientific Corp., and Cypher, by Johnson & Johnson's Cordis Corp.
At an American College of Cardiology meeting on Saturday, Dr. Gregg Stone of Columbia University said that Abbott Laboratories Inc.'s Xience stent proved "at least as safe and effective" and, by some measures, better than Taxus in a comparison study of 1,000 patients. Stone consults for both companies, and Abbott paid for the test.
"He doesn't have adequate data to tell us if it's safer," and no one knows whether the federal Food and Drug Administration will require that proof because of worries about existing stents, said Dr. Spencer King, an Atlanta heart specialist and past president of the cardiology group.
Xience's very thin metal base is coated with a drug called everolimus to discourage scar tissue. It is already sold overseas; the new study is aimed at getting approval in the U.S. and Japan.
Doctors also gave results of the first human study in the world of a temporary stent, Absorb, also made by Abbott. It is designed to hold arteries open for about six months and then completely dissolve over the next two years or so.
No deaths, blood clots or repeat artery-opening procedures occurred among the first 30 patients to get it, and only one mild heart attack occurred in the first six months of use, said study leader Dr. Patrick Serruys of Erasmus University Medical Center in Rotterdam, the Netherlands.
Much more study is needed, but doctors say it would be a welcome alternative to current stents, which are permanent, foreign metal objects that can interfere with imaging tests increasingly used in heart care.
"The concept is extremely enticing," said Dr. Deepak Bhatt, a Cleveland Clinic cardiologist who had no role in the study.
On Sunday, Dr. Marcel Beijk of the University of Amsterdam will report what he termed "early encouraging early results" in 152 patients who received a stent called Genous, which is coated with a substance designed to attract stem cell-like cells from the bloodstream to help the artery heal.
In May, results are due on Cordis' experimental stent, CoStar. Its anti-clotting drug is contained in tiny wells designed to dissolve over time so that after about six months, the device turns into a plain metal stent.
Medtronic Inc. also is seeking FDA approval for its Endeavor stent, which it claims is less likely to cause artery inflammation problems.
"Technologies never stand still - they're constantly improving," said Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute.
Yet key questions remain about the safety of all of these devices. An expert panel led by Harvard cardiologist Dr. Eugene Braunwald is finalizing a report on what the federal agency's role should be in resolving the safety issues, Nabel said.
The group will recommend whether a new clinical trial, a registry to track patients or some other solution is needed, Nabel said.
Girls overdose death raises questions
Sat, 24 Mar 2007 01:52:41 GMTBy DENISE LAVOIE, Associated Press Writer
HULL, Mass. - In the final months of Rebecca Riley's life, a school nurse said the little girl was so weak she was like a "floppy doll." The preschool principal had to help Rebecca off the bus because the 4-year-old was shaking so badly. And a pharmacist complained that Rebecca's mother kept coming up with excuses for why her daughter needed more and more medication. None of their concerns was enough to save Rebecca.
Rebecca — who had been diagnosed with attention deficit hyperactivity and bipolar disorder, or what used to be called manic depression — died Dec. 13 of an overdose of prescribed drugs, and her parents have been arrested on murder charges, accused of intentionally overmedicating their daughter to keep her quiet and out of their hair.
Interviews and a review of court documents by The Associated Press make it clear that many of those who were supposed to protect Rebecca — teachers, social workers, other professionals — suspected something was wrong, but never went quite far enough.
But the tragic case is more than a story about one child. It raises troubling, larger questions about the state of child psychiatry, namely: Can children as young as Rebecca be accurately diagnosed with mental illnesses? Are rambunctious youngsters being medicated for their parents' convenience? And should children so young be prescribed powerful psychotropic drugs meant for adults?
Dispensing drugs to children diagnosed with mood or behavior problems is "the easiest thing to do, but it's not always the best thing to do," said Dr. Jon McClellan, medical director of the Child Study and Treatment Center in Lakewood, Wash. "At some level, I would hope that you'd also be teaching kids ways to control their behavior."
According to the medical examiner, Rebecca died of a combination of Clonidine, a blood pressure medication Rebecca had been prescribed for ADHD; Depakote, an antiseizure and mood-stabilizing drug prescribed for the little girl's bipolar disorder; a cough suppressant; and an antihistamine. The amount of Clonidine alone in Rebecca's system was enough to be fatal, the medical examiner said.
The two brand-name prescription drugs are approved by the Food and Drug Administration for use in adults only, though doctors can legally prescribe them to youngsters and do so frequently.
Rebecca's parents, Michael and Carolyn Riley, say they were only following doctor's orders. Rebecca, they told police, had been diagnosed when she was just 2 1/2, and Rebecca's psychiatrist prescribed the same potent drugs that had been prescribed for her older brother and sister when she diagnosed them with the same illnesses several years earlier.
But Rebecca's teachers, the school nurse and her therapist all told police they never saw behavior in Rebecca that fit her diagnoses, such as aggression, sharp mood swings or hyperactivity.
Prosecutors say the Rileys intentionally tried to quiet their daughter with high doses of Clonidine. Relatives told police the Rileys called Clonidine the "happy medicine" and the "sleep medicine."
Through their attorneys, Michael Riley, 34, and Carolyn Riley, 32, have accused Rebecca's psychiatrist, Dr. Kayoko Kifuji, of over-prescribing medication.
Kifuji did not return calls for comment and declined to be interviewed. But Kifuji has vehemently denied any role in Rebecca's death. She has agreed to a suspension of her license while the state's medical board investigates.
Kifuji told police Rebecca had been her patient since August 2004, when she was 2. She said she based her diagnoses of ADHD and bipolar disorder on the family's mental health history, as described by Carolyn Riley, and Rebecca's behavior, as described by Carolyn and briefly observed by her during office visits.
Kifuji told police she became alarmed in October 2005 when Carolyn Riley told her she had increased Rebecca's nighttime dose of Clonidine from 2 to 2 1/2 tablets, and warned Carolyn the increased dose could kill Rebecca.
But Carolyn told investigators Kifuji told her she could give Rebecca and her sister extra Clonidine at night to help them sleep.
Tufts-New England Medical Center, where Kifuji worked, issued a statement supporting Kifuji, saying her care of Rebecca "was appropriate and within responsible professional standards."
In the months leading up to Rebecca's death, others noticed there was something wrong.
Teachers and staff members at the Johnson Early Childhood Center in Weymouth, about 20 miles south of Boston, say they called Rebecca's mother repeatedly to tell her that Rebecca was "out of it," but her mother said the girl was tired because she wasn't sleeping well.
A neighbor who lived next door to the family in the last month of Rebecca's life said Rebecca and her siblings seemed listless.
"They looked like little robots. They looked very lethargic," Phyllis Lipton said. "I said, `Wow, they don't look right,' but who knew?"
Pharmacists at Walgreens in Weymouth called Kifuji twice to complain that Carolyn Riley was asking for more Clonidine, even though her prescription was not due to be refilled yet, according to state police.
Once, Riley said she had lost a bottle of pills, and another time, she said water had gotten into her prescription bottle and ruined the pills, according to police.
Kifuji authorized refills, but after the second incident, she began prescribing Clonidine in 10-day refills instead of 30-day supplies, investigators said.
On Aug. 16, a prescription for 35 Clonidine tablets — a 10-day supply — was filled at Walgreens, even though the Rileys had obtained a 10-day refill only the day before, investigators said.
Walgreens spokeswoman Tiffani Bruce said: "The scrip was filled as written, as it was prescribed by the doctor, and all the appropriate information on the medications was given to the family."
After Rebecca's death, police found only seven Clonidine tablets in the family's medicine tray; the pharmacist said there should have been 75. All together, prosecutors say, Carolyn Riley got 200 more pills in one year than she should have.
The Rileys' lawyers call them unsophisticated people who did not question their children's doctors.
Both were unemployed; they collected welfare and disabilty benefits and lived in subsidized housing. Michael Riley, who is also awaiting trial on charges of molesting a stepdaughter in 2005, claimed to suffer from bipolar disorder and a rage disorder; his wife told police she suffered from depression and anxiety.
"They are not the sort of people who go on the Internet and look on WebMD. These are the sort of people who, when they go to a doctor, the doctor is God and they do what the doctor says," said John Darrell, Michael's lawyer.
Carolyn's lawyer, Michael Bourbeau, said that because the Rileys' three children were all taking Clonidine, Rebecca's prescription may have come up short at times when her siblings were given some of her pills. And some of the pills may have been lost when they were split in half, he said.
In July, after a therapist filed a complaint with the state Department of Social Services, social workers met with the family's doctors and other medical professionals and were assured that the medications Rebecca was taking were within medical guidelines.
"There were lots of medical eyes on this case and none of them seemed to say there was an issue of over-medication in this case," said Social Services Commissioner Harry Spence, who has come under fire for the agency's handling of the case.
Still, there were lingering concerns. When social workers tried to make a home visit in November, Carolyn "resisted and evaded," Spence said. Weeks later, workers resolved to make a surprise check, but Rebecca died the very next day, before they could visit.
Rebecca was found dead on the floor of her parents' bedroom wearing only a pink pull-up diaper and gold-stud earrings, on top of a pile of clothes, magazines and a stuffed brown bear.
Rebecca's uncle, James McGonnell, and his girlfriend, Kelly Williams, who lived with the Rileys, told police that the Rileys would put their kids to bed as early as 5 p.m. Rebecca, they said, often slept through the day and got up only to eat.
When Michael Riley decided the kids were "acting up," he told Carolyn to give them pills, McGonnell and Williams told police.
According to McGonnell and Williams, Rebecca spent the last days of her life wandering around the house, sick and disoriented. But the Rileys told police they were not alarmed. "It was just a cold," Carolyn repeatedly said during police interviews.
The medical examiner said Rebecca died a slow and painful death. She said the overdose of Clonidine caused her organs to shut down, filling her lungs with fluid and causing congestive heart failure.
Williams told police that the night before she died, Rebecca was pale and seemed "out of it." At one point, the little girl knocked weakly on her parents' bedroom door and softly called for her mommy, but Michael Riley opened the door a crack and yelled at her to go back to her room, Williams said.
Later that night, McGonnell told police, he heard someone struggling to breathe and found Rebecca gurgling as if something was stuck in her throat. McGonnell told police he wiped vomit from his niece's face, then kicked in the door to her parents' room and yelled at the Rileys to take Rebecca to the emergency room.
Instead, Carolyn Riley said, she gave her daughter a half-tablet of Clonidine.
Carolyn's mother, Valerie Berio, said that when she visited the kids the night of Dec. 11, Rebecca seemed congested but not seriously ill. In a photograph Berio said she took that night, Rebecca is smiling slightly as her mother holds a new green velvet dress in front of her.
Berio said that shows that her daughter and son-in-law could not have known how sick Rebecca was.
Rebecca's death has inflamed a long-running debate in psychiatry. Some psychiatrists believe bipolar disorder, which was traditionally diagnosed in adolescence or early adulthood, has become a trendy diagnosis in young children.
"As a clinician, I can tell you it's just very difficult to say whether someone is just throwing tantrums or has bipolar disorder," said Dr. Oscar B. Bukstein, a child psychiatrist and associate professor at the University of Pittsburgh.
A study of mentally ill children discharged from community hospitals, published in January in the Archives of General Psychiatry, found the proportion of children diagnosed with bipolar disorders jumped from 2.9 percent in 1990 to 15.1 percent in 2000.
A report released by the Centers for Disease Control and Prevention in 2002 estimated that about 7 percent of elementary school-age children — or approximately 1.6 million youngsters ages 6 to 11 — have been diagnosed with ADHD.
The annual number of U.S. children prescribed anti-psychotic drugs jumped fivefold between 1995 and 2002, to an estimated 2.5 million, according to a study published last year by researchers at Vanderbilt Children's Hospital in Nashville, Tenn.
Some child psychiatrists say bipolar disorder may have been under-diagnosed in children for years, partly because several key symptoms are also symptoms of ADHD, including hyperactivity, distractibility and talkativeness.
Dr. Janet Wozniak, director of the Pediatric Bipolar Disorder Research Program at Massachusetts General Hospital, said early diagnosis and treatment are critical because the illness can cause social and academic problems, and lead to drug abuse, crime and suicide.
"What's commonly overlooked when considering diagnosing and treating children at such an early age is the risk of not treating and not intervening," Wozniak said.
