Archive for April, 2018

Childhood Trauma

April 19th, 2018

Nadine Burke Harris, MD, a San Francisco based physician, made a presentation that captured both my attention and my concern, and I’d like to share some of the information from that presentation. Let’s be clear, these are her words, not mine, but if you take a deep dive into her work, it may be a little like the kid who saw his reflection in the water because many of us grew up in an era when several of the “conditions” mentioned in this description were considered normal.

In the mid-1990’s, a discovery was made that exposure to one thing contributed to the cause of seven of the ten most likely causes of death in the United States.  This discovery was known to impact Brain Function, the Immune System, the Hormonal System, and even DNA function. People who were exposed to it had a 20-year difference in life-expectancy with triple the amount of heart disease and lung cancer.  Now, that was a blockbuster discovery, but physicians are still not trained in even the most routine screening for this diagnosis let alone for its treatment.

What was this amazing discovery?  It was Childhood Trauma. The short list of things that fall into this category are abuse, neglect, and dealing with a parent who struggles with Drug and Alcohol Abuse or Mental Illness.

The discovery came from a paper written by Dr. Vince Felitti of Kaiser and Dr. Bob Onda from the Center for Disease Control. It was titled “Adverse Childhood Experience Study,” and over 17,500 adults who were exposed to these adverse experiences were interviewed for this study.  It became known as the ACE study.  This study included people who had been exposed to emotional or sexual abuse, physical or emotional neglect, parental mental illness, substance abuse or dependence, incarceration, separation, or divorce, or domestic violence.  That’s a list that many people can absolutely relate to on many levels.

For every YES checked off on that list, the participants got one point on the ACE score, and then the physicians compared them to health outcomes.  Of those interviewed, 67% of the population had at least one on the ACE score, 12.6% had four or more ACES.

Here’s the discovery. There was a direct response relationship between ACE (Adverse Childhood Experiences) and health outcomes.  The higher the score, the greater the risk and the worse the health outcomes.  Depression was 4.5 times more likely to be present, 3.5 higher risk for lung cancer, and a  3.5 times more likelihood of getting heart disease, but the most dramatic prediction was the incidence of suicidality, this suicide or attempted suicide statistic was 12 times higher.

There are real neurologic reasons why folks who were exposed to childhood diversity were more likely to engage in high-risk behavior, but even if they weren’t engaged in that behavior, they were still more likely to get heart disease or cancer.  You see, when you’re exposed to stress, the body’s stress response system that governs your flight or fight response mechanism ignites, and if that stress is coming at you every day, it evolves from being adaptive and life-saving to maladaptive and health damaging.

The most likely reason this “discovery” hasn’t become more highly promoted within the medical community may be because of something that is not directly evident. The information generated from these 17,500 people may have been marginalized because, as Dr. Harris points out, people may have just thought, “It’s those kids from those neighborhoods.”  The reality, however, is that the participants in the study were 70% Caucasian and 70% college educated. Maybe the study hasn’t been more widely embraced because it truly is “too close to home.”

This is an issue that touches many of us, and it’s easy to look away.  The very real courage must come from our ability to acknowledge this is a real problem and then in taking the steps necessary to deal with it through a multi-disciplinary treatment team that works to reduce impact of adversity through care coordination, counseling, attention to nutrition, holistic interventions, and, when needed, medicine.


Birthday Thoughts

April 5th, 2018


When I was on that gurney in the ER at age 38 with a ruptured esophagus or was having stents placed at ages 49, 50, 58, and 67, or even at age 17 when the car full of my high school buddies was hydroplaning and spinning out of control on Route 51, I never thought I’d make it this far.

But as I look back over the past 70 years, I know for sure there have been accomplishments, successes, and joys that my parents would have been incredibly proud of and would have enjoyed sharing with me. I miss my family and friends very much.

Of course, I’ve made mistakes, plenty of them and would have done some things completely differently, but we can’t live a woulda, coulda, shoulda life either. We can’t change yesterday, and we don’t have tomorrow yet. All we have is, today, and we must make the most of it that we can.

But there is one thing that I really do know. The best part of my life started about fifteen years ago when a baby named Jude was born. After Jude came Nina, Lucy, Laura, Zoey, and Pete, and nothing, absolutely nothing has been more perfect than having had the opportunity to be their grandfather. The joy that I’ve experienced from having those kids in my life was magnitudes greater than I ever thought possible.

Do not get me wrong, I adore my kids and would give my life for them any day of the week, but when you have your own kids they come with a lot of responsibility. You’re not only responsible for feeding, clothing, housing. and educating them, it’s your job to make sure they grow up to be productive world citizens and that responsibility comes with a lot of angst and concerns.

Yeah, it all worked out great, but there were plenty of frightening days and nights during that journey. These grandkids, though, well, they clearly are not my responsibility, and what a relief that has been. It’s freedom, happiness, joy, and unlimited, unconditional love. There’s nothing like it.

However, my second shift of babies are growing up, my journey is once again changing, and I find myself searching for ways to continue to remain relevant. People ask me about my bucket list, but it’s pretty much empty because I’ve gotten to experience things that I never dreamed possible. No, I’m not wealthy, I’m not a TV star or a celebrity, and I’m not famous, but I’ve been very lucky with absolutely the most important thing life can offer, a wonderful family and the knowledge of having lived a purpose driven life.

It’s been almost 10 years since I’ve had to wear a suit and tie every day to work, since I’ve had to answer to a board of directors, since I’ve been on call 24/7 365 with the responsibility of hundreds of lives to protect and support. Truth be told, I don’t miss that part of my life very much. Sure, I miss the interactions with friends and co-workers, the banter at lunchtime, the challenges of building, growing, and maintaining something, but there’s a lot to be said for my life now.

I recently heard a student of Stephen Hawking talk about his passing from an astrophysics perspective. She said, ”When a large heavenly body dies, it explodes into many pieces and produces lots of stars.” That’s the legacy I hope to leave behind.”

So, where does it go from here? I’m not afraid of death, but I’m in no hurry to get there. That’s in the hands of a higher power, but when grandparent’s day rolls around, count on the fact that this poppa will be floating higher than a Snoopy balloon at the Thanksgiving Day parade because my legacy will live on six different ways through six amazing, wonderful, beautiful stars, my grandchildren, and that’s enough for me.