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First Published May 29, 2008.

  It turns out that trust is chemical, at least according to modern neuroscience and research into oxytocin.  Oxytocin is a hormone produced by the neuron part of the pituitary gland that has long been known to strengthen uterine contractions in childbirth and to start milk production in breast feeding.   More recently, scientists have started to understand its role in brain and behavior with key role in trust. Read the rest of this entry »

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First Published March 25th 2008

MS NBC has a beautiful little story about a relatively new phenomenon, perinatal hospice and the experience of having a child with a fatal prenatal diagnosis given before birth. (hat tip to PalliMed).

Scientists have now unlocked the entire human genome, madly dashing to figure out what the function of each piece is. As a result our ability to test for genetic disease has exploded for an entire host of conditions. Unfortunately, diagnosing is a lot different than treating or curing. Knowing what is coming most often does not include being able to treat it or improving outcomes.

In many ways this is a throwback to the medicine of past centuries. Back then, doctors didn’t have a lot of effective treatments, so they made house calls, they learned to comfort patients, and be of whatever assistance they could. Childbirth was vastly different then as well. Infant mortality was much higher. Names weren’t picked out until you knew the child was okay. Attachment and hope were much more cautious.

My chosen specialty is often like this, though less often than you might think. There is an old joke about neurologists being admirers of disease rather than treaters. This is becoming less true everyday, but like most stereotypes, maybe had a small kernel of truth at its base, now distorted and stretched by the generalization. The sad truth is, any pediatric subspecialty is going to have more than its fair share of heartache and incurable conditions. And so, my heart went out to this family. I can relate. We doctors have to learn to deal with grief too. We love to bottle it up and this has led more than one physician on the fast track to burnout.

It makes me wonder what the impetus is for developing these gene tests. Too often in Obstetrics, it feels like the entire point of prenatal testing is to abort the pregnancy should it be deemed “defective”. I know this isn’t always the case. Being given time to adjust, grieve and mourn a very real loss can be helpful to so many families in this situation. Often, the worst part for families dealing with childhood illness is not having a diagnosis. Even if you can’t treat it, there is real relief in giving it a name and description of what to expect. It is not my wish to stand in judgement of any parent who has faced such a very difficult situation. Certainly facing the choice of “terminating” vs palliative care is heartbreaking either way. I have to say I was absolutely floored by the video interview of this family and the courage they took in loving, embracing, and caring for their child with Edward’s syndrome for the duration of its very brief life.

It would have been so easy not to get attached. It would have been simple not to mourn. It is the default protection response of many. It is a form of denial, the first stage of grief. I think it stops the grieving process dead in its tracks, and can make a family sick. You never get the chance to try to make peace with the tragedy.

I think this story is a beautiful example of what can be gained by not giving in to this impulse. In short, families are allowed to grieve, to cherish a memory and their short time with the baby. Then they can heal. Sometimes we need to allow pain to wash over and immerse us in order to move on and be healed. We need to grieve, and grieve fully.

The number of families that choose to carry a pregnancy with a terminal diagnosis to term is unknown, but definitely a small minority. They face family and friends who are often baffled by their decision not to terminate. One small British study showed that the number of families who choose this options reached 40% when perinatal hospice is offered. This tells me there are many who would like to see, spend time with, and know their infant and be able to tell them good bye. They just need a little help and support in doing so. What a wonderful cause.

Anyone who is interested in learning more, supporting, or referring a friend to perinatal hospice can find information at Http://www.perinatalhospice.org

Epocrates is sponsoring the 2008 medical weblog awards at Medgadget, and they are currently taking nominations.
As you should already know, the medical blogosphere is stuffed full of great blogs, but if a certain neuroscience, medicine, doctor, spirituality, Mormonism, philosophy, psychology, brain, neurology blog happens to be your thing, too bad. That’s not a category.

–However, best new blog might be a possibility. (wink, wink, nudge, nudge, know what I mean, know what I  mean.)

   In any case, head on over here to nominate your favorites.  The more voices the better.

   Neurology has traditionally been a rather laid back specialty.  The delight of it for me is the chance to ponder the inner workings of the brain as it affects the nervous system in a systematic and reflective manner.  We don’t usually go into for the thrill of racing to save someone in a life and death situation.  In fact, at least for me, this is when my brain functions at its worst.  Thoughts begin to race, focus is scattered, and things become less clear.  However, times have rapidly changed with the advent of thrombolytic therapy for stroke. Read the rest of this entry »

Welcome one and all to an irregular installment of my irregularly irregular collection of the very best of all things mind, soul, and body on the internet (That I could find, anyway).  Today I have Mormons and basketball, Pygmy Tarsiers, Mogwai, kilobunnies and kilorats, the spirituality of chess, and husbands in the doghouse to help heal your social phobia, ADHD, Bipolar, Depression, amnesia, self harm, or whatever else it is you are in need of.  So here is all I got… Read the rest of this entry »

Welcome, welcome to another edition of the very best stuff to come to my attention online this week. There is something for everyone here, whether you want to laugh, cry, learn, or ponder life’s mysteries, have a seat and dig in. Read the rest of this entry »

It’s BAACK. It took all of a day longer to fill, but I hope you find it worth the wait. Without further delay, here is the very best of the internet to have crossed my eyes in the past 8 days. Read the rest of this entry »

We live in an age where our understanding of life is far beyond what our forefathers could have dreamed. We have cracked the genetic code. We have to capability to splice and dice. We have an entirely new field, bioengineering dedicated to the proposition that we can literally, “engineer life” to suit our needs. The breakthroughs we have made are astonishing. We have sequenced the entire genome of mankind. We have the power to modify species at will.

In a sense we have been at this for a very long time. We have domesticated the dog and the cat. The grains that we rely on to feed mankind are all a product of manipulation of one seed with another, keeping the ones that grow the “best” crop. Rice, wheat, corn are all essentially artificial and manmade in a sense. I find it a little ironic those that will look at genetically altered agricultural produce with fear and disdain when by definition, agricultural products are manmade. Whether we select genetic traits in a lab or in the field, the fact is we alter them. Read the rest of this entry »

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